ISPOR 2nd Asia-Pacific Conference SHANGHAI WORLDFIELD CONVENTION HOTEL SHANGHAI, CHINA

Transcription

INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH
ISPOR 2nd
Asia-Pacific Conference
SHANGHAI WORLDFIELD CONVENTION HOTEL
SHANGHAI, CHINA • 5 - 7 M A R C H 2 0 0 6
Improving Evidence and Outcomes in Health Care
Decision Making in Asia-Pacific: Challenge to a New Era
ORGANIZED BY
International Society for Pharmacoeconomics
and Outcomes Research (ISPOR)
&
ISPOR Asia Consortium
&
Fudan University, P.R. China
PROGRAM
AND SCHEDULE OF EVENTS
Look for Upcoming
ISPOR Asia-Pacific Conferences:
SOUTH
KOREA
THAILAND
SINGAPORE
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ISPOR
International Society for Pharmacoeconomics and Outcomes Research
3100 Princeton Pike
Building 3, Suite E
Lawrenceville, NJ 08648 USA
Tel: 609-219-0773
Fax: 609-219-0774
email: [email protected]
Internet: www.ispor.org
2005-2006 BOARD OF DIRECTORS
Shanlian Hu MD, MSc
Wen Chen PhD
Dear Friends and Colleagues:
On behalf of the Program Committee, we are very pleased to welcome you to the 2nd AsiaPacific Conference of the International Society for Pharmacoeconomics and Outcomes
Research (ISPOR) in the city of Shanghai, People's Republic of China.
The theme of the conference is “Improving Evidence and Outcomes in Health Care
Decision Making in Asia Pacific: Challenge to a New Era”. Two program highlights are the
plenary sessions. The first session examines the use of pharmacoeconomics and outcomes
research in health care decisions in Asia-Pacific: China, Japan, South Korea, Singapore,
Thailand, Pakistan, Malaysia and India. The second session focuses on international experience in the development and implementation of pharmacoeconomic guidelines. In addition,
there are 35 podium presentations, 17 workshop discussions, 11 special session presentations,
and over 150 poster presentations. Also nine very informative short courses precede this
conference.
We are extremely grateful to the members of the Program Committees who have dedicated
time and energy in planning this conference. We also thank the Conference Co-Sponsors as
well as the Conference Advisory Committee.
We would like to thank the ISPOR Asia Consortium members who initiated this conference
two years ago to help advance the science of pharmacoeconomics and health outcomes
research in the Asia region. This conference continues ISPOR's global outreach to further
its mission of translating pharmacoeconomics and outcomes research into practice so that
society allocates scarce healthcare resources wisely, fairly and efficiently.
President
Peter Neumann ScD
Harvard School of Public Health
[email protected]
President-elect
Michael Drummond PhD
University of York
[email protected]
Past President
Lieven Annemans PhD, MSc, Mman
Ghent University/HEDM-IMS
[email protected]
Directors
Laurie Beth Burke MPH, RPh
Office of New Drugs, CDER, FDA
[email protected]
Jens Grueger PhD
Novartis Pharmaceuticals AG
[email protected]
Isao Kamae MD, DrPH
Kobe University
[email protected]
Joyce Cramer
Yale University School of Medicine
[email protected]
Finally we would like to acknowledge the efforts of Dr. Marilyn Dix Smith, the Founding
Executive Director of ISPOR, and her highly skilled staff for their dedication in making this
conference a success.
Scott D. Ramsey MD, PhD
Fred Hutchinson Cancer
Research Center
[email protected]
We hope that this conference is beneficial to you and please take time to enjoy the vibrant
city of Shanghai!
Treasurer
Lorne Basskin PharmD
Healthsouth Sunrise Rehab Hospital
[email protected]
Sincerely,
Shanlian Hu MD, MSc
Wen Chen PhD
Fudan University
Fudan University
ISPOR 2nd Asia-Pacific Conference Co-chairs
Founding Executive Director
Marilyn Dix Smith RPh, PhD
ISPOR
[email protected]
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ISPOR 2nd Asia-Pacific Conference
SHANGHAI WORLDFIELD CONVENTION HOTEL • SHANGHAI, CHINA • 5-7 MARCH 2006
CO-ORGANIZERS
ISPOR Asia Consortium
Fudan University, P. R. China
CO-SPONSORS
Health Sciences Authority Centre for Drug
Administration, Singapore
Chinese Medical Doctor Association, P.R. China
Chinese Health Economics Association, P.R. China
Chinese Clinical Epidemiology Society, P.R. China
Chinese Cochrane Center, P.R. China
China Social Insurance Association Medical Insurance
Branch, P.R. China
Shanghai Academy of Social Sciences, P.R. China
Chinese Medical Association, P.R. China
Peking University, P.R. China
The Chinese University of Hong Kong, P.R. China
The Pharmaceutical Association of Thailand under the
Royal Patronage, Thailand
CONFERENCE PROGRAM COMMITTEE
ISPOR 2nd ASIA-PACIFIC CONFERENCE PROGRAM COMMITTEE
SHORT COURSE COMMITTEE CO-CHAIRS:
CO-CHAIRS:
Kenneth KC Lee JP, BSc(Pharm), MPhil, PhD, Professor, School of Pharmacy, Faculty of
Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China
Shanlian Hu MD, MSc, Professor, School of Public Health, Fudan University, Shanghai,
P.R. China
Wen Chen PhD, Professor and Associate Dean, School of Public Health, Fudan University,
Shanghai, P.R. China
Isao Kamae MD, DrPH, Professor, Graduate School of Medicine, Kobe University, Kobe,
Japan
CONTRIBUTED RESEARCH REVIEW COMMITTEE CO-CHAIRS:
Bong-Min Yang PhD, Professor of Economics and Dean, School of Public Health, Seoul
National University, Seoul, South Korea
Gordon G. Liu PhD, Professor and Chair, Department of Health Economics and
Management, Guanghua School of Management, Peking University, Beijing, P.R. China
Lillian Yu-Jen Wang MS, Health Economics and Market Access Manager, Boehringer
Ingelheim Taiwan Limited, Taipei, Taiwan
Hiroyuki Sakamaki MBA, Director and Chief Researcher, Research Department, Institute
for Health Economics and Policy, Japan
Nathorn Chaiyakunapruk PharmD, PhD, Assistant Professor, Department of Pharmacy
Practice, Naresuan University, Pitsanuloak, Thailand
Eui-Kyung Lee PhD, Senior Research Fellow and Director, Korea Institute for Health and
Social Affairs, Seoul, South Korea
CONFERENCE ADVISORY COMMITTEE
CONFERENCE ADVISORY COMMITTEE CHAIR:
Tony Yen-Huei Tarn PhD, Director, Department of Pharmacy, Taipei City Hospital, Taipei,
Taiwan
Gordon G. Liu PhD, Chair, ISPOR Asia Consortium Executive Committee, Professor and
Chair, Department of Health Economics and Management, Guanghua School of
Management, Peking University, Beijing, P.R. China
Vithaya Kulsomboon PhD, Assistant Professor and Chair of Social Pharmacy
Department, Chulalongkorn University, Bangkok, Thailand
CONFERENCE ADVISORY COMMITTEE MEMBERS:
CONTRIBUTED WORKSHOP REVIEW COMMITTEE CO-CHAIRS:
Dongjin Wang, Vice Minister, Ministry of Labor and Social Security, P.R. China
Alison Tan-Mulligan PhD, MBBS, Health Outcome & Epidemiology Manager,
GlaxoSmithKline Pharmaceuticals (China) Investment Co. Ltd, Shanghai, P.R. China
Xiaoping Zhao, Director General, Department of Price Supervision, National Development
and Reform Commission, P.R. China
Shunya Ikeda MD, MS, DMSc, Assistant Professor, Department of Health Policy and
Management, School of Medicine, Keio University, Japan
Fengxia Lu, Director, Center of Drug Price Evaluation, National Development and Reform
Commission, P.R. China
Shu-Chuen Li PhD, MS, MBA, Associate Professor, Department of Pharmacy, National
University of Singapore, Singapore
Hong Yao, Director General, Department of Health Insurance, Ministry of Labor and Social
Security, P.R. China
Jin-Hyun Kim PhD, Associate Professor, Department of Health Policy and Management,
Inje University, South Korea
Yanfei Liu, Director, Department of Science, Technology and Education, Ministry of
Health, P.R. China
Ming-Chin Yang DrPh, Associate Professor, School of Public Health, National Taiwan
University, Taipei, Taiwan
Dezhi Yu, Deputy Director, Department of Planning and Budgeting, Ministry of Health, P.R.
China
Surachat Ngorsuraches PhD, RPh, Head of Pharmacy Administration Department,
Prince of Songkla University, Hatyai, Songkhla, Thailand
Shifei Chen, Deputy Director, Food and Drug Administration, Zhejiang Province, P.R. China
SPECIAL SESSION COMMITTEE CO-CHAIRS:
Jing Yang, President, Chinese Medical Doctor Association, P.R. China
Zhiqiang Guan MD, MPH, Director, National Institute for Social Insurance, Beijing, P.R.
China
Feng Han, Chairperson of China Social Insurance Association Medical Insurance Branch,
P.R. China
Takashi Fukuda PhD, Associate Professor, Department of Pharmacoeconomics, Graduate
School of Pharmaceutical Sciences, University of Tokyo, Japan
Jiyao Wang, President, Chinese Clinical Epidemiology Society, P.R. China
Guoming Qi, Vice Chairman, Chinese Medical Association, P.R. China
Tae-Jin Lee PhD, Assistant Professor, Department of Social & Preventive Medicine,
College of Medicine, Hallym University, Chuncheon, South Korea
Renhua Cai, Professor and Honorary Dean, School of Public Health, Shanghai Jiao Tong
University, P.R. China and Vice Executive President, Chinese Health Economics
Association, P.R. China
Hsiao-Yi Lin MD, Rheumatologist, Taipei Veteran General Hospital, and Associate
Professor of National Yang-Ming University, Taipei, Taiwan
Xuejin Zuo, Professor of Economics, Executive Vice President, Shanghai Academy of
Social Sciences, P.R. China
Usa Chaikledkaew PhD, Department of Pharmacy, Faculty of Pharmacy, Mahidol
University, Bangkok, Thailand
Donglu Bai, President, Shanghai Pharmaceutical Association, P.R. China and Professor,
Shanghai Institute of Material Medical, Chinese Academy of Sciences, P.R. China
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Lihua Sun, PhD, Professor and Dean, Pharmaceutical Business School, Shenyang
Pharmaceutical University, Shenyang, Liaoning, P.R. China
Hai Gu PhD, Professor, International Pharmaceutical Business School, China
Pharmaceutical University, Nanjing, Jiangsu, P.R. China
Youping Li, Professor, West China Center of Medical Sciences, Sichuan University,
Chengdu, Sichuan, P.R. China, President, Chinese Cochrane Center, P.R. China
Jianhong Tao, Deputy Director, South Medicinal Economical Research Institute, the State
Food and Drug Administration, P.R. China and Editor in Chief, Medicinal Economics
Newspaper, Guangzhou, Guangdong, P.R. China
CONTRIBUTED RESEARCH REVIEW COMMITTEE
Michael Adena BS, PhD, Director, Statistical Consultancy, Covance Pty Ltd, Canberra,
Australia
Boon Peng Lim RPh, Pharmacist, National Healthcare Group, Singapore, Singapore
Ahmad Fuad Afdhal PhD, CEO, AFA Communiction, Jakarta, Indonesia
Ya-Ming Liu PhD, Assistant Professor, National Cheng Kung University, Department of
Economics, Tainan, Taiwan
Graily Aldridge BSc (Hons), M-TAG Pty Ltd, Chatswood, Australia
Meaghan Lynch BSc, MSc, Economist, M-TAG, Chatswood, Australia
Sang-Cheol Bae MD, MPH, PhD, Professor, Hanyang University, Seoul, South Korea
Grace Malanos PharmD, Head, Health Economics, Roche Products Pty Limited, Dee Why,
NSW, Australia
Heng Bee Hoon MSc, Principal Epidemologist, National Healthcare Group, Singapore,
Singapore
Bernard van den Berg PhD, Economist, University of Technology, Sydney, NSW, Australia
Mary-Ann Bonney BSc, MSc, Health Economics Project Leader, Novartis Pharmaceuticals
Australia, Sydney, NSW, Australia
Sharon Meere, Project Manager, Health Economics, Janssen-Cilag, North Ryde, NSW,
Australia
Vinita Nand PhD, Grad, Cert, Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia
Usa Chaikledkaew PhD, Faculty Member, Mahidol University, Bangkok, Thailand
Yasushi Ohkusa PhD, Surveillance Center, National Institute of Infectious Deseases,
Tokyo, Japan
Nathorn Chaiyakunapruk PharmD, PhD, Assistant Professor, Naresuan University,
Phitsanulok, Thailand
Michael Ortiz BSc, MSc, PhD, RPh, Associate Director Health Outcomes, SanofiSynthelabo, North Ryde, NSW, Australia
Ku-Chou Chang MD, Assistant Professor, Chang Gung Memorial Hospital, Kaohsiung
County, Taiwan
Petcharat Pongcharoensuk PhD, Associate Professor, Mahidol University, Bangkok,
Thailand
Li-Jen Cheng PhD, USA
Mark Schulz PhD, Senior Health Outcomes Manager, Merck Sharp & Dohme (Australia)
Pty Limited, Granville, NSW, Australia
Anthony DeCastella Dip, App, Sc, BA, Alfred Psychiatry Research Centre, Melbourne,
Australia
Andrew Eggleston MSc, RPh, Associate Director Health Economics, Janssen-Cilag Pty
Ltd, North Ryde, NSW, Australia
Karen Eggleston PhD, Professor, Department of Economics, Tufts University, Boston, MA,
USA
Alex Zhenghong Fu PhD, Professor, Pharmaceutical Policy and Evaluative Sciences, UNCChapel Hill, Chapel Hill, NC, USA
Takashi Fukuda PhD, Associate Professor, Graduate School of Pharmaceutical Sciences,
University of Tokyo, Tokyo, Japan
Yuji Inoue MD, PhD, Professor and Chairman, Yamaguchi University School of Medicine,
Yamaguchi, Japan
Huanguang (Charlie) Jia MPH, PhD, Research Health Scientist, US Department of
Veterans Affairs Outcomes Research Center of Excellence, Baltimore, MD, USA
Paul A Scuffham PhD, Director, University of Queensland, Brisbane, Australia
Amelia Shann BSc, Health Economist, Schering-Plough, Sydney, NSW, Australia
Lizheng Shi PhD, MsPharm, School of Publicd and Tropical Medicine, Tulane University,
New Orleans, LA, USA
Takuro Shimbo MD, Associate Professor, Department of Clinical Epidemiology, Kyoto,
Japan
Cha-onsin Sooksriwong B.Sc. (Pharm)D, Associate Professor, Department of Pharmacy,
Faculty of Pharm, Bangkok, Thailand
Xin Sun MSc, West China Hospital, Sichuan University, Chengdu, China
Yi-Wen (Ivy) Tsai, National Health Research Institutes, Taipei, Taiwan
Hsu-Min Tseng PhD, Head of Department of Healthcaree Managemetn, Chang Gung
University, Taoyuen Hsien, Taiwan
Hong Wang, Professor, Yale University New Haven Medical Center, New Haven, CT, USA
Hye-Young Kang PhD, Assistant Professor, Graduate School of Public Health, Yonsei
University, Seoul, South Korea
Michael Wonder BSc, Senior Health Economist, Novartis Pharmaceuticals Australia, North
Ryde, NSW, Australia
Makoto Kobayashi M. Eng, Manager, CRECON Research & Consulting Inc, Tokyo, Japan
Jipan Xie PhD, Centers for Disease Control and Prevention, Atlanta, GA, USA
Hiroyo Kuwabara MPH, Medical Research Associate, AstraZeneca K.K, Tokyo, Japan
Feng Xie MSc, Graduate Student, National University of Singapore, Singapore, Singapore
Tang Ching Lau MD, MSc, Consultant Rheumatologist, Tan Tock Seng Hospital, Singapore,
Singapore
Shuichi Yajima, Manager for Marketing Office, Taiho Pharmaceutical Co, Ltd, Tokyo, Japan
Dae Hee Lee MD, MPH, Health Economics Manager, Aventis Pharma Co., Ltd., Seoul,
South Korea
Lijing Yan PhD, Professor, Peking University, Beijing, China
Tae-Jin Lee PhD, Assistant Professor, Department of Social & Preventative Medicine,
Chuncheon, South Korea
Sang-IL Lee, University of Ulsan College of Medicine, Seoul, South Korea
Shu Chuen Li BSc, MBA, MSc, PhD, Assistant Professor, National University of Singapore,
Singapore, Singapore
Tetsuji Yamada PhD, Professor, Department of Economics, Tufts University, Boston, MA, USA
Shinichiro Yanagisawa MCS, Research Associate, Research Center for Urban Safeth and
Security, Kobe University, Kobe, Japan
Harry Qi Zhang PhD, Professor, The University of Chicago, Chicago, IL, USA
Zhongyun Zhao PhD, Health Outcomes Research Scientist, Global Health Outcomes, Eli
Lilly and Company, Indianapolis, IN, USA
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CONFERENCE AT-A-GLANCE
7:30-17:30
REGISTRATION
8:00-17:00
PRE-CONFERENCE SHORT COURSES (FULL DAY SESSIONS)
8:00-12:00
PRE-CONFERENCE SHORT COURSES (MORNING SESSION)
13:00-17:00
PRE-CONFERENCE SHORT COURSES (AFTERNOON SESSION)
17:30
BUSES ARRIVE AT THE HOTEL FOR TRANSPORT TO CRUISE LOCATION
18:30-20:30
HUANGPU RIVER CRUISE (SEPARATE REGISTRATION REQUIRED)
REGISTRATION
SUNDAY, 5 MARCH
8:00-9:20
WELCOME
9:20-9:30
BREAK
9:30-11:00
FIRST PLENARY SESSION
11:00-11:15
BREAK
11:15-12:15
CONTRIBUTED PODIUM PRESENTATIONS-SESSION 1
12:15-14:00
LUNCH, EXHIBITS AND CONTRIBUTED POSTER RESEARCH PRESENTATIONS
12:45-13:45
BENEFITS DESIGN INSTITUTE EDUCATIONAL SYMPOSIUM
14:00-15:00
CONTRIBUTED WORKSHOPS SESSION I
W1
W2
W3
15:00-15:15
BREAK
15:15-16:15
CONTRIBUTED WORKSHOPS SESSION II
W7
W8
W9
W4
W5
W10
16:15-16:30
BREAK
16:30-17:30
CO-SPONSOR SPECIAL SESSIONS 1
17:30-19:30
RECEPTION, EXHIBITS & CONTRIBUTED POSTER RESEARCH PRESENTATIONS
17:30-18:30
POSTER PRESENTATION AUTHOR HOUR
18:30-19:30
SPECIAL DISCUSSION: CHINA PHARMACOECONOMIC GUIDELINES
19:30-21:30
FUDAN UNIVERSITY DINNER
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EXHIBITS
REGISTRATION
POSTER PRESENTATIONS
7:30-17:30
REGISTRATION
MONDAY, 6 MARCH
CONFERENCE AT-A-GLANCE
8:00-9:00
EXHIBITS & CONTRIBUTED POSTER RESEARCH PRESENTATIONS
9:00-9:15
ISPOR SERVICE AWARDS
9:15-10:30
SECOND PLENARY SESSION
10:30-10:45
BREAK
10:45-11:45
CONTRIBUTED PODIUM PRESENTATIONS-SESSION II
11:45-12:00
BREAK
12:00-13:00
CONTRIBUTED WORKSHOPS SESSION III
W11
W12
W14
W15
13:00-14:45
LUNCH, EXHIBITS AND CONTRIBUTED POSTER RESEARCH PRESENTATIONS
13:30-14:30
IMS EDUCATIONAL SYMOSIUM
14:45-15:45
CONTRIBUTED WORKSHOPS SESSION IV
W16
W17
W19
EXHIBITS
REGISTRATION
7:30-17:30
REGISTRATION
TUESDAY, 7 MARCH
W20
15:45-16:00
BREAK
16:00-17:00
CO-SPONSOR SPECIAL SESSIONS II
17:00-17:15
BREAK
17:15-17:30
ISPOR CONTRIBUTED RESEARCH AWARDS PRESENTATION
AND CLOSING REMARKS
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Table Of Contents
Welcome Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Speaker Biograhical Information . . . . . . . . . . . . . .32
Conference At-A-Glance . . . . . . . . . . . . . . . . . . . . .6-7
Workshop Presentations . . . . . . . . . . . . . . . . . . . . .34
Key Conference Information . . . . . . . . . . . . . . . . . . .8
Poster Presentation Abstracts . . . . . . . . . . . . . . . . .39
Short Course Program . . . . . . . . . . . . . . . . . . . . . . . .9
Podium Presentation Abstracts . . . . . . . . . . . . . . . .73
Conference Program . . . . . . . . . . . . . . . . . . . . . . . . .11
Exhibit Program . . . . . . . . . . . . . . . . . . . . . . . . . . . .82
ISPOR Service Awardees . . . . . . . . . . . . . . . . . . . . .18
ISPOR Leadership Directory & Initiatives . . . . . . . .89
First Plenary Session Key Information . . . . . . . . . .19
Hotel Floor Plans . . . . . . . . . . . . . . . . . . . . . . . . . . .95
Poster Presentations . . . . . . . . . . . . . . . . . . . . . . . .22
Key Information
CONFERENCE OBJECTIVES
PARTICIPANTS WILL BE ABLE TO:
• Learn new pharmacoeconomic methodologies and outcomes research
techniques
• Improve the quality of their decision-making by better utilization of pharmacoeconomic studies
• Learn the latest about patient-reported outcomes (quality of life)
ABSTRACTS REFERENCE PAGE NUMBERS
Page numbers to the left of program items refer to the corresponding page for
the abstract published this Program, see pages 39-80.
ABSTRACT SUBMISSION INFORMATION
For the ISPOR 2nd Asia Pacific Conference, 254 abstracts were submitted for
consideration. A total of 150 poster presentations and approximately 35 podium presentations will be given. Seventeen workshops will be conducted and
nine pre-conference short courses will also be administered.
In 2003, 140 abstracts were submitted for the First Asia-Pacific Conference
held in Kobe, Japan. Eighty-four poster presentations and 10 workshops were
given.
HANDOUTS
Handouts for general sessions will be made available in the session room at the
time of the presentation. All remaining or additional handouts will be made
available at designated handout tables.
All handouts for contributed presentations (podium, poster and workshop) are
the sole responsibility of the presenter(s). ISPOR requires all contributed presenters to provide at least 100 copies of their presentation.
POSTER PRESENTATIONS (OVER 150 POSTER PRESENTATIONS)
• Poster Set-Up: 8:00-12:00 Monday, 6 March 2006
• Author Presentation Hours: 17:30-18:30 Monday, 6 March 2006
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• Display Hours: 12:00 Monday, 6 March until 16:00 Tuesday 7 March 2006
• For contributed research poster presentation abstracts see pp xxx-xxx of this
Program and Schedule of Events
CONTRIBUTED PODIUM & POSTER AWARDS
Contributed poster & podium awards will be presented Tuesday, 7 March at
17:15-17:30 in the Auditorium. All poster judges evaluations must be submitted by Monday, 6 March at 17:30 to ISPOR's registration desk. All judge's
podium evaluations must be submitted by Tuesday, 7 March at 12:00 to the
ISPOR registration desk.
EXHIBITS
Exhibits will be on view in the Exhibit Hall located in Hong Kong Hall I (Level 2)
MONDAY 6 MARCH: 12:00 - 19:30
TUESDAY 7 MARCH: 8:00 - 16:00
CONFERENCE PROGRAM WARNING
Please be advised that recording, by any means, any Conference presentation
is prohibited. The International Society for Pharmacoeconomics and Outcomes
Research (ISPOR) will strictly enforce its rights as the exclusive licensee of all
publication and reproduction rights to each presentation, and no presentation, in
whole or in part, may be reproduced without the express written approval from
ISPOR.
TRANSLATION
All plenary sessions, podiums and workshops in the Auditorium will be
translated from English to Chinese/Chinese to English. The two Educational
Symposiums will not be translated.
SHORT COURSES & SPECIAL EVENING EVENT
SUNDAY, 5 MARCH 2006
FULL DAY COURSE – 8:00-17:00
INTRODUCTION TO PHARMACOECONOMICS
Shanghai Room 5
Kenneth KC Lee JP, BSc(Pharm), MPhil, PhD, Professor, School of Pharmacy,
Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China
Course Description: This course is designed to teach clinicians and new
researchers how to incorporate pharmacoeconomics into study design and data
analysis. Participants will learn how to collect and calculate the costs of different alternatives, determine the economic impact of clinical outcomes, and how
to identify, track and assign costs to different types of health care resources
used. The development of economic protocols and data collection sheets will
be discussed. Different pharmacoeconomic models and techniques will be
demonstrated and practiced in lectures and case studies. These include costminimization, cost-of-illness, cost-effectiveness, cost-benefit, and cost-utility
analysis. Decision analysis, sensitivity analysis, and discounting, will all be
demonstrated and practiced. Participants will also learn to compare and evaluate interventions such as drugs, devices and clinical services. This course is
suitable for those with little or no experience with pharmacoeconomics.
MORNING COURSES – 8:00-12:00
INTRODUCTION TO QUALITY OF LIFE ASSESSMENT
Shanghai Room 6
Bruce Crawford MA, MPH, Director, Patient-Reported Outcomes and
Regulatory Consulting, and Operations Director, Mapi Values, Boston, MA, USA
Ming-Chin Yang DrPh, Associate Professor, School of Public Health, National
Taiwan University, Taipei, Taiwan
Course Description: This course is designed to provide a range of methods
that may help to solve common problems encountered with quality of life /
patient-reported outcomes. These include an overview of psychometric validation
methods, missing data analysis techniques, and a variety of methods to assess
minimally clinically important differences. This course includes a discussion of the
ISPOR co-developed report: “Incorporating The Patient's Perspective Into Drug
Development and Communication Report” as well as the “Principles of Good
Practice for the Translation and Cultural Adaptation Process for Patient-Reported
Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and
Cultural Adaptation”. Specific examples will be used throughout the course and
participants will be asked to complete a short exercise. This course is designed
for individuals with little experience with quality of life studies.
META-ANALYSIS AND SYSTEMATIC LITERATURE REVIEW
Shanghai Room 2
results, as well as for quantitatively evaluating sources of heterogeneity and
bias. A systematic literature review often includes meta-analysis and involves
an explicit, detailed description of how a review was conducted. This course
highlights and expounds upon four key areas: 1) impetus for meta-analysis and
systematic reviews; 2) basic steps to perform a quantitative systematic review;
3) statistical methods of combining data; and 4) appraisal and use of metaanalytic reports. The material is motivated via applications in pharmacoeconomics, outcomes research, and clinical studies from the published literature
and hypothetical examples. Interactive exercises are part of the course. This
course is designed for those with little experience with meta-analysis.
INTRODUCTION TO BIOSTATISTICS IN CLINICAL TRIALS
Shanghai Room 1
Isao Kamae MD, DrPH, Professor, Graduate School of Medicine, Kobe
University, Kobe, Japan
Course Description: This course provides an introduction to biostatistics and
pharmacoeconomic analysis in clinical trials including the Bayesian approach.
The topics will include elementary probability theory, basic concepts of statistical inference, sampling theory, hypothesis tests for randomized controlled trials, the power and sample size analysis, and introduction to the Bayesian statistics. Examples will be used to illustrate these methods in the context of costeffectiveness analysis. This course will include a discussion of the “ISPOR Good
Research Practices for Cost-Effectiveness Analysis alongside Clinical Trials: The
ISPOR RCT-CEA Task Force Report”. This course is to familiarize new
researchers or managers interested in research with current statistical techniques so they will be able to use them both in their own research and to
appreciate critically the work of others.
INTRODUCTION TO DECISION ANALYSIS
Shanghai Room 3
Shu-Chuen Li PhD, MS, MBA, Associate Professor, Department of Pharmacy,
National University of Singapore, Singapore
Course Description: Decision analysis is a tool that uses an explicit, quantitative structure to describe and analyze complex health care decisions. This
course will provide an introduction to the principles and practice of decision
analysis. Upon completion of the course, participants will be able to evaluate
the appropriateness of decision analysis in different settings, construct simple
decision trees, understand the basic mechanics of tree evaluation and sensitivity analysis, and acquire skill in the interpretation of a published decision analysis. Extension of basic techniques, such as cost-effectiveness analysis and the
assessment of patient preferences will be briefly discussed. Pen and paper
exercises will be used to illustrate these principles. This course is suitable for
those with little experience with decision analysis
Nathorn Chaiyakunapruk PharmD, PhD, Assistant Professor, Department of
Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand
Course Description: Meta-analysis may be defined as the statistical analysis
of data from multiple studies for the purpose of synthesizing and summarizing
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SHORT COURSES & SPECIAL EVENING EVENT
SUNDAY, 5 MARCH 2006
AFTERNOON COURSES – 13:00-17:00
RETROSPECTIVE DATA ANALYSIS
Shanghai Room 6
FORMULARY DEVELOPMENT
Shanghai Room 1
Jeff J. Guo BPharm, PhD, Associate Professor of Pharmacoepidemiology and
Pharmacoeconomics, College of Pharmacy, and Faculty Research Fellow,
Institute for Health Policy and Health Service Research, University of Cincinnati
Medical Center, Cincinnati, OH, USA
Peter K Wong PhD, MBA, MS, RPh, Regional Director, Pharmaceutical Care &
Services, Mercy Health Partners, Mercy Hospital at Western Hill, Cincinnati,
Ohio, USA
Course Description: A drug formulary is a list of medications that are preferred for use by a health system. This course will describe the procedures and
necessary steps in the development of a formulary, the composition and establishment of the Pharmacy & Therapeutic Committee (P&T), the preparation of
drug and medical device monographs, the adoption of Pharmacoeconomics in
the review process, and the population-based drug coverage decisions. These
processes can be applied to both hospitals or national health plans. There will
be an in-depth discussion of the evidence-based practices and policies, the
enforcement of drug formulary, the roles of key health care providers & policy
decision-makers and the technology assessment responsibilities of the P&T.
This course will employ real life examples. This course is designed for those
with little experience in developing a formulary.
COST DATA ANALYSIS IN HEALTH CARE
Shanghai Room 2
Syed Mohamed Aljunid PhD, MD, MSc, FAMM, Professor of Health Economics
and Head of the Department of Community Health, Faculty of Medicine,
Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
Course Description: Participants will be introduced to the different types of
costing data and ways to identify and obtain these data from different sources
in the health care system with special focus on hospital services. Issues of
obtaining timely and accurate cost data from hospitals, especially those with
basic hospital information systems in developing countries, will be discussed.
Role of clinicians and the use of clinical pathways to improve data accuracy will
be covered in this course. Three cost analysis methods: activity-based costing,
step-down costing and case-mix costing will be discussed in this course. Tools
available to undertake the different cost-analysis methods will be described.
The instructor will demonstrate the use of the different tools using databases
available from earlier completed cost-analysis projects. In addition, data
requirements, the advantages and disadvantages of different methods and
issues of cost-outliers will be discussed. This introductory course is designed
for participants who wish to undertake cost-analysis in their future works.
10
Course Description: Large administrative claims databases provide a unique
opportunity to examine retrospectively the effects of drug use on clinical and
economic outcomes in "real world" settings. This course will cover a discussion
of the ISPOR Checklist for Retroactive Database Studies and selected topics
related to sampling, bias, and analysis. This course is designed for those with
little experience with database analysis.
MODELING: STRUCTURE AND DESIGN OF A MODEL
Shanghai Room 3
Tony Hsiu-Hsi Chen PhD, Professor, Institute of Preventive Medicine, National
Taiwan University, Taipei, Taiwan
Course Description: This course will present pharmacoeconomic modeling
techniques such as Monte Carlo analysis, Markov modeling, discrete event
models, and other modeling techniques and their appropriate use as described
in the “ISPOR Principles of Good Practice for Decision Analytic Modeling in
Health Care Evaluations”. The steps involved with model structure, data inputs
(data identification, data modeling, and data incorporation); data validation
(internal, between-models, external, and prediction) will be discussed.
This intermediate course requires basic understanding of decision analysis.
18:30-20:30
SPECIAL EVENING EVENT
HUANGPU RIVER CRUISE (registration required; ticket will be in
your registration packet)
• Buses will pick up attendees in front of the Shanghai Worldfield Convention
Hotel at 17:30.
• Buses will return to the Shanghai Worldfield Convention Hotel at approximately 21:30.
CONFERENCE PROGRAM
MONDAY, 6 MARCH 2006
8:00-8:20
WELCOME FROM FUDAN UNIVERSITY Auditorium (Chinese translation available)
Shanlian Hu MD, MPH, Program Co-Chair and Professor, School of Public Health, Fudan University, Shanghai, P.R. China
Wen Chen PhD, Program Co-Chair, Professor and Associate Dean, School of Public Health, Fudan University, Shanghai, P.R. China
Shenghong Wang, Professor and President, Fudan University, Shanghai, P.R. China
8:20-8:30
WELCOME FROM SHANGHAI CITY Auditorium (Chinese translation available)
Vice Mayor, Shanghai City, P.R. China (invited)
8:30-8:45
WELCOME FROM ISPOR Auditorium (Chinese translation available)
Peter Neumann ScD, 2005-2006 ISPOR President, Professor and Director, Center for the Evaluation of Value and Risk in Health, Tufts University School of
Medicine, Boston, MA, USA
Michael Drummond PhD, 2005-2006 ISPOR President-elect, and Professor of Health Economics, Centre of Health Economics, University of York, Heslington, York, UK
Isao Kamae MD, DrPH, 2004-2006 ISPOR Board of Directors and Professor, Graduate School of Medicine, Kobe University, Kobe, Japan
Marilyn Dix Smith RPh, PhD, ISPOR Founding Executive Director on ISPOR Past, Present and Future
8:45-9:00
WELCOME FROM ISPOR ASIA CONSORTIUM Auditorium (Chinese translation available)
Gordon G. Liu PhD, 2004-2006 Chair, ISPOR Asia Consortium Executive Committee, Professor and Chair, Department of Health Economics and Management,
Guanghua School of Management, Peking University, Beijing, P.R. China
Kenneth KC Lee JP, BSc (Pharm), MPhil, PhD, 2004-2006 Chair-elect and Professor, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong
Hong Li PhD, MPH, 2005-2007 Chair, ISPOR Asia Consortium Advisory Committee and Director, OR-ROW Liaison, Department of Global Epidemiology and
Outcomes Research, Bristol-Myers Squibb Company, Wallingford, CT, USA
Jeff J. Guo PhD, 2005-2007 Chair-elect, ISPOR Asia Consortium Advisory Committee, Associate Professor of Pharmacoepidemiology and Pharmacoeconomics,
College of Pharmacy, and Faculty Research Fellow, Institute for Health Policy and Health Service Research, University of Cincinnati Medical Center, Cincinnati, OH, USA
9:00-9:20
GUEST PRESENTATION Auditorium (Chinese translation available)
ROLE OF PHARMACOECONOMICS AND OUTCOMES RESEARCH IN HEALTH INSURANCE DECISIONS IN CHINA
Dongjin Wang, Vice Minister, Ministry of Labor and Social Security, P.R. China
9:20-9:30
BREAK Coffee & Tea supported by China Chemical & Pharmaceutical Co., Ltd.
9:30-11:00
FIRST PLENARY SESSION Auditorium (Chinese translation available)
PHARMACOECONOMIICS AND OUTCOMES RESEARCH IN ASIA-PACIFIC: CHINA, JAPAN, SOUTH KOREA, SINGAPORE, THAILAND, PAKISTAN,
MALAYSIA AND INDIA
Moderator: Tony Yen-Huei Tarn PhD, Director, Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
Speakers:
Shanlian Hu MD, MSc, Professor, School of Public Health, Fudan University, Shanghai, P.R. China
Isao Kamae MD, DrPH, Professor, Graduate School of Medicine, Kobe University, Kobe, Japan
Bong-Min Yang PhD, Professor of Economics and Dean, School of Public Health, Seoul National University, Seoul, South Korea
Shu-Chuen Li PhD, MS, MBA, Associate Professor, Department of Pharmacy, National University of Singapore, Singapore
Viroj Tangcharoensathien PhD, Director of International Health Policy Program, Ministry of Public Health, Thailand
Aamir Hameed FCPS, MBBS, BSc, Senior Instructor & Consultant Cardiologist, Department of Medicine, The Aga Khan University, and Member of the Scientific
Council on Atherosclerosis and Thrombosis of the Pakistan Cardiac Society for STEMI Guidelines Task Force, Karachi, Pakistan
Syed Mohamed Aljunid PhD, MD, MSc, FAMM, Professor and Head, Department of Community Health, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur,
Malaysia
Renuka Kulkarni Munshi PhD, Department of Clinical Pharmacology, TN Medical College and BYL Nair Hospital, Mumbai, India
This presentation will examine the use of pharmacoeconomics and outcomes research in health care decisions in China, Japan, South Korea, Singapore, Thailand, Pakistan Malaysia
and India. The session moderator will present key information common to all countries, which includes information of demographics, health care, health care insurance and health care
expenditure and controls. This information is on pages 19-21 of the Program. Speakers from each country will discuss core issues in their countries, including problems and experience in the use of the science of pharmacoeconomics.
11:00-11:15
BREAK Coffee & Tea supported by China Chemical & Pharmaceutical Co., Ltd.
11:15-12:15
PODIUM SESSION I (for podium presentation abstract, see indicated page in this program)
Moderator: Hsiao-Yi Lin MD, Rheumatologist, Taipei Veteran General Hospital; Associate Professor of National Yang-Ming University, Taipei, Taiwan
ARTHRITIS Shanghai Room 1
pg 73
AR1 COST-UTILITY ANALYSIS OF LINGZHI AND SEN MIAO SAN FOR THE TREATMENT OF RHEUMATOID ARTHRITIS Shanghai Room 1
Lee VW, Lee KKC, Li E, Chu KY, Law CL Ng TM Tam LS, The Chinese University of Hong Kong, Shatin, Hong Kong, China
11
pg 73
AR2 WHAT HEALTH DOMAINS & ITEMS ARE IMPORTANT TO PATIENTS WITH KNEE OSTEOARTHRITIS? A FOCUS GROUP STUDY IN A MULTIETHNIC URBAN ASIAN
POPULATION
Xie F1, Li SC2, Fong K, FRCP3, Lo N3, Yeo S3, Yang K3, Thumboo J3, 1National University of Singapore, Singapore, Singapore; 2 National University of Singapore,
Singapore, Singapore; 3 Singapore General Hospital, Singapore, Singapore
pg 73
AR3 COST-EFFECTIVENESS ANALYSIS OF CELECOXIB ON AN AVOIDANCE OF GASTROINTESTINAL EVENTS IN PATIENTS WITH OSTEOARTHRITIS
Limwattananon S, Limwattananon C, Srisuk P, Loengpirom S, Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand
pg 73
AR4 ABATACEPT LEADS TO RAPID AND SUSTAINED IMPROVEMENTS IN MULTIPLE ASPECTS OF QUALITY OF LIFE IN RHEUMATOID ARTHRITIS PATIENTS WITH
INADEQUATE RESPONSES TO METHOTREXATE
Becker JC1, Emery P2, 1Bristol-Myers Squibb, Princeton, NJ, USA; 2 University of Leeds, Leeds, UK
CARDIOVASCULAR DISEASE Shanghai Room 2
Moderator: Vithaya Kulsomboon PhD, Assistant Professor and Chair of Social Pharmacy Department, Chulalongkorn University, Bangkok, Thailand
pg 73
CV1 CHOLESTEROL GOAL ATTAINMENT AMONG CHD PATIENTS IN HONG KONG
Lee VW 1, Alemao E2, Yin D2, Cook JR3, Lee KKC1, 1The Chinese University of Hong Kong, Shatin, Hong Kong, China; 2 Merck and Co, Whitehouse Station, NJ,
USA; 3 Merck and Co, Blue Bell, PA, USA
pg 74
CV2 LOW-HDL CHOLESTEROL IN SOUTH ASIAN POPULATION, IS IT A MAJOR CONTRIBUTING RISK FACTOR FOR HIGH CORONARY HEART DISEASE
Pathan AN, Syed SH, Pfizer Laboratories Limited, Karachi, Sindh, Pakistan
CV3 DISEASE MANAGEMENT: IMPACT ON USAGE OF EVIDENCE-BASED MEDICINES FOR THE TREATMENT OF HEART FAILURE; HEALTHCARE UTILISATION AND
CLINICAL OUTCOMES IN PATIENTS ENROLLED IN THE NHG HEART FAILURE DISEASE MANAGEMENT PROGRAMME
Tan HN1, Ng K2, Wong LM1, Cheah J1, 1National Healthcare Group, Singapore, Singapore, 2The Heart Institute @Tan Tock Seng Hospital, Singapore, Singapore
pg 74
CV4 LONG-TERM COST-EFFECTIVENESS OF CLOPIDOGREL IN ACUTE CORONARY SYNDROMES – CURE MODEL TAIWAN ADAPTATION
Tarn YH1, Lin WA2, 1Taipei City Hospital, Taipei, Taiwan; 2 National Defense Medical Center, Taipei, Taiwan
DIABETES Shanghai Room 5
Moderator: Tae-Jin Lee PhD, Assistant Professor, Department of Social & Preventive Medicine, College of Medicine, Hallym University, Chuncheon, South Korea
pg 74
DB1 THE METABOLIC EFFECTS OF ORLISTAT AND ROSIGLITAZONE ON INSULIN ACTION IN A GROUP OF CHINESE PATIENTS AFFECTED BY THE METABOLIC
SYNDROME
Loh SC1, Tomlinson B2, CN Chan JCN2, You HS3, Lee KKC4, 1The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; 2 The Chinese University
of Hong Kong, Hong Kong, China; 3 The Chinese University of Hong Kong, Shatin, Hong Kong; 4 The Chinese University of Hong Kong, Shatin, Hong Kong, China
pg 74
DB2 THE RELATIONSHIP BETWEEN HOSPITAL COMPETITION AND PRESCRIBING BEHAVIORS - A CASE STUDY OF ORAL HYPOGLYCEMIC AGENTS IN AMBULATORY CARE
Ou H, Liu Y, Yang Kao YH, National Cheng Kung University, Tainan, Taiwan
pg 75
DB3 THE CORE DIABETES MODEL – SIMULATING LONG-TERM EFFECTS OF IMPLEMENTING HEALTH POLICIES FOR MANAGEMENT OF DIABETES
Palmer A1, Valentine WJ1, Ray JA1, Lurati FM1, Foos V1, Minshall ME2, Roze S1, 1CORE - Center for Outcomes Research, Binningen, Switzerland, 2CORE - Center
for Outcomes Research, Fishers, IN, USAa
pg 75
DB4 STATIN UTILIZATION IN PRIMARY PREVENTION IN PATIENTS WITH DIABETES MELLITUS IN HONG KONG
Lee VW, Chan SY, Ho CH, Tam KY Lee KKC, The Chinese University of Hong Kong, Shatin, Hong Kong, China
HEALTH CARE USE & POLICY STUDIES I Shanghai Room 6
Moderator: Gordon G. Liu PhD, Professor and Chair, Department of Health Economics and Management, Peking University, Beijing, P.R. China
pg 75
HP1 INCOME INEQUALITY IN HEALTH CARE UTILIZATION : EMPIRICAL DATA OF NATIONAL HEALTH INSURANCE IN TAIWAN.
Liang LY1, Li PC2, Huang SM2, Lan CF1, 1Yang Ming University, Taipei, Taiwan; 2 Department of Health, Taipei, Taiwan
pg 75
HP2 DYNAMIC FINANCIAL MODELS OF EMERGENCY CARE IN THAILAND
Srijariya W, Riewpaiboon A, Chaikledkaew U, Mahidol University, Bangkok, Thailand
METHODS & CONCEPTS Auditorium (Chinese translation available)
Moderator: Zhongyun Zhao PhD, Health Outcomes Research Scientist, Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA
pg 76
MC1 NONPARAMETRIC ANALYSIS OF INCREMENTAL NET BENEFITS: STATISTICAL OPTIMALITIES
Jiang JG, Cephalon, Inc, Frazer, PA, USA
pg 76
MC2 APPLYING EXPECTANCY-VALUE MODEL TO UNDERSTAND HEALTH PREFERENCE- AN EXPLORATORY STUDY
Zhang XH1, Xie F1, Wee HL2, Thumboo J2, Li SC1, 1National University of Singapore, Singapore, Singapore; 2 Singapore General Hospital, Singapore, Singapore
pg 76
MC3 DEVELOPING THE GUIDELINES FOR ECONOMIC EVALUATION OF PHARMACEUTICALS IN KOREA
Bae EY, Health Insurance Review Agency, Seoul, South Korea
pg 76
MC4 VALUE OF INFORMATION: AN APPLICATION IN HEALTH ECONOMIC EVALUATION OF RENAL REPLACEMENT THERAPY IN THAILAND
Teerawattananon Y, International Health Policy Program - Thailand, Nonthaburi, Thailand
12:15-14:00 LUNCH, EXHIBITS AND CONTRIBUTED RESEARCH PRESENTATIONS-POSTER VIEWING Hong Kong Hall 1
Lunch supported by Zhuhai SCHWARZ PHARMA Company Limited
(Over 150 research posters presented, see pages 22 to 31 in this program for poster title, presenters and abstract page references.)
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12:45-13:45 EDUCATIONAL SYMPOSIUM (ALL ARE INVITED TO ATTEND) Auditorium
Sponsored by Benefits Design Institute with a grant from Sanofi-Aventis
EVIDENCE-BASED POLICY AND BENEFIT DESIGN FOR HEALTH CARE VALUE
Schumarry H. Chao, MD MBA, Clinical Professor, University of Southern California and Co-Executive Director, Benefits Design Institute; Peter Neumann ScD, Professor of Medicine,
Tufts School of Medicine and Director, Center for Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies; Gordon Liu PhD, Professor and Chair,
Department of Health Economics and Management, Peking University and University of North Carolina. Due to intense market competition and escalating health care costs, payers are
increasingly pressured to contain costs. While evidence-based outcome research is central to quantifying value and optimizing resources, it is often not considered in actual policy and
“real world” reimbursement decisions. This session explores the gaps and innovative models in US for integrating outcome research into policy and benefit design decisions to optimize value to consumers, payers, and society. Speakers will discuss US experience and implications for China.
14:00-15:00 WORKSHOP SESSION I (for workshop purpose and description, see indicated page in this program)
HEALTH POLICY
pg 34
W1 DRUG PRICING AND REIMBURSEMENT ISSUES USING HEALTH ECONOMICS AND OUTCOMES RESEARCH IN DRUG REIMBURSEMENT – WHICH WAY
FORWARD FOR THE ASIAN REGION Shanghai Room 1
Discussion Leaders: Peter Davey BA(Ec), MA(Ec), Director, M-TAG Pty Ltd, Chatswood, Australia; Oh-Serk Hahn, Executive Director, Korean Health Isurance
Review Agency, South Korea; Lee Pak Wai, Chief Pharmacist, Hong Kong Hospital Authority, P.R. China
pg 34
W2 USE OF PHARMACOECONOMICS IN SELECTION OF NATIONAL ESSENTIAL MEDICINES Auditorium (Chinese translation available)
Discussion Leaders: Lin Yan PhD, Center for Drug Reevaluation, State Food and Drug Administration, Beijing, China; Jieming Zhou MD, Deputy Chief, Center for
Drug Reevaluation, State Food and Drug Administration, Beijing, China; Gang Cheng PhD, Chief, Center for Drug Reevaluation, State Food and Drug
Administration, Beijing, China; Liya Cao, Master, Director, Center for Drug Reevaluation, State Food and Drug Administration, Beijing, China
pg 34
W3 HEALTH TECHNOLOGY ASSESSMENT - ISSUES ON ITS USE BY EUROPEAN DECISION MAKERS WITH ADDITIONAL INSIGHTS INTO THE GERMAN HEALTH
CARE SYSTEM-LESSONS FOR ASIA Shanghai Room 5
Discussion Leaders: JM von der Schulenburg PhD, Professor, University of Hannover, Hannover, Germany; Wolfgang Greiner PhD, Professor, University of
Bielefeld, Bielefeld, Germany; Thomas Mittendorf MSc, University of Hannover, Hannover, Germany
OUTCOMES RESEARCH METHODS
pg 34
W4 ADAPTING MODELS TO ASIA Shanghai Room 6
Discussion Leaders: Bruce Crawford MA, MPH, Director, Patient-Reported Outcomes and Regulatory Consulting, and Operations Director, Mapi Values, Boston,
MA, USA; Takashi Fukuda PhD, Associate Professor, University of Tokyo, Tokyo, Japan; Eui Kyung Lee PhD, Director, Korea Institute for Health and Social Affairs
(KIHASA), Seoul, South Korea
pg 35
W5 ASIAN-PACIFIC ISSUES IN MEASURING HEALTH-RELATED QUALITY OF LIFE Shanghai Room 2
Discussion Leaders: Wolfgang Greiner MBA, Professor, Bielefeld University, Bielefeld, Germany; Rosalind Rabin, Executive Officer EuroQoL Group, Rotterdam,
Netherlands
15:00-15:15 BREAK Coffee & Tea supported by China Chemical & Pharmaceutical Co., Ltd.
15:15-16:15
WORKSHOP SESSION II (for workshop purpose and description, see indicated page in this program)
HEALTH POLICY
pg 35
W7 OUTCOMES RESEARCH FOR THE ASIAN MARKET: APPLICATIONS AND COMMUNICATIONS Auditorium (Chinese translation available)
Discussion Leaders: Bruce Crawford MA, MPH, Director, Patient Reported Outcomes and Regulatory Consulting, and Operations Director, Mapi Values, Boston,
MA, USA; Lillian Yu-Jen Wang MSc, Health Economics and Market Access Manager, Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan; Michael Stanley BA,
Director, Adelphi Targis, Tokyo, Japan
pg 35
W8 PAYOR ORIENTED EVIDENCE GUIDELINES Shanghai Room 5
Discussion Leader: Joseph Singer MD, Co-Chair VBR POEM Working Group, HealthCore, Inc, Wilmington, DE, USA
pg 35
W9 INTERPRETATION OF COST-EFFECTIVENESS RESULTS IN ASIA Shanghai Room 1
Discussion Leaders: Bruno Jolain MD, Director Health Economics Intercontinental Region, Sanofi-Synthelabo, Gentilly Cedex, France; Bong-Min Yang PhD,
Professor of Economics and Dean, School of Public Health, Seoul National University, Seoul, South Korea; Nathorn Chaiyakunapruk PharmD, PhD, Assistant
Professor, Department of Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand
pg 36
W10 MEASURING TREATMENT ADHERENCE USING PAID CLAIMS RECORDS AND APPLICATION OF LATENT CLASSIFICATION ANALYSIS (LCA) IN PATIENTS WITH
SCHIZOPHRENIA Shanghai Room 2
Discussion Leaders: Lizheng Shi PhD, Assistant Professor, Tenure Track, Tulane University, New Orleans, LA, USA; Jeonghoon Ahn PhD, Assistant Professor,
University of Southern California, Los Angeles, CA, USA
16:15-16:30 BREAK Coffee & Tea supported by China Chemical & Pharmaceutical Co., Ltd.
16:30-17:30 CO-SPONSOR SPECIAL SESSIONS I
OUTCOMES RESEARCH ON DRUG PRICING AND REIMBURSEMENT IN CHINA Auditorium (Chinese translation available)
Peter Scheuer, Executive Director, R&D Pharmaceutical Association of China, R&D-based Pharmaceutical Association Committee, Beijing, P.R. China
13
HEALTH CARE DELIVERY AND REIMBURSEMENT POLICIES IN PAKISTAN Shanghai Room 1
Aamir Hameed FCPS, MBBS, BSc, Senior Instructor & Consultant Cardiologist, Department of Medicine, The Aga Khan University, and Member of the Scientific
Council on Atherosclerosis and Thrombosis of the Pakistan Cardiac Society for STEMI Guidelines Task Force, Karachi, Pakistan
Access to health care is a basic human right, which is instilled in the constitution of Pakistan. It is both the mandate and responsibility of the Government to ensure the health and well being
of the country's population. At least one third of the population lives below the poverty line. The Government is trying to alleviate poverty through better health care in the
country. The pubic health sector has always been the center of criticism for its failure to deliver health care to the people. It is has a complex matrix organizational set-up which lacks coordination between different cells. Planning is mostly on a bureaucratic ad hoc basis. General taxation is the major source of the Government's financing for health and it spends only 0.9% of
the GDP on health. Major bulk of the budget goes into salaries of the health personnel. Funds are channeled through three levels, the federal, provincial and district governments. The recent
political and administrative devolution empowers the districts with 60% of the budget utilization. The health care delivery system consists of public and private institutions, Non governmental
organizations and Traditional medicine set-ups, which deliver allopathic, traditional and homeopathic medicine to the masses. The public health care system comprises of outreach and community based activities, primary care facilities, Tehsil and district hospitals that provide basic inpatient and outpatient care and tertiary care hospitals based in major cities that provide specialized care. The poor quality of primary health facilities cause patients to be shunted to tertiary care facilities that remain overburdened handling problems of a primary care nature. The principal
modes of financing remain through out of pocket payments and tax based revenues. In the private sector, reimbursement is mainly out of pocket payment, with a thin minority being reimbursed through group insurance in large organizational set-ups. Donor funds, social security schemes and safety nets comprise the minor rest. The private institutions are more geared
towards tertiary care delivery and even in the public sector a tertiary care bias is noted in the utilization of funds, which are channeled to provide high tech care, at the cost of much needed
primary care and thus a hiatus exists. Currently, the health policy is under review and a major overhaul that will bring relief is expected.
EVIDENCE-BASED DECISION-MAKING AND HEALTH TECHNOLOGY ASSESSMENT IN SOUTH KOREA Shanghai Room 2
Sang Moo Lee MD, PhD, Director, Health Technology Assessment System Group, and Medical Consultant, Health Insurance Review Agency, South Korea;
Seong-Hi Park PhD, Director, Health Technology Assessment Team in Health Insurance Review Agency, South Korea
In the health care system, government level policy decision making has many variables and the need for explicit and transparent decision-making processes are increasing amongst public
reimbursement policies. Many countries are confronted with increasing healthcare costs. Evidence-based decision-making becomes an essential element in the rational use of health care
resources. In South Korea, past health care policy making decisions had been based solely on the authors' opinion. Authors' opinions are criticized because they may be unclear or too subjective. The demand for an objective rational system of decision-making is increasing. Health care decisions should be balanced and supported by evidences obtained by comprehensive, explicit
and systematical health technology assessment.South Korea is developing a health technology assessment (HTA) system. Most recently, HTA was temporarily used for public funding of the
national health insurance program. In July 2003, HTA task force team introduced the HTA system and the Korean Medical Law, which assures the safeties and effectiveness of a medical technology, was amended to include the HTA system. HTA task force team has published three HTA reports. The cost-effectiveness of a Korean technology is assessed by Medical Insurance Act.
PHARMACISTS AND PHARMACOECONOMIC DISCIPLINE UNDER DYNAMIC HEALTH CARE SYSTEM IN THAILAND Shanghai Room 5
Sunibhond Pummangura, PhD, President of The Pharmaceutical Association of Thailand under the Royal Patronage, Thailand
With the progress of social welfare system development, Thailand has been moving to National Health Insurance system toward universal coverage direction. Not surprisingly that such system must require quality, efficiency, and equity of the health care services for the beneficiaries. As various new health care technologies are emerging at very fast speed, health care decision makers have been facing with the decision to balance between opportunity to consume new technologies and the rising of expense of overall health care system. Thai pharmacists, who
have their role to improve pharmaceutical care, also have their responsibilities to make decisions on providing pharmaceutical under the cost-conscious environment. Triangular decision
based on efficacy, treatment cost, and equity to access of new technology of overall patients requires new emerging science, pharmacoeconomics, to support pharmacists to fulfill their role
on pharmaceutical care philosophy. As a dynamic health professionals, pharmacists have their role at the level of health system, health care institution, and individual patient. The
Pharmaceutical Association of Thailand under the Royal Patronage as a focal point of pharmacy profession will promote the concept of pahrmacoeconomics to assure the balance between
cost and outcome. Pharmacoeconomic aspect will be integrated in the decision at every level, at the national level when selecting drug in national formulary, at managed care level when
establishing pharmaceutical benefit package, and at individual patient level when acting as a partnership with a patient for the treatment decision. The Pharmaceutical Association will work
together with health system pharmacist, hospital and managed care pharmacist, and community pharmacist in Thailand to further improve essential and appropriate drug treatment.
Emerging of the pahrmacoeconomic discipline, at present, stimulate pharmacy profession to keep pace with the decision that concern overall health care system and patients' accessibility to
advance technology which will consequently result in overall improvement of health and quality of the Thai population under efficiency and equity direction.
ISPOR LOCAL CHAPTERS OUTCOMES RESEARCH INITIATIVES Shanghai Room 6
Moderator: Jawahar S. Bapna PhD, MD, MB, Professor, Pharmaceutical Management, Indian Institute of health Management Research, Jaipur, India
Isao Kamae, MD, DrPH, President, ISPOR Japan Chapter and Professor, Graduate School of Medicine, Kobe University, Kobe, Japan
Tony Yen-Huei Tarn, PhD, President, ISPOR Taiwan Chapter and Director, Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
Wen Chen PhD, Representative, ISPOR Chinese Medical Doctor Association PE Chapter & Professor and Associate Dean, School of Public health, Fudan
University, Shanghai, China
Vithaya Kulsomboon PhD, President, ISPOR Thailand Chapter, and Assistant Professor in Social Pharmacy and Chair of Social Pharmacy Department,
Chulalongkorn University, Bangkok, Thailand
ISPOR Taiwan Chapter, Japan Chapter, Chinese MDA-PE Chapter and Thailand Chapter present their actives and initiatives in advancing the science of pharmaconomics and outcomes
research in their regions.
17:30-19:30 ISPOR ASIA CONSORTIUM RECEPTION, EXHIBITS AND CONTRIBUTED RESEARCH PRESENTATION-POSTER VIEWING Hong Kong Hall 1
All poster presentation authors MUST be with their posters
17:30-18:30 POSTER PRESENTATION AUTHOR HOUR Hong Kong Hall 1
18:30-19:30 ISPOR ASIA CONSORTIUM BUSINESS MEETING (BY INVITATION ONLY) Shanghai Room 1
18:30-19:30 SPECIAL DISCUSSION Auditorium
CHINA PHARMACOECONOMICS GUIDELINES (In Chinese)
Shanlian Hu MD, MSc, Professor, School of Public Health, Fudan University, Shanghai, P.R. China
19:30-21:30 FUDAN UNIVERSITY DINNER & ENTERTAINMENT (ALL ARE INVITED TO ATTEND) Dinner supported by ROCHE CHINA Grand Ballroom, First Floor
19:30-20:00
ROCHE (CHINA) PRESENTATION (hors d’oevres served) Grand Ballroom, First Floor
Peter Neumann ScD, 2005-2006 ISPOR President and Professor and Director, Center for the Evaluation of Value and Risk in Health, Tufts
University School of Medicine, Boston, MA, USA
20:00-21:30
14
DINNER AND ENTERTAINMENT Grand Ballroom, First Floor
TUESDAY, 7 MARCH 2006
8:00-9:00
EXHIBITS AND CONTRIBUTED RESEARCH PRESENTATION-POSTER VIEWING Hong Kong Hall 1
9:00-9:15
ISPOR SERVICE AWARDS PRESENTATION Auditorium (Chinese translation available)
(Please see page 18 in this program for Service Awardees)
Peter Neumann ScD, 2005-2006 ISPOR President and Professor and Director, Center for the Evaluation of Value and Risk in Health, Tufts University School of
Medicine, Boston, MA, USA
9:15-10:30
SECOND PLENARY SESSION Auditorium (Chinese translation available)
DEVELOPMENT AND IMPLEMENTATION OF PHARMACOECONOMICS REQUIREMENTS: INTERNATIONAL EXPERIENCES
Moderator: Wen Chen PhD, Professor and Associate Dean, School of Public Health, Fudan University, Shanghai, P.R. China
EXPERIENCES IN PHARMACOECONOMICS OVERSEAS: DEVELOPMENTS IN METHODS
Michael Drummond PhD, Professor of Health Economics, Centre for Health Economics, University of York, Heslington, York, UK
The growing use of economic evaluation in decisions about the pricing and reimbursement of pharmaceuticals has led to more scrutiny of methods. This presentation will discuss some of the main issues that have arisen, such as the selection of alternative therapies for comparison with the drug of interest, the role of
decision-analytic modelling, the measurement and valuation of health outcomes and the characterization of uncertainty.
EXPERIENCES IN PHARMACOECONOMICS OVERSEAS: POLICIES AND PROCEDURES
Suzanne Hill PhD, Scientist, Policy, Policy, Access and Rational Use, Medicines Policy and Standards, World Health Organization, Geneva, Switzerland
A number of countries have developed initiatives to use pharmacoeconomics in decision-making, including health tehnology assessment in Canada and Spain,
reimbursement decisions (Australia, The Netherlands and Canada) and comprehensive health care guidance (the UK). In this presentation, the experiences of
implementing these policies in two countries (Australia and the UK) and the challenges of balancing considerations such as quality, innovation, drug prices and
value for money will be discussed.
10:30-10:45 BREAK, EXHIBITS AND CONTRIBUTED RESEARCH POSTER PRESENTATION VIEWING Hong Kong Hall 1
10:45-11:45
PODIUM SESSIONS II (for podium presentation abstract, see indicated page in this program)
GI DISORDERS Shanghai Room 1
Moderator: Surachat Ngorsuraches PhD, RPh, Head of Pharmacy Administration Department, Prince of Songkla University, Hatyai, Songkhla, Thailand
pg 76
GI2 COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF SACRAL NERVE STIMULATION (SNS) WITH INTERSTIM ® IN FAECAL INCONTINENCE (FI)
PATIENTS IN SPAIN
Rodriguez JM1, Navarro A2, Muñoz A2, Brosa M3, Serrano-Contreras D1, Minda K4, 1Medtronic Iberica, Madrid, Spain; 2 Hospital Mutua de Terrassa, Terrassa,
Barcelona, Spain; 3 Oblikue Consulting, Barcelona, Spain; 4Medtronic S.A, Tolochenaz, Morges, Switzerland
pg 77
GI3 COMPARATIVE EFFECTIVENESS OF LAMIVUDINE MONOTHERAPY FOR PATIENTS WITH CHRONIC HEPATITIS B
Sun X1, Zhou R2, Li P2, Li Y3, Guyatt G4, 1The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China; 2 West China Hospital,
Sichuan University, Chengdu, Sichuan, China; 3 Chinese Evidence-Based Medicine Center, West China Hospital, Chengdu, Sichuan, China; 4 Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
pg 77
GI4 OUTCOMES AND COSTS OF GENERIC AND TRADE RANITIDINE USE IN THE UNITED STATES AND JAPAN
Yanagisawa S1, Kamae I1, Oderda GM2, Otsuka M3, Jorgenson J4, Otsuka K1, Brixner D2, 1Kobe University, Kobe, Japan; 2 University of Utah College of
Pharmacy, Salt Lake City, UT, USA; 3 Musashino University, Nishi-Tokyo, Japan; 4 University of Utah Hospital and Clinics, Salt Lake City, UT, USA
HEALTH CARE USE & POLICY STUDIES II Auditorium (Chinese translation available)
Moderator: Eui-Kyung Lee PhD, Senior Research Fellow and Director, Korea Institute for Health and Social Affairs, Seoul, South Korea
pg 77
HP5 CATASTROPHIC AND POVERTY IMPACTS OF OUT-OF-POCKET HEALTH PAYMENTS BEFORE AND AFTER THE UNIVERSAL HEALTH CARE COVERAGE IMPLEMENTATION IN THAILAND
Limwattananon S1, Prakongsai P2, Tangcharoensathien V3, 1Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand; 2 International Health Policy Program,
Amphoe Muang, Nonthaburi, Thailand; 3 International Health Policy Program, Nonthaburi, Thailand
pg 78
HP7 SURVEILLANCE OF ANTIMICROBIAL RESISTANCE AND USE IN THE COMMUNITY: A TIME-SERIES STUDY.
Kulkarni RA1, Thatte UM2, Holloway KA 3, Sørensen TL4, Koppikar GV1, Shinkre NN1, Chaudhury RR5, 1BYL Nair Ch hospital, Mumbai, Maharashtra, India; 2 BYL
Nair Charitable hospital, Mumbai, Maharashtra, India; 3 World Health Organisation, Geneva, Switzerland; 4 Bispebjerg Hospital, Bispebjerg, The Netherlands; 5
Delhi Society for Promotion of Rational Use of Drugs, Delhi, India
pg 78
HP8 OPTIMAL CONTRACT DESIGN UNDER PRICE-VOLUME AGREEMENTS
Zhang H, Zaric GS, PhD, The University of Western Ontario, London, ON, Canada
INFECTION Shanghai Room 5
Moderator: Eric Qiong Wu PhD, Analysis Group Inc., Boston, MA, USA
pg 78
IN1 ADVERSE EVENTS OF ANTIRETROVIRAL THERAPIES CONTAINING NEVIRAPINE OR EFAVIRENZ BASED ON INTENSIVE ADR MONITORING DATABASE
Kulsomboon V1, Maleewong U1, Suwankaesawong V2, Jameekornkul C2, 1Chulalongkorn University, Bangkok, Thailand; 2 Food and Drug Administration Office,
Nonthaburee, Thailand
15
pg 78
IN2 PRODUCTIVITY COSTS AND CARER BURDEN OF HOME PARENTERAL ANTIBIOTIC THERAPY
Neilson GS, Neilson JS, Whitby M, Princess Alexandra Hospital, Brisbane, Queensland, Australia
pg 78
IN3 ECONOMIC EVALUATION OF VACCINATION AGAINST POLIOMYELITIS IN MALAYSIA: ORAL POLIO VACCINE (OPV) VS INACTIVATED POLIO VACCINE (IPV)
Aljunid SM, MD, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
pg 79
IN4 MODELING ECONOMIC BENEFITS OF SUPPRESSING VIRAL REPLICATION IN CHRONIC HEPATITIS B (CHB) PATIENTS IN CHINA: A COST-EFFECTIVENESS
ANALYSIS OF ENTECAVIR AND LAMIVUDINE BASED ON A PHASE III CLINICAL TRIAL
Yuan Y1, Iloeje U2, Li H3, Hay J4, Bi Yao GB5, 1Bristol-Myers Squibb Company, Plainsboro, NJ, USA; 2 Bristol-Myers Squibb Company, Wallingford, CT, USA;
3 Bristol-Myers Squibb Co, Wallingford, CT, USA; 4 University of Southern California, Los Angeles, CA, USA; 5 Jin An District Hospital & Shanghai Fudan University,
Shanghai, China
MENTAL HEALTH Shanghai Room 6
Moderator: Lillian Yu-Jen Wang MS, Health Economics and Market Access Manager, Boehringer Ingelheim Taiwan Limited, Taipei, Taiwan
pg 79
MH2 THE IMPACT OF SCHIZOPHRENIA ON CAREGIVERS: BURDEN OF ILLNESS AND QUALITY OF LIFE
Crowley S1, Adams J2, Nand V3, Le Reun C4, Mudge M2, Eggleston A3, Schrover R5, Brown A2, 1University of Melbourne, North Ryde, NSW, Australia; 2 Medical
Technology Assessment Group, Chatswood, NSW, Australia; 3 Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia; 4 M-TAG Pty Ltd, Chatswood, Australia; 5
Janssen-Cilag Pty Ltd/University of Melbourne, North Ryde, NSW, Australia
pg 79
MH3 THE QUALITY OF LIFE IN DEPRESSED OUTPATIENTS: 6 MONTH FOLLOW-UP STUDY IN SHANGHAI, CHINA
Ji J1, Chen X2, Tan-Mulligan A3, Sheng F3, 1Zhongshan Hospital, Fudan University, Shanghai, China; 2 Fudan University, Shanghai, China; 3 GlaxoSmithKline
Pharmaceuticals China, Shanghai, China
pg 79
MH4 PHARMACOECONOMIC EVALUATION OF RELAPSED AND NON-RELAPSED GENERALISED ANXIETY DISORDER PATIENTS
Jorgensen TR1, François C2, Despiegel N2, 1H. Lundbeck A/S, Valby, Copenhagen, Denmark; 2 H. Lundbeck A/S, Paris, France
URINARY/KIDNEY DISORDERS Shanghai Room 2
Moderator: Nathorn Chaiyakunapruk PharmD, PhD, Assistnat Professor, Department of Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand
pg 80
UK1 A REGIONAL ASIAN ANALYSIS OF THE COST-EFFECTIVENESS OF EARLY IRBESARTAN TREATMENT VERSUS CONVENTIONAL ANTIHYPERTENSION
TREATMENT, AND LATE IRBESARTAN TREATMENT IN PATIENTS WITH TYPE 2 DIABETES HYPERTENSION AND KIDNEY DISEASE
Annemans L1, Demarteau N2, Hu S3, Lee TJ4, Morad Z5, Thanom S6, Yang WC7, 1IMS Health and Ghent University, Brussels, Belgium; 2 IMS Health, Brussels,
Belgium; 3 Fudan University (former Shanghai Medical University), Shanghai, China; 4 College of Medicine, Hallym University, Chuncheon, South Korea; 5 Hospital
Kuala Lumpur, Kuala Lumpur, Malaysia; 6 Phramongkutklao Army Hospital, Bangkok, Thailand; 7 Veteran General Hospital and National Yang-Ming University,
School of Medicine, Taipei, Taiwan
pg 80
UK2 ESTIMATED ANNUAL COST OF OVERACTIVE BLADDER IN THAILAND
Prasobsanti K1, Ponprasit K2, 1Chulalongkorn University Hospital, Bangkok, Thailand; 2 Pfizer Thailand Ltd, Bangkok, Thailand
pg 80
UK3 ETHICAL DIMENSION OF RESOURCE ALLOCATION: THE CASE OF SCALING UP ACCESS TO RENAL REPLACEMENT THERAPY IN THAILAND
Tangcharoensathien V1, Prakongsai P2, Kasemsup V3, Teerawattananon Y4, 1International Health Policy Program, Nonthaburi, Thailand; 2 International Health
Policy Program, Amphoe Muang, Nonthaburi, Thailand; 3 Mahidol University, Bangkok, Thailand; 4 International Health Policy Program - Thailand, Nonthaburi,
Thailand
pg 80
UK4 ECONOMIC ANALYSIS OF ORAL CARBONACEOUS ADSORBENT AST-120 IN DELAYING THE INITIATION OF DIALYSIS TREATMENTS AMONG PATIENTS WITH
CHRONIC RENAL FAILURE
Kang HY1, Cho WH1, Lee SM2, Kim HJ3, Woo TW4, 1Yonsei University, Seoul, South Korea; 2 Yonsei University, Graduate School, Seoul, South Korea; 3 Pochon
CHA University, Pochon, Kyoung-gi, South Korea; 4 CJ Corp, Seoul, South Korea
11:45-12:00 BREAK AND CONTRIBUTED RESEARCH POSTER PRESENTATION VIEWING Hong Kong Hall 1
12:00-13:00 WORKSHOP SESSION III (for workshop purpose and description, see indicated page in this program)
HEALTH POLICY
pg 36
W11 ISSUES IN DRUG PRICING, REIMBURSEMENT, AND ACCESS IN THE ASIA-PACIFIC REGION Auditorium (Chinese translation available)
Discussion Leaders: Stuart O. Schweitzer PhD, Professor of Health Services, UCLA School of Public Health, P.R. China; Yingyao Chen PhD, Professor of
Hospital Management, Fudan University School of Public Health, P.R. China
pg 36
W12 INTERPRETING REAL WORLD PHARMACOECONOMIC INTERVENTIONS – DIFFICULTIES ARISING FROM UNFORESEEN ACCESS EFFECTS Shanghai Room 2
Discussion Leader: Jeonghoon Ahn PhD, Assistant Professor, University of Southern California, Los Angeles, CA, USA
pg 36
W14 PHARMACOECONOMICS: EVALUATING FREE SOFTWARE ON THE INTERNET FOR COST-EFFECTIVENESS ANALYSIS, DECISION ANALYSIS AND NUMBER
NEEDED TO TREAT CALCULATIONS Shanghai Room 6
Discussion Leader: William McGhan PharmD, PhD, Professor of Pharmacy & Health Policy, University of the Sciences, Philadelphia, PA, USA
pg 37
W15 RETROSPECTIVE DATABASES IN THE UNITED STATES, EUROPE AND ASIA Shanghai Room 1
Discussion Leaders: Diana Brixner PhD, Associate Professor, University of Utah College of Pharmacy, Salt Lake City, UT, USA; Gary M Oderda PharmD, MPH,
Professor, University of Utah College of Pharmacy, Salt Lake City, UT, USA
16
13:00-14:45 LUNCH, EXHIBITS AND CONTRIBUTED RESEARCH PRESENTATIONS-POSTER VIEWING Hong Kong Hall 1
13:30-14:30 IMS HEALTH SYMPOSIUM (ALL ARE INVITED TO ATTEND) Auditorium
IMPLEMENTING PHARMACOECONOMIC GUIDELINES IN ASIA: WILL INCREASING EFFICIENCY HELP CONTAIN COSTS?
Moderator: Lieven Annemans PhD, MSc, Mman, Principal, Health Economics and Outcomes Research, IMS Health
Budget constraints and growing public demand for innovative drugs have made the efficient delivery of quality health care a major priority worldwide. As a result, an increasing number of countries have implemented pharmacoeconomic guidelines and requirements. As Asian health care systems move into an era of budget constraints and rising pharmaceutical
costs, many policy makers are looking towards pharmacoeconomic requirements as a cost control solution. But is pharmacoeconomics an effective cost containment strategy? A panel
of global experts will discuss this pressing question. Key opinion leaders from Asia will discuss the anticipated impact of pharmacoeconomic requirements on pharmaceutical spending
in the region. Experts from Europe, Australia and Asia will explore the evolution of pharmacoeconomic requirements and discuss their value in containing pharmaceutical spending.
14:45-15:45 WORKSHOP SESSION IV (for workshop purpose and description, see indicated page in this program)
HEALTH POLICY
pg 37
W16 THE ECOMONIC BENEFITS OF WORKSITE PROMOTION & DISEASE PREVENTION IN THE US: LESSONS FOR ASIA Shanghai Room 6
Discussion Leaders: Louis Yen PhD, Research Scientist and Director, International Research and Development, Health Management Research Center, The
University of Michigan; Dee W Edington PhD, Director and Professor, The University of Michigan, USA
pg 37
W17 HOW ARE PHARMACEUTICAL PRICES AND ACCESS SET IN COUNTRIES IN THE ASIA-PACIFIC REGION: COMPARING “HEALTH POLICY” AND “HEALTH
INDUSTRY POLICY” Shanghai Room 2
Discussion Leader: Marco R. Di Tommaso PhD, Professor, University of Ferrara, Ferrara, Italy
pg 37
W19 CURRENT DEVELOPMENTS AND ISSUES ABOUT DRUG SAFETY Auditorium (Chinese translation available)
Discussion Leaders: Jeff Jianfei Guo PhD, Associate Professor, University of Cincinnati, Cincinnati, OH, USA; Yong Hua Jing MS, Research Assistant, University
of Cincinnati, Cincinnati, OH, USA; Wenmin Du PhD, Deputy Director, Shanghai Adverse Drug Reaction Monitoring Center, Shanghai, China
pg 38
W20 EQ-5D AND OTHER GENERIC MEASURES OF HEALTH Shanghai Room 1
Discussion Leaders: Frank De Charro, Executive Director, EuroQoL Group, Centre for Health Policy and Law, Rotterdam, Netherlands; Paul Kind, Principal
Investigator, Outcomes Research Group, York, UK
15:45-16:00 BREAK AND CONTRIBUTED RESEARCH POSTER PRESENTATION VIEWING Hong Kong Hall 1
16:00-17:00 CO-SPONSOR SPECIAL SESSIONS II
EVIDENCE-BASED MEDICINE IN CHINA Auditorium (Chinese translation available)
Youping Li PhD, President, Chinese Cochrane Center and Professor, West China Center of Medical Sciences, Sichuan University, Sichuan, China
Since its introduction to China in 1996, evidence-based medicine has been receiving increasing attention and is playing an important role in healthcare and clinical decision-making.
The Chinese Evidence-Based Medicine Center and the Chinese Cochrane Centre, which are the only authorized academic organizations of evidence-based medicine in China, have
assumed the responsibilities of developing and promoting the production and use of high-quality evidence in health decision-making of all levels. As internally recognized academic
entities, the Centers are taking the leadership in evidence-based medicine in China. In this session, a delegate from these Centers will discuss evidence-based medicine initiatives in
China in terms of its history of development, the achievements, and the challenges and opportunities that are confronted.
INTERNATIONAL COMPARISON OF THE PHARMACEUTICAL EXPENDITURES AND PHARMACEUTICAL POLICY IN JAPAN Shanghai Room 5
Hiroyuki Sakamaki, MBA, Director and Chief Researcher, Research Department, Institute for Health Economics and Policy, Japan
In drafting domestic policies, countries refer to the situation of medical expenditure in other nations. When comparing the expenditure internationally, we have to take account of differences in the definition and use of drugs among countries. This presentation will discuss differences in drug expenditure and drug use among Japan and Western countries and will
report the policies for controlling expenditure for drugs in Japan.
FORMULARY ASSESSMENT AND DRUG CONTROL IN MALAYSIA Shanghai Room 6
Samsinah Hussain PhD, Associate Professor, Head of Department of Pharmacy, University of Malaysia, and Member of the Drug Control Authority (DCA) and
Pharmacy Board, Ministry of Health, Malaysia
Formulary management is one of the strategies that can be implemented to curb increasing drug cost. This presentation will explore hospital drug use issues and formulary assessment. An overview of the regulatory functions of the Malaysian regulatory agency will be presented. Suggestions to control drug price through medication regulation will be discussed.
SINGAPORE HEALTH AUTHORITY CENTER FOR DRUG ADMINISTRATION FORUM Shanghai Room 1
Moderator: Phua Kai Hong PhD, Joint Professor of Health Policy and Management, Lee Kuan Yew School of Public Policy and Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
Shu-Chen Li PhD, MS, MBA, Visiting Specialist and Consultant, Center for Drug Administration, Health Science Authority, and Associate Professor, Department of
Pharmacy, National University of Singapore, Singapore;
Eileen Lim, Official, Center for Drug Administration, Health Science Authority, Singapore
The drug regulatory framework and process, the finance of the system in Singapore and its implication for the maintenance of the Ministry of Health Standard Drug List will be discussed.
ISPOR ASIA MEDICAL DEVICE & DIAGNOSTICS COUNCIL FORUM Shanghai Room 2
Welcome & Opening Remarks
Nancy S. Travis, Chair, ISPOR Asia Pacific Medical Device & Diagnostics Council Steering Committee, Associate Vice President (Asia), Advanced Medical
Technology Association (AdvaMed);
Marilyn Dix Smith PhD, ISPOR Founding Executive Director, ISPOR
17
ISPOR and the Medical Device World - Synergies and Unique Issues
Michael Drummond PhD, Professor of Health Economics, University of York, Centre for Health Economics and ISPOR President-elect
Medical Device Outcomes Research Issues
Isao Kamae MD, PhD, Professor of Biostatistics and Health Decision Sciences, Graduate School of Medicine, Kobe University, Kobe, Japan
Jie Chen PhD, Director, Key Lab of Health Technology Assessment, Ministry of Health and Professor, Fudan University, Shanghai, China
Ashoke Bhattacharjya PhD, Executive Director, Health Policy and Economics, Johnson & Johnson, Titusville, NJ, USA
During this forum, unique aspects of medical device development and assessment (distinct from pharmaceuticals), such as statistical issues in dealing with smaller sample sizes or
using real world evidence (distinct from RCTs) will be discussed. The ISPOR book initiate, Medical Devices & Diagnostics Outcomes Research: Issues & Good Research Practices will be
presented.
17:00-17:15
BREAK
17:15-17:30
ISPOR CONTRIBUTED RESEARCH AWARDS PRESENTATION AND CLOSING REMARKS Auditorium (Chinese translation available)
17:15-18:00
ISPOR ASIA-PACIFIC MEDICAL DEVICE & DIAGNOSTICS COUNCIL MEETING (BY INVITATION ONLY) Hong Kong Hall IV
18:00-20:00 ISPOR ASIA-PACIFIC MEDICAL DEVICE & DIAGNOSTICS COUNCIL RECEPION AND DINNER (BY INVITATION ONLY) Hong Kong Hall IV
ISPOR SERVICE AWARDEES
ISPOR SERVICE AWARDEES - PROGRAM COMMITTEE CO-CHAIRS:
Shanlian Hu MD, MSc, Professor, School of Public Health, Fudan University,
Wen Chen PhD, Professor and Associate Dean, School of Public Health, Fudan
University, Shanghai, P.R. China
Gordon G. Liu PhD, Professor and Chair, Department of Health Economics and
Management, Guanghua School of Management, Peking University, Beijing, P.R. China
Hiroyuki Sakamaki MBA, Director and Chief Researcher, Research Department,
Institute for Health Economics and Policy, Japan
Eui-Kyung Lee PhD, Senior Research Fellow and Director, Korea Institute for Health
and Social Affairs, Seoul, South Korea
Tony Yen-Huei Tarn PhD, Director, Department of Pharmacy, Taipei City Hospital,
Taipei, Taiwan
Usa Chaikledkaew PhD, Department of Pharmacy, Faculty of Pharmacy, Mahidol
University, Bangkok, Thailand
Kenneth KC Lee JP, BSc(Pharm), MPhil, PhD, Professor, School of Pharmacy, Faculty
of Medicine, The Chinese University of Hong Kong, Hong Kong, P.R. China
Isao Kamae MD, DrPH, Professor, Graduate School of Medicine, Kobe University,
Kobe, Japan
Bong-Min Yang PhD, Professor of Economics and Dean, School of Public Health,
Seoul National University, Seoul, South Korea
Lillian Yu-Jen Wang MS, Health Economics and Market Access Manager, Boehringer
Ingelheim Taiwan Limited, Taipei, Taiwan
Nathorn Chaiyakunapruk PharmD, PhD, Assistant Professor, Department of
Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand
Vithaya Kulsomboon PhD, Assistant Professor and Chair of Social Pharmacy
Department, Chulalongkorn University, Bangkok, Thailand
ISPOR SERVICE AWARDEES-CONFERENCE SUPPORTERS:
Alison Tan-Mulligan PhD, MBBS, Health Outcome & Epidemiology Manager,
GlaxoSmithKline Pharmaceuticals (China) Investment Co. Ltd, Shanghai, P.R. China
Pfizer Hong Kong Ltd.
Shunya Ikeda MD, MS, DMSc, Assistant Professor, Department of Health Policy and
Management, School of Medicine, Keio University, Japan
Bristol-Myers Squibb Company
Shu-Chuen Li PhD, MS, MBA, Associate Professor, Department of Pharmacy, National
University of Singapore, Singapore
Shanghai Roche Pharmaceuticals Ltd.
Pfizer Inc.
Sino-American Shanghai Squibb Pharm. Ltd
F. Hoffmann-La Roche Ltd
Jin-Hyun Kim PhD, Associate Professor, Department of Health Policy and
Management, Inje University, South Korea
AstraZeneca China
Ming-Chin Yang DrPh, Associate Professor, School of Public Health, National Taiwan
University, Taipei, Taiwan
Novartis Pharma AG
Surachat Ngorsuraches PhD, RPh, Head of Pharmacy Administration Department,
Prince of Songkla University, Hatyai, Songkhla, Thailand
Merck Sharp & Dohme (China) Ltd.
Zhiqiang Guan MD, MPH, Director, National Institute for Social Insurance, Beijing, P.R.
China
Medtronic Asia Pacific
Takashi Fukuda PhD, Associate Professor, Department of Pharmacoeconomics,
Graduate School of Pharmaceutical Sciences, University of Tokyo, Japan
IMS Health
Tae-Jin Lee PhD, Assistant Professor, Department of Social & Preventive Medicine,
College of Medicine, Hallym University, Chuncheon, South Korea
Zhuhai Schwarz Pharma Company Ltd.
Hsiao-Yi Lin MD, Rheumatologist, Taipei Veteran General Hospital, Taipei, Taiwan
AstraZeneca Pharmaceutical Co. Ltd.
Novartis Pharma AG Infectious Disease Group
Sanofi-Aventis
Boston Scientific
Innovus Research Inc.
China Chemical & Pharmaceutical Company
Xian-Janssen Pharmaceutical Ltd.
18
FIRST PLENARY SESSION: Pharmacoeconomics and Outcomes Research in Asia-Pacific:
China, Japan, South Korea, Singapore, Thailand, Pakistan, Malaysia and India
Category/Country
China
Japan
(1$=JPÄ120)
South Korea
(2003 data)
Singapore
(2004 data)
Thailand
Pakistan
Malaysia
India
Size of nation (km2)
9.60 million
378 k
98,585
699
514 k
804 k
330 k
3,29 k
Population - all
1.26 billion
128 million
47.8 million
4.25 million
65 million
162 million
25 million
1.03 billion
Percent age distribution
(aged 14, 15~64, e65)
1-14 yr. 20.3%
15-64yr. 71.2%
>65yr. 8.5%
13.9 %
(age<=14)
66.6 % (15~64)
19.5 % (>=65)
20.0%, 71.7%,
8.3%
0-14: 16%
15-64: 75.9%
65yrs: 8.1%
0-14 years: 23.9%
15-64 years: 68.6%
65 years and
over: 7.5%
39.6%
56.3%
4.1%
32.6%, 62.9%,
4.5% (2001)
aged 15=35.6%,
age 65 =4.1%)
Average citizen income in
US dollars (GDP)
9101 Yuan (RMB)
equal to $1109 USD
per capita
$32,725
(JP¥3,927,000
12,651$
US$27,800
per capita
GNI per capita
2540 USD
(WDR 2004)
US $ 736
(2004 - 2005)
4,700 USD
(2005)
Per capita
income:
US$ 530/year (2003)
DEMOGRAPHICS
HEALTH CARE
HEALTH
CARE
Health care (i.e. traditional
medicine, western medicine)
Both of them are part western medicine
of health system.
For instance, there
were 18393 hospital
beds in China in 2004
16.2% belongs to
traditional medicine
hospitals, which contain
8.3% patients in
hospitalization
western + traditional
medicine
Western medicine
(dominant part of the
healthcare system)
plus traditional
medical practice
Western medicine is
the dominant part of
the healthcare system,
while traditional
medical still practiced
Traditional and
Yes
western medicine.
People approach
the traditional
system more than
the western system
in the rural areas
due to quality
issues
Both western and
traditional systems
of Medicine are part
of health care system.
Number of hospitals (<100
beds, 100~500, 500~1000,
>1000 beds)
<100 beds 30867
100-500 beds 6568
500-800 beds 715
>800 beds
243
(2004 data)
3,667 (<=100beds)
4,970 (100~500)
416 (500~900)
69 (>=900)
Total 1,425
29 (13 public;
16 private)
NA
Public:
916 hospitals
Private: 520
Public: 48, 58,
15, 4 (Total=125)
Private: 189, 29,
0,0 (total= 218)
(Year 2004)
No. of hospital
beds is 665,639.
Population per
hospital bed is
1,451 (1998 data)
Number of hospitals beds
/10,000
2.4
142.6
71
Total beds: 11,844
(Public: 8813)
29 beds/10,000
population
462 population per
hospital bed,
21.65 beds / 10,000
population
6.8/ 10,000
17.8 (2003)
6.9 (1998)
Number of primary care
clinics/10,000
NA
7.5
4.91
17 public polyclinics;
1480 private clinics
Total 9.765 PHC clinics
serving 58.9 million
population, 1.67 PHC
clinics / 10,000
population
Public: 4554
1.2 (public)
dispensaries, 5290 2.0 (private)
Basic Health Units,
522 Rural Health
centers, 285 TB
centers
Private: 340
dispensaries, 450
diagnostic clinics,
300 maternal and
child health centers
Total number of
health care centres
including Sub-centres
Primary health centres
& Community health
centres is 163181
Number of physicians/10,000
15.0
20.6
16
15
3
7.3 (2003)
7.2 (2003)
5.2
Number of pharmacists/10,000
1.26 (15*0.084)
18.0
.53
3
1.1
3.4 (1996)
14.0 (2004)
0.8
HEALTH CARE INSURANCE
Health insurance
system (types)
There are two types
health insurance systems: Basic employee's
medical insurance in
urban China, which contains personal medical
savings accounts (paid
for ambulatory service)
and pooled fund (paid
for inpatient and catastrophic illnesses) and
new type cooperative
medical scheme in rural
China (which has pooled
fund and/or family medical savings accounts).
Other supplementary
insurance schemes are
also existed.
Universal coverage
(Nation-wide)
Public and private insurance available.
(Public: MediShield and
IncomeShield Plan MA &
MB.) MediShield is an
opt-out scheme for all
Medisave account holders who are Singapore
Citizens or Permanent
Residents. IncomeShield
Plan MA & MB offers
higher claimable limits
compared to MediShield,
but also has higher
deductibles
Thailand achieves
Universal Coverage in
2002. There are currently three public insurance
schemes covers the
whole population in
Thailand
Social Health Insurance
(SHI) for private sector
employee
Civil Servant Medical
Benefit Scheme
(CSMBS) for public sector employee, dependants and pensioners
The Universal Coverage
Scheme (UC) covers rest
of the population
1, Private insurance
(only 0.5% of GDP), as
a proportion of the GDP,
Pakistan's private
insurance industry is
the smallest compared
to other developing
countries.2, Employees
Social Security Scheme
covers 1.2 million individuals, which represent 3.06% of total
work force. 3, Smaller
social health insurance
i.e. workers welfare
fund, Zakat, Bait-ulmal, employee's old
age benefit, Guzara
program and workers
participation fund.
Public (none)
Private Insurance
and Employees
Benefit
The health insurance market in India is very limited
covering about 10% of the
total population. The existing schemes can be categorized as:
(1) Voluntary health insurance schemes or privatefor-profit schemes;
(2) Employer-based
schemes; (3) Insurance
offered by NGOs / community based health insurance,
and (4) Mandatory health
insurance schemes or government run schemes
(namely ESIS, CGHS).
19
China, Japan, South Korea, Singapore, Thailand, Pakistan, Malaysia and India continued
Category/Country
China
Japan
(1$=JPÄ120)
South Korea
(2003 data)
Singapore
(2004 data)
Thailand
Pakistan
Malaysia
India
25%
Approximately 10%
HEALTH CARE INSURANCE continued
% of population with
insurance coverage
135 million employees
100% for Japanese
covered by urban medical
insurance, and 165
million rural residents
covered by cooperative
medical scheme. Both
together are covered
about 23% population in
China
97.5%
>2 million
contributors
to MediShield
in 1999
SHI 13%
CSMBS 10%
UC 74%
3 - 5%
approximately
Reimbursement method
Including deductible,
co payment and ceiling.
There has drug
reimbursement list
(A and B) for urban
medical insurance system
fee-for-service
Including deductible,
co-payment and
claim ceiling.
SHI - inclusive capitation for ambulatory
care and admission,
fee schedule for
additional pay for high
cost care CSMBS fee for service
reimbursement UC capitation for ambulatory
care, global budget and
DRG for inpatient care
Out of pocket
Mostly fee for
(98.35% of private service
expenditure on
health (2002)
Fee for service,
but partly flat
payment
HEALTH
CARE CARE
Expenditures
& CONTROLS
HEALTH
EXPENDITURES
AND CONTROLS
Health expenditure (% of GDP): 5.62%(2003 data)
public/private
8.58 %
2.8%/2.8%
4.3% GDP (Public:
0.9%) 2002 data
4.4% GDP (2002),
public 70%
Private 30%
0.9% of GDP in
4.5%(2.0% public;
public sector and 2..5% private)
3.2% of GDP, 2002
in Private sector
For the period 1998, the
total health expenditure as a
percentage of the GDP was
5.1%. Public expenditure on
health was 18% of the total
expenditure on health. The
total government health
expenditure as a percentage
of the total government
expenditure was 5.6%.
Health expenditure per
capita: public/private
¥509.5($62)
(2003 data)
$2,035
(JP¥244,200)
348$
US$1105 per capita
( Public: $307 per
capita) 2002 data
321 PPP $ (2002)
90 US$ (2002)
62 US $
(year 2002)
RM 301 Public;
RM 367 Private
(2003)
The per capita total
expenditure on health in
India is US$ 23, of which
the per capita
Government expenditure
on health is US$ 4.
Drug spending per capita
¥224.7($27.4)
(2003 data)
$393
(JP¥47,160)
~US$75 per capita
115.69 PPP$ (2002)
32.44 USD (2002)
7 US $ (2004)
USD 27.
(2003)
Data not available
Drugs of total health
spending (%)
44.1% (2003 data)
23.3%
~8% (estimated)
36.04%
80% of total health 12% (2003)
expenditure on
(Public sector)
buying medicines
15%
National drug budget
No Data. Total drug exp
¥290.4($35.4) billion
$60.5 billion
(JP¥7,253.8 billion)
No data available.
Total drug exp:
US: $311 million
Integrated in capitation
budget for SHI and UC
scheme. No drug budget
ceiling for CSMBS.
298,350 US $(Pak
Rs. 17,901,000)
(2004 -2005). This is
the Drug Controller
Budget, Ministry of
Health. No other
figure is available.
The estimated
expenditure on health
and family welfare is
Rs.10,280 crore
Pricing/reimbursement
Govn't control
Govn't control
Govn't control
No specific reimbursement for drugs
as included in DRG
and global budget for
public hospitals or
polyclinics.
Reference pricinginternational
No
No
No
No
20
28%
No specific reimbursement for drugs in SHI and
UC as drug expenditure
are included in the capitation for ambulatory
care and global budget
and DRG for inpatient
care Beneficiaries covered by CSMBS reimburse drugs for OP and IP
based on hospital price
list, generally cost plus
15% margin.
No
RM 751million
(2003)
RM 808 million
(2004)
(Public Sector Only)
Government
Control in
according to laws Public Sector
that are in the
process of being
amended. Reimbursement for
the minority that
comes under
insurance coverage.
No
No
Data not available
China, Japan, South Korea, Singapore, Thailand, Pakistan, Malaysia and India continued
China
Category/Country
Japan
(1$=JPÄ120)
South Korea
(2003 data)
Singapore
(2004 data)
Thailand
No
No
Pakistan
Malaysia
India
National List of Essential
No
Drug (NLED) was referred
as the minimum pharmaceutical benefit package
for all three public insurance schemes, Reference
price for National List of
Essential Drugs was promulgated for purchase by
government hospitals,
according to Procurement
Regulation
No
Data not available
Data not available
HEALTH CARE EXPENDITURES & CONTROLS continued
Reference pricingnational clusters
No
Use of pharmacoeconomics
Yes, but has not been
Yes, but not Govn't's
required by Government requirement
in registering new drugs
Recently pharmacoeconomics evaluation
guidelines are under
prepared by pharmacoeconommics
Recommended, but
not required
Not legal requirement
but implicitly used
in the selection of
drugs for inclusion
into Standard Drug
List maintained by
Ministry of Health.
Increasing application of
No
evidence from pharmacoeconomics for the revision
of National List of
Essential Drugs, as NLED
is referred as minimum
drug package for all public
insurance schemes. PE is
not applied at the hospital
level.
Very limited
but developing
Co-payments
10% of annual salary
30%
as deductible, 10% and
over for drugs, based on
HI categories. Ceiling
usually set on 4 times of
annual salary and wages
in urban medical
insurance system.
Yes
Public sector
healthcare institution
heavily subsidized for
citizens and permanent
Co-payments for
standard drugs at
public institutions.
No co payment for
drugs in SHI and UC,
Beneficiaries covered
by CSMBS have to
pay in full for drugs
outside the NLED
Yes, in public
Data not available
sector but subsidy
upt to 80 -90%
of cost in public
sector
Profit/revenue controls
No. some cities now are No
conducting hospital global
budget control and
revenue capping.
No
Singapore has a mixed
healthcare market with
free market private
providers. Public hospitals are allowed to keep
a portion of profits. Profit
control at public hospitals by requiring the
returning of excess profit
once a limit is reached.
Free market for
No
private hospital sector,
Government hospitals
allows 15% margin
for drug sales
No
Data not available
Clinical practice guidelines
Have, but not required
by Govn't
partially
Well developed by
MOH and updated
regularly
Well developed by
No
Royal Colleges, but lack
of enforcement mechanisms, or other
incentive structure
fostering the use of CPG.
Yes
Guidelines available at
State levels, not at
National level
Drug budgets/financial
No. unless case payment, No
incentives aimed at prescrib- global control & hosp
ing doctors
revenue capping policy
implementation
No
Blocked budget at
public hospitals with
no separate drug
budget account to
encourage prudent
and rational drug
prescribing.
In the future, the CSMBS No
has a policy to harmonize
payment mechanism with
the other two schemes
(SHI and UC), namely capitation for ambulatory care,
and global budget with
DRG for inpatient care.
Capitation and global
budget sends a strong signal towards efficient use
of diagnostic and therapeutic services including
drugs.
No
Data not available
Availability of local
pharmacoeconomic data
Yes
Limited
At an infancy phase
Very limited
In infancy stage at
present
Yes, from some
Chinese literatures
No
Have, but not
required by Govn't
Yes, from Japanese
literature, but limited
No
No
21
For poster presentation abstract, see indicated page in this program.
ARTHRITIS
pg 39 PAR1
ARE THEY RELEVANT? A CRITICAL EVALUATION OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH CORE
SETS FOR OSTEOARTHRITIS FROM THE PERSPECTIVE OF PATIENTS WITH KNEE OSTEOARTHRITIS IN SINGAPORE
Xie F1, Thumboo J2, Fong KY2, Lo NN2, Yeo SJ2, Yang KY2, Li SC1, 1National University of Singapore, Singapore, 2Singapore General Hospital, Singapore
pg 39 PAR2
COST-EFFECTIVENESS ANALYSIS OF TREATMENT OPTIONS FOR METHOTREXATE-RESISTANT RHEUMATOID ARTHRITIS IN KOREA
Lee EK1, Park EJ1, Sung YK2, Park SJ1, Kim JJ3, Bae SC2, 1Korea Institute for Health and Social Affairs (KIHASA), Seoul, South Korea, 2Hanyang University
Hospital, Seoul, South Korea, 3Sook-myung Women’s University, Seoul, South Korea
pg 39 PAR3
DIRECT MEDICAL COST OF RHEUMATOID ARTHRITIS IN HONG KONG
Lee VWY1, Lee KK1, Li EK2, Chan CW1, Chan LH1, Ng TS1, Tam LS2, 1The Chinese University of Hong Kong, Shatin, Hong Kong, China, 2Rheumatology/Faculty
of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
pg 39 PAR4
RELATIONSHIP BETWEEN HEALTH-RELATED QUALITY OF LIFE AND CLINICAL IMPAIRMENT IN TAIWANESE PATIENTS WITH RHEUMATOID
ARTHRITIS
Lin HY1, Huang VWH2, Tarn TH3, Su KYJ4, Huang KYC4, 1Taipei Veterans General Hospital, Taipei, Taiwan, 2Protech Pharmaservices Corporation, Taipei, Taiwan,
3Taipei City Hospital, Taipei, Taiwan, 4Protech Pharmaservices Corporation, Taipei, Taiwan
pg 39 PAR5
DIRECT MEDICAL COST OF ANKYLOSING SPONDYLITIS IN SOUTHERN CHINESE
Tam LS1, Li EK1, So SW2, Chan BM2, Kan KW2, Hwang WW1, Lee KK2, Lee VWY2, 1Rheumatology/Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, Hong Kong, China, 2The Chinese University of Hong Kong, Shatin, Hong Kong, China
ASTHMA
pg 40 PAS1
ESTIMATING ECONOMIC BURDEN OF CHILDHOOD ASTHMA IN KOREA USING THE NATIONAL HEALTH INSURANCE CLAIMS DATA
Kang HY1, Park CS2, Bang HR3, Kocevar VS4, Kim CJ3, 1Yonsei University, Seoul, South Korea, 2Korea University, Seoul, South Korea, 3MSD Korea LTD, Seoul,
South Korea, 4Merck & Co., Inc, Whitehouse Station, NJ, USA
pg 40 PAS2
IS IT WORTH TO USE INHALED CORTICOSTEROIDS TO CONTROL MILD-TO-MODERATE ASTHMA UNDER THE THAI HEALTH CARE CONTEXT?
Limwattananon C1, Limwattananon S1, Saklertsakul D1, Phumas P2, 1Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand, 2Mahasarakham University,
Amphoe Muang, Mahasarakham, Thailand
pg 40 PAS3
FIVE-YEAR CLAIM DATABASE ANALYSIS OF ASTHMA IN TAIWAN
Lu CH, Armed Forces Beitou Hospital, Taipei, Taiwan, Tarn YH, Taipei City Hospital, Taipei, Taiwan
pg 40 PAS4
THAI PATIENTS’ EXPERIENCE OF THE BURDEN OF ASTHMA: QUALITATIVE STUDY
Sirimai P1, Limwattananon C2, Limwattananon S2, Tangcharoensathien V3, Boonsawat W4, Schommer JC5, 1Prachuapkhirikhan Hospital, Prachuapkhirikhan,
Thailand, 2Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand, 3International Health Policy Program, Nonthaburi, Thailand, 4Khon Kaen University, Khon
Kaen, Thailand, 5University of Minnesota, Minneapolis, MN, USA
CANCER
pg 41 PCN1
COST-EFFECTIVENESS OF PEMETREXED PLUS CISPLATIN VERSUS CISPLATIN ALONE IN THE TREATMENT OF MALIGNANT PLEURAL MESOTHELIOMA
Davey P1, Cordony A1, Rajan N2, Arora B2, Pavlakis N3, 1M-TAG, A Unit of IMS Health, Chatswood, NSW, Australia, 2Eli Lilly Australia Pty Ltd, West Ryde, NSW,
Australia, 3University of Sydney, St Leonards, NSW, Australia
pg 41 PCN2
A COST-EFFECTIVENESS ANALYSIS OF ADJUVANT CHEMOTHERAPY FOR NODE POSITIVE EARLY BREAST CANCER IN KOREA: DOCETAXEL, DOXORUBICIN AND CYCLOPHOSPHAMIDE (TAC) VERSUS 5-FLUOROURACIL, DOXORUBICIN AND CYCLOPHOSPHAMIDE (FAC)
Lee SG1, 2Jee YK, 3Chung HC, 4Kim SB, 5Ro J, 6Im YH, 7Im SA, 8Seo JH, 9Lee SM, 1Dankook University, College of Medicine, Cheonan, Chungnam, South
Korea, 2Pochon CHA University, College of Medicine, Seongnam, Gyunggi, South Korea, 3Yonsei University, College of Medicine, Seoul, South Korea, 4University
of Ulsan, College of Medicine, Seoul, Seoul, South Korea, 5Korean National Cancer Center Hospital, Goyang, Gyeonggi, South Korea, 6Sungkyunkwan University,
College of Medicine, Seoul, South Korea, 7Seoul National University, College of Medicine, Seoul, South Korea, 8Korea University, College of Medicine, Seoul,
South Korea, 9Yonsei University, Graduate School, Seoul, South Korea
pg 41 PCN3
INCREMENTAL LIFETIME COST OF LIVER CANCER INCIDENCE-BASED APPROACH
Lang HC, University of California at Berkeley, Moraga, CA, USA
pg 41 PCN4
ECONOMIC EVALUATION OF A NEW DIAGNOSTIC METHOD FOR DETECTING THE METASTASIS OF BREAST CANCER
Miyake K, Kamae I, Yanagisawa S, Kobe University, Kobe, Hyogo, Japan
22
pg 41 PCN5
DOCUMENTATION OF PHARMACY COST IN THE PREPARATION OF CHEMOTHERAPY INFUSIONS IN ACADEMIC AND COMMUNITY-BASED ONCOLOGY PRACTICES
Brixner D, Oderda GM, Nickman N, University of Utah College of Pharmacy, Salt Lake City, UT, USA
pg 42 PCN6
IMPACT OF BREAST CANCER TREATMENT ON HEALTH RELATED QUALITY OF LIFE
Raetai K, Pratheepawanit N, Weerapreeyakul T, Khon Kaen University, Khon Kaen, Thailand
pg 42 PCN7
PATIENT PREFERENCE AND WILLINGNESS-TO-PAY FOR PEMETREXED VERSUS DOCETAXEL IN THE SECOND-LINE TREATMENT OF ADVANCED
NON-SMALL CELL LUNG CANCER: A DISCRETE CHOICE CONJOINT ANALYSIS
Brown A1, Aristides M2, Fitzgerald P3, Liepa A4, Boyer M4, Clarke S5, 1Medical Technology Assessment Group: A Unit of IMS Health, Chatswood, NSW,
Australia, 2M-TAG, a division of IMS Health Economics and Outcomes Research, London, United Kingdom, 3M-TAG, A division of IMS Health Economics and
Outcomes Research, London, United Kingdom, 4Eli Lilly and Company, Indianapolis, Indiana, USA, 5Sydney Cancer Centre, Camperdown, Australia
pg 42 PCN8
METHODS OF COST DATA COLLECTION FOR PHARMACOECONOMIC STUDY ALONG WITH A CLINICAL TRIAL IN JAPAN
Fukuda T1, Mouri M2, Hirose N2, Ohsumi S3, Mukai H4, Morita S5, Imai H6, Watanabe T7, Shimozuma K8, Ohashi Y1, 1University of Tokyo, Bunkyo, Tokyo,
Japan, 2Japan Clinical Research Support Unit, Bunkyo, Tokyo, Japan, 3Shikoku Cancer Center, Matsuyama, Kagawa, Japan, 4National Cancer Center, Kashiwa,
Chiba, Japan, 5Kyoto University, Kyoto, Japan, 6Asahikawa Medical College, Asahikawa, Hokkaido, Japan, 7Hamamatsu Oncology Center, Hamamatsu,
Shizuoka, Japan, 8University of Marketing and Distribution Sciences, Kobe, Japan
CARDIOVASCULAR DISEASE
pg 42 PCV1
COST-EFFECTIVENESS ANALYSIS OF CLOPIDOGREL IN ACUTE CORONARY SYNDROMES IN SOUTH KOREA BASED ON CURE TRIAL
Ko S1, Park D2, Yang BM2, 1Health Insurance Review Agency, Seoul, South Korea, 2Seoul National University, Seoul, South Korea
pg 43 PCV2
COST-EFFECTIVENESS ANALYSIS OF SINGLE VS. DUAL CHAMBER PACEMAKERS IN THE TREATMENT OF BRADYCARDIA IN SPAIN.
Mercader-Cuesta J1, Rodriguez JM2, Serrano-Contreras D2, Caro JJ3, Ward AJ3, Malik F4, 1Hospital de Granollers, Granollers, Barcelona, Spain, 2Medtronic
Iberica, Madrid, Spain, 3Caro Research Institute, Concord, MA, USA, 4Medtronic S.A, Tolochenaz, Morges, Switzerland
pg 43 PCV3
COST-EFFECTIVENESS OF EPLERENONE IN PATIENTS WITH HEART FAILURE AFTER ACUTE MYOCARDIAL INFARCTION WHO WERE TAKING BOTH
ACE INHIBITORS AND ?-BLOCKERS: RESULTS FROM EPHESUS
Zhang Z, Weintraub WS, Christiana Care Health System, Newark, DE, USA
pg 43 PCV4
A HEALTH ECONOMIC EVALUATION OF ASPIRIN IN THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE
Lamotte M1, Annemans L2, Evers T3, Kubin M3, Hu S4, 1HEDM - IMS Health, Brussels, Belgium, 2IMS Health and Ghent University, Brussels, Belgium, 3Bayer
Healthcare AG, Wuppertal, Germany, 4Fudan University (former Shanghai Medical University), Shanghai, China
pg 43 PCV5
FACTORS AFFECTING COST OF STATIN THERAPY IN HONG KONG
Cheng C1, Chan JC2, Tomlinson B2, Woo KS3, You JH4, 1Chinese University of Hong Kong, Shatin, Hong Kong, 2The Chinese University of Hong Kong, Hong
Kong, China, 3The Chinese University of Hong Kong, Shatin, Hong Kong, 4The Chinese University of Hong Kong, Shatin, N.T, Hong Kong
pg 44 PCV6
TREND ANALYSIS OF PRICE AND UTILIZATION OF STATIN DRUGS IN U.S. MEDICAID PROGRAMS
Jing Y, Chen Y, Kelton CM, Guo JJ, University of Cincinnati, Cincinnati, OH, USA
pg 44 PCV8
ANALYSES FOR PRICE AND UTILIZATION OF CALCIUM CHANNEL BLOCKERS IN US MEDICAID PROGRAMS
Chen Y, Guo JJ, Jing YH, Wigle P, University of Cincinnati, Cincinnati, OH, USA
pg 44 PCV9: DRUG PRICE AND UTILIZATION OF BETA BLOCKERS IN US MEDICAID PROGRAMS
Jing Y, Chen Y, Wigle P, Guo JJ, University of Cincinnati, Cincinnati, OH, USA
pg 44 PCV10 PHYSICAL INACTIVITY IS ASSOCIATED WITH INCREASED HEALTHCARE USE AND EXPENDITURES IN INDIVIDUALS WITH HYPERTENSION
Iyer R1, Modi A2, 1University of Appalachia College of Pharmacy, Grundy, VA, USA, 2Purdue University, Indianapolis, IN, USA
pg 45 PCV11 STATINS UTILIZATION FOR SECONDARY PREVENTION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION IN HONG KONG
Lee VWY1, Chan WK2, Lee BS3, Tomlinson B4, Chong AC5, Wong JC3, Lee KK1, 1The Chinese University of Hong Kong, Shatin, China, 2Department of Medicine
& Geriatrics, United Christian Hospital, Kwun Tong, China, 3Department of Pharmacy, Prince of Wales Hospital, Shatin, China, 4Department of Medicine &
Therapeutics, The Chinese University of Hong Kong, Hong Kong, China, 5United Christian Hospital, Kwun Tong, China
pg 45 PCV12 THE COST-EFFECTIVENESS OF CRYOPLASTY IN THE TREATMENT OF FEMOROPOPLITEAL ARTERIAL DISEASE
Audi S, Coles T, Boston Scientific Ltd, St. Albans, United Kingdom
pg 45 PCV13 COST-SAVING OF PHARMACIST INTERVENTION ON WARFARIN THERAPY IN PATIENTS WITH MECHANICAL HEART VALVES.
Rojsutee S, Musikachai P, Pongchareonsuk P, Chaikledkaew U, Mahidol University, Bangkok, Thailand
DIABETES
pg 45 PDB1
PREVALENCE OF DIABETES MELLITUS AND TREATMENT PATTERNS BASED ON CLASSIFICATION OF BODY MASS INDEX AMONG ADULTS
Suh DC1, Choi IS1, Shin HC1, Barone JA1, Park J2, Vo L1, 1Rutgers University, Piscataway, NJ, USA, 2Inha University, Incheon, South Korea
23
pg 45 PDB2
A POPULATION APPROACH TO COMPARE DIABETES IN THE US AND IN TAIWAN
Chang HY1, Hsu CC1, Chiang CY1, Hung BS2, 1National Health Research Institutes, Maoli, Taiwan, 2Bureau of Health Promotion, Taichung, Taiwan
pg 46 PDB3
COST OF MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN HONG KONG CHINESE
Chan BS1, Tsang M2, Lee VW1, Lee KK3, 1The Chinese University of Hong Kong, Hong Kong, China, 2United Christian Hospital, Hong Kong, China, 3The Chinese
University of Hong Kong, Shatin, Hong Kong, China
pg 46 PDB4
HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN THAI DIABETIC PATIENTS
Thavorncharoensap M, Pongcharoensuk P, Chaikledkaew U, Suksomboon N, Mahidol University, Rajathevi, Bangkok, Thailand
pg 46 PDB5
IS DIABETES KNOWLEDGE ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE AMONG ENGLISH-SPEAKING SUBJECTS WITH DIABETES IN
SINGAPORE?
Zhang XH1, Wee HL2, Tan K3, Tan HH4, Thumboo J2, Li SC1, 1National University of Singapore, Singapore, 2Singapore General Hospital, Singapore, 3Diabetic
Society of Singapore, Singapore, 4Singhealth Polyclinics, Singapore
pg 46 PDB6
OBESITY’S IMPACT ON DIABETES PATIENTS’ HEALTH-RELATED QUALITY OF LIFE IN THE U.S.
Cremieux PY1, Xie J2, Greenberg P1, Wu EQ3, Castor AR1, 1Analysis Group Inc, Boston, MA, USA, 2The University of North Carolina at Chapel Hill, Chapel Hill,
NC, USA, 3Analysis Group, Boston, MA, USA
pg 46 PDB7
IMPACT OF OBESITY AND DIABETES ON HEALTH RELATED QUALITY OF LIFE
Iyer R, University of Appalachia College of Pharmacy, Grundy, VA, USA
pg 47 PDB8
PERCEIVED SELF-EFFICACY TRAINING (PSET) PROGRAM IN TYPE 2 DIABETES
Suksomboon N1, Poolsup N2, Hoharitanon S3, Luckanajantachote P3, 1Mahidol University, Rajathevi, Bangkok, Thailand, 2Silpakorn University, Nakornprathom,
Thailand, 3Samutsakorn Hospital, Samutsakorn, Thailand
pg 47 PDB9
COSTS OF DIABETES PATIENTS IN THAI GOVERNMENT HOSPITALS
Pongcharoensuk P1, Kongsaktrakool B1, Tantivipanuwong S1, Sema-ngern K1, Chaiyakunapruk N2, 1Mahidol University, Bangkok, Thailand, 2Naresuan
University, Muang, Phitsanulok, Thailand
pg 47 PDB10 WEIGHT GAIN IN MIDDLE AGE AND DIABETES-RELATED MEDICAL UTILIZATION AND COSTS IN OLDER AGE
Yan LL, Wang R, Liu K, Garside DB, Carnethon MR, Metzger B, Daviglus ML, Northwestern University, Chicago, IL, USA
pg 47 PDB11 THE CORE DIABETES MODEL – SIMULATING LONG-TERM EFFECTS OF IMPLEMENTING HEALTH POLICIES FOR MANAGEMENT OF DIABETES
Palmer A1, Valentine WJ1, Ray JA1, Lurati FM1, Foos V1, Minshall ME2, Roze S1, 1CORE - Center for Outcomes Research, Binningen, Switzerland, 2CORE Center for Outcomes Research, Fishers, IN, USA
pg 48 PDB12 SYSTEMATIC REVIEW OF ECONOMIC STUDIES ON INSULIN GLARGINE
Tang Z1, Hu Y2, 1School of Public Health, Fudan University, Shanghai, China, 2Zhongshan Hospital, Fudan University, Shanghai, China
pg 48 PDB13 TYPE 2 DIABETES MODELS THAT DO NOT ACCOUNT FOR MICROVASCULAR DISEASE SCREENING RATES AND IMPORTANT CONCOMITANT MEDICATION USE MAY LEAD TO SUBSTAINTIAL MISREPRESENTATION OF COST-EFFECTIVENESS OF NEW MEDICATIONS
Palmer AJ1, Valentine WJ1, Ray JA1, Minshall ME2, Roze S1, 1CORE - Center for Outcomes Research, Binningen, Basel, Switzerland, 2CORE - USA, LLC,
Fishers, IN, USA
pg 48 PDB14 PHARMACOECONOMIC EVALUTIONS REGARDING TYPE-2 DIABETES IN ASIA-PACIFIC
Shimaya M1, Li C2, Yanagisawa S2, Kamae I2, 1Harvard University, Boston, MA, USA, 2Kobe University, Kobe, Hyogo, Japan
pg 48 PDB15 FACTORS ASSOCIATED WITH HEALTHCARE COSTS AND HOSPITALIZATIONS IN PATIENTS WITH DIABETES IN THAI PUBLIC HOSPITALS
Chaikledkaew U1, Pongchareonsuk P2, Thavornchareonsap M2, Suksomboon N3, Tantivipanuwong S2, 1Mahidol University, Bangkok, Thailand, 2Mahidol
University, Payathai, Bangkok, Thailand, 3Mahidol University, Rajathevi, Bangkok, Thailand
ENDOCRINE DISORDER
pg 48 PEN1
BUDGET-IMPACT OF THYROIDS DISEASE IN GERMANY
Vauth C, University of Hanover, Hanover, Germany, Greiner W, Bielefeld University, Bielefeld, Germany
EYE
pg 49 PEY1
EFFECTS OF PILOCARPINE ON QUALITY OF LIFE OF THAI PATIENTS WITH GLAUCOMA
Tripop S1, Pratheepawanit N1, Asawaphureekorn S1, Anutangkoon W2, Inthayung S1, 1Khon Kaen University, Khon Kaen, Thailand, 2Khon Kaen Hospital, Khon
Kaen, Thailand
24
GI DISORDERS
pg 49 PGI1
THE ADDITIVE CLINICAL VALUE OF LAMIVUDINE IN ANTVIRAL THERAPY FOR PATIENTS WITH CHRONIC HEPATITIS B
Sun X1, Wang X2, Liu X2, Li Y3, Guyatt G4, 1The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China, 2Sichuan University,
Chengdu, Sichuan, China, 3Chinese Evidence-Based Medicine Center, West China Hospital, Chengdu, Sichuan, China, 4Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, Ontario, Canada
pg 49 PGI3
COST-EFFECTIVENESS OF THE INTRAVENOUS PROTON PUMP INHIBITORS COMPARED WITH HISTAMINE-2 RECEPTOR ANTAGONISTS IN THE
TREATMENT OF NON-VARICEAL UGIB
Chen Y, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
pg 49 PGI4
ECONOMICS EVALUATION OF LAMIVUDINE IN THE TREATMENT OF CHRONIC HEPATITIS B
Lu XZ1, Chen W2, Tan-Mulligan A1, 1GlaxoSmithKline (China) Investment Co Ltd, Shanghai, China, 2Fudan University (former Shanghai Medical University),
Shanghai, China
pg 50 PGI5
AUSTRALIAN ECONOMIC EVALUATION OF PEGASYS (PEGINTERFERON ALFA-2A) VERSUS LAMIVUDINE FOR THE TREATMENT OF CHRONIC
HEPATITIS B
Todd CJ1, Patel KK2, Adena M3, Veenstra DL4, 1Roche Products Pty Limited, Sydney, New South Wales, Australia, 2Hoffmann-La Roche, Nutley, NJ, USA,
3Covance Pty Ltd, Canberra, ACT, Australia, 4University of Washington, Seattle, WA, USA
pg 50 PGI6
PHARMACOECONOMICS OF CHRONIC HEPATITIS C IN SLOVAKIA.
Bielik J1, Huzicka I2, 1Trencín University, Trencín, Slovak Republic, 2Schering-Plough, Bratislava, Slovak Republic
pg 50 PGI7
VALUING HEALTH STATES USING UTILITY WEIGHTS TO CAPTURE THE IMPACT OF DISEASE PROGRESSION IN CHRONIC HEPATITIS B (CHB)
Lam CL1, Levy A2, Lozano-Ortega G2, Tafesse E3, Mukherjee J3, Iloeje U4, Briggs AH5, 1The University of Hong Kong, Hong Kong, China, 2Oxford Outcomes,
Vancouver, British Columbia, Canada, 3BMS, Wallingford, CT, USA, 4Bristol-Myers Squibb Company, Wallingford, CT, USA, 5University of Glasgow, Glasgow, UK
pg 50 PGI8
TREATMENT PREFERENCE AND IMPROVEMENTS IN HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN RENAL TRANSPLANT RECIPIENTS WITH
GASTROINTESTINAL (GI) COMPLAINTS CONVERTED FROM MYCOPHENOLATE MOFETIL (MMF) TO ENTERIC-COATED MYCOPHENOLATE SODIUM
(EC-MPS)
Bonney MA1, Fassett R2, Kark A3, Faull R4, Hutchison B5, Walker R6, Mahony J7, Goodman D8, Pussell B9, Ierino F10, Kurstjens N1, 1Novartis
Pharmaceuticals Australia, Sydney, NSW, Australia, 2Launceston General Hospital, Launceston, TAS, Australia, 3Royal Brisbane Hospital, Brisbane, QLD,
Australia, 4Royal Adelaide Hospital, Adelaide, SA, Australia, 5Sir Charles Gairdner Hospital, Perth, WA, Australia, 6Royal Melbourne Hospital, Melbourne, VIC,
Australia, 7Royal North Shore Hospital, Sydney, NSW, Australia, 8St Vincents Hospital, Melbourne, VIC, Australia, 9Prince of Wales Hospital, Sydney, NSW,
Australia, 10Austin Hospital, Melbourne, VIC, Australia
pg 51 PGI9
SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS IN DRUG DECISION-MAKING: AN EXAMPLE FROM ANTIVIRAL THERAPY FOR CHRONIC
HEPATITIS B
Sun X1, Li Y2, Zhou R3, Hu S4, 1The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China, 2Chinese Evidence-Based Medicine
Center, West China Hospital, Chengdu, Sichuan, China, 3West China Hospital, Sichuan University, Chengdu, China, 4Fudan University (former Shanghai Medical
University), Shanghai, China
HEMATOLOGICAL DISORDERS
pg 51 PHM1 HEALTH-RELATED QUALITY OF LIFE OF ANEMIA PATIENTS IN THE US
Cremieux PY1, Xie J2, Wu EQ3, Castor AR1, 1Analysis Group Inc, Boston, MA, USA, 2The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
3Analysis Group, Boston, MA, USA
INDIVIDUAL’S HEALTH
pg 51 PIH1
COST-BENEFIT ANALYSIS OF THE SCHOOL-BASED HEALTH CENTER PROGRAM IN GREATER CINCINNATI
Guo JJ1, Jang R1, Keller KN2, 1University of Cincinnati, Cincinnati, OH, USA, 2Health Foundation of Greater Cincinnati, Cincinnati, OH, USA
pg 51 PIH2
A GERIATRIC SCREENING PROGRAM CONDUCTED AT THE OBSERVATION ROOM OF AN EMERGENCY DEPARTMENT (GSPOR)
Ho WWS, Dai D, The Chinese University of Hong Kong, Hong Kong
pg 51 PIH3
FEASIBILITY OF A COMPUTER-MEDIATED TAI CHI EXERCISE
Li J, Finkelstein J, University of Maryland School of Medicine, Baltimore, MD, USA
pg 52 PIH4
TAI CHI FOR IMPROVING BALANCE AND PREVENTING FALLS - A REVIEW OF EXISTING OBSERVATIONAL STUDIES
Li J, Lawpoolsri S, Finkelstein J, University of Maryland School of Medicine, Baltimore, MD, USA
pg 52 PIH5
MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) OF THE ERECTION QUALITY SCALE
Huang X1, Harris K1, Song J1, Wincze J2, Rosen R3, 1Bayer Pharmaceuticals Corporation, West Haven, CT, USA, 2Brown University, Providence, RI, USA,
3UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA
25
pg 52 PIH6
A COST-EFFECTIVENESS ANALYSIS OF CONTRACEPTIVES IN UKRAINE
Zaliska O, Pushak K, Lviv National Medical University named Danylo Galitsky, Lviv, Ukraine
pg 52 PIH7
THE SITUATION OF HEALTH TECHNOLOGY ASSESSMENT IN HUNGARY
Kincses G, National Institute of Strategic Health Research, Budapest, Hungary
pg 52 PIH8
PRIVATE PRACTICE AMONG PUBLIC MEDICAL DOCTOR IN THAILAND
Prakongsai P1, Tantivess S2, Tangcharoensathien V2, 1International Health Policy Program, Amphoe Muang, Thailand, 2International Health Policy Program,
Nonthaburi, Thailand
INFECTION
pg 53 PIN1
COST-EFFECTIVENESS OF NEVIRAPINE VERSUS EFAVIRENZ BASED HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN HIV-INFECTED PATIENTS IN
THAILAND
Phumipan S1, Kaewnoi C1, Pongchareonsuk P1, Chaikledkaew U2, 1Mahidol University, Payathai, Bangkok, Thailand, 2Mahidol University, Bangkok, Thailand
pg 53 PIN2
COMPARING COST-EFFECTIVENESS OF INTERVENTIONS TO REDUCE MOTHER-TO-CHILD TRANSMISSION OF HIV IN SOUTH AND SOUTH-EAST
ASIA
Chang CW, Taipei Medical University, Taipei, Taiwan
pg 53 PIN3
COST-EFFECTIVENESS OF SINGLE-DOSE PERINATAL NEVIRAPINE PLUS STANDARD ZIDOVUDINE TO PREVENT MOTHER-TO-CHILD TRANSMISSION OF HIV IN THAILAND
Yuwaree V1, Ponsoongnern K1, Pongcharoensuk P2, Chaikledkaew U2, 1Mahidol University, Bangkok, Thailand, 2Mahidol University, Rajathevi, Bangkok,
Thailand
pg 53 PIN4
CAN REDUCTION OF OPPORTUNISTIC INFECTION TREATMENT COST OUTWEIGH COST OF TRIPLE ANTIRETROVIRAL THERAPY?
Loongbarn S, Kulsomboon V, Chulalongkorn University, Bangkok, Thailand
pg 54 PIN5
QUALITY OF LIFE INSTRUMENTS IN HIV/AIDS PATIENTS: AN APPROPRIATE INSTRUMENT FOR THAI PATIENTS
Inngam P, Pratheepawanit N, Tripop S, Johns J, Khon Kaen University, Khon Kaen, Thailand
pg 54 PIN6
ECONOMIC EVALUATION OF INFLUENZA VACCINATION AMONG THE ELDERLY IN BANGKOK
Plasai V1, Viputsiri OA2, Pongpanich S3, Lertmaharit S4, Panichpathompong U5, Tarnmaneewongse V5, Cheunkitmongkol S5, Baron-Papillon F6, 1College of
Public health Chulalongkorn University, Bangkok, TN, Thailand, 2Dept. Preventive & Social Medicine Chulalongkorn University, Bangkok, Thailand, bangkok,
Thailand, 3college of public Health Chulalongkorn University, Bangkok, Thailand, 4Dept. Preventive & Social Medicine Faculty of Medicine, Bangkok, Thailand,
5sanofi pasteur, Bangkok, Thailand, 6sanofi pasteur, Lyon cedex 07, France
pg 54 PIN7
EFFECT OF INTEGRATED TRADITIONAL CHINESE MEDICINE AND WESTERN MEDICINE ON SARS TREATMENTS: SYSTEMATIC REVIEW AND META
ANALYSIS
Chen Y1, Guo JJ1, Daniel PH1, Zhan SY2, 1University of Cincinnati, Cincinnati, OH, USA, 2Peking University, Beijing, China
pg 54 PIN8
ECONOMIC EVALUATION COMPARING VORICONAZOLE WITH CONVENTIONAL AMPHOTERICIN B AS THE PRIMARY TREATMENT REGIMENS OF
INVASIVE ASPERGILLOSIS IN TAIWAN
Lin SSF1, Chu CHY1, Li MPY1, Chen YJ2, Roberts C3, Chen NCC1, 1Pfizer Limited Taiwan, Pfizer Global Pharmaceutical, Tamsui, Taipei County, Taiwan,
2National Taiwan University Hospital, Taipei, Taiwan, 3Pfizer Inc, New York, NY, USA
pg 55 PIN9
HBE-ANTIGEN NEGATIVE CHRONIC HEPATITIS B: COST-EFFECTIVENESS OF PEGINTERFERON ALFA-2A COMPARED TO LAMIVUDINE TREATMENT
IN TAIWAN
Veenstra DL1, Sullivan SD1, Lai MY2, Lee CM3, Tsai CM4, Patel KK5, 1University of Washington, Seattle, WA, USA, 2National Taiwan University Hospital, Taipei,
Taiwan, 3Chang Gung Memorial Hospital, Kaohsiung, Taiwan, 4Roche Products Ltd, Taipei, Taiwan, 5Hoffmann-La Roche, Nutley, NJ, USA
pg 55 PIN10 COST-EFFECTIVENESS OF PEGINTERFERON ALFA-2A COMPARED TO LAMIVUDINE TREATMENT IN PATIENTS WITH HBE-ANTIGEN POSITIVE
CHRONIC HEPATITIS B IN TAIWAN.
Sullivan SD1, Veenstra DL1, Chen PJ2, Chang TT3, Chuang WL4, Tsai CM5, Patel KK6, 1University of Washington, Seattle, WA, USA, 2National Taiwan University,
Taipei, Taiwan, 3National Cheng Kung University Hospital, Tainan, Taiwan, 4Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 5Roche Products Ltd,
Taipei, Taiwan, 6Hoffmann-La Roche, Nutley, NJ, USA
pg 55 PIN11 COST-MINIMIZATION ANALYSIS OF DURAPREP AND AQUEOUS IODOPHOR SCRUB FOR SKIN PREPARATION IN CABG SURGERY IN SOUTH KOREA:
A RANDOMIZED CONTROLLED TRIAL
Jo MW1, Kim YS2, Lee SI1, 1University of Ulsan College of Medicine, Seoul, South Korea, 2University of Ulsan, College of Medicine, Asan Medical Center, Seoul,
South Korea
pg 55 PIN12 ESTIMATION OF CLINICAL AND ECONOMIC CONSEQUENCES OF COUNTERFEIT ANTIMALARIAL MEDICINES IN LAO PDR: USING AN EPIDEMIOLOGIC MODEL
Suyavong P1, Chaiyakunapruk N2, Patmasiriwat D2, 1National University of Laos, Vientiane, Vientiane, Laos, 2Naresuan University, Muang, Phitsanulok, Thailand
26
pg 55 PIN14 PREDICTING TREATMENT COST OF BACTERIAL DIARRHEA
Riewpaiboon A1, Intraprakan K2, Phoungkatesunthorn S3, 1Mahidol University, Bangkok, Thailand, 2Phobpra Hospital, Amphur Phobpra, Tak, Thailand,
3Saraburi Hospital, Amphur Muang, Saraburi, Thailand
pg 56 PIN15 INITIAL CONTENT VALIDATION OF A DISEASE-TARGETED HEALTH-RELATED QUALITY OF LIFE (HRQOL) INSTRUMENT IN CHRONIC HEPATITIS B
VIRUS (HBV) INFECTION
Spiegel B1, Bolus R1, Han S2, Talley J1, Ong SH3, Chang J4, Kanwal F1, 1UCLA/VA Center for Outcomes Research and Education (CORE), Los Angeles, CA,
USA, 2UCLA Medical Center, Los Angeles, CA, USA, 3Novartis Pharmaceuticals, Basel, Switzerland, 4Novartis Pharmaceuticals, East Hanover, NJ, USA
pg 56 PIN16 QUALITY OF LIFE AND COST OF DIFFERENT TREATMENT STRATEGIES FOR HEPATITIS C PATIENTS IN TAIWAN
Yang MC, Wen CY, National Taiwan University, Taipei, Taiwan
pg 56 PMC1 USING DRUG PRICE DISCREPANCY INDEX TO IMPROVE EFFICIENT USE OF PHARMACY BUDGET
Kulsomboon V, Sriwiriyanuparb W, Chulalongkorn University, Bangkok, Thailand
pg 56 PMC2 PHARMACOECONOMIC ASPECTS OF THE ADMINISTRATIVE REFORMS IN PHARMACEUTICAL SECTORS OF REPUBLIC HEALTH DEPARTMENTS IN
MONTENEGRO
Tomic Z1, Sabo A1, Bralic R2, Glomazic Z2, Mikov M1, Lazovic V3, 1Faculty of Medicine, Novi Sad, Serbia and Montenegro, 2Republic Health Department,
Podgorica, -, Serbia and Montenegro, 3Faculty of Economy, Podgorica, Serbia and Montenegro
pg 57 PMC3 USE OF OBSERVATIONAL HEALTH DATABASES FOR RESEARCH IN PHARMACOECONOMICS AND PHARMACOEPIDEMIOLOGY
Guo JJ, University of Cincinnati, Cincinnati, OH, USA
pg 57 PMC4
SELECTING A PROPER EQ-5D VALUE SET MODEL FOR TAIWAN POPULATION
Tarn YH1, Chang TJ2, 1Taipei City Hospital, Taipei, Taiwan, 2Tri-Service General Hospital, Taipei, Taiwan
pg 57 PMC5 FEASIBILITY AND ACCEPTABILITY OF TTO AND SG AND FACTORS INFLUENCING THEIR ACCEPTANCE FOR HEALTH VALUATION AMONG
SINGAPOREANS
Wee HL1, Li SC2, Xie F2, Zhang XH2, Luo N3, Cheung YB4, Machin D5, Fong KY1, Thumboo J1, 1Singapore General Hospital, Singapore, 2National University of
Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer Centre,
Singapore
pg 57 PMC6 A SURVEY OF PATIENT-REPORTED OUTCOME(PRO) CLAIMS IN PHARMACEUTICAL ADVERTISING
Yuwaree V, Rojsutee S, Thavorncharoensap M, Mahidol University, Bangkok, Thailand
pg 58 PMC8 AFFORDABLE BOOTSTRAPS? EVALUATING FREEWARE OPTIONS FOR ANALYZING INCREMENTAL COST EFFECTIVENESS DATA
McGhan W, Gandhi P, Ruparel P, Peterson A, University of the Sciences, Philadelphia, PA, USA
MENTAL HEALTH
pg 58 PMH1 MENTAL HEALTH SERVICES AND DRUG UTILIZATION PATTERNS FOR STUDENTS WITH MENTAL ILLNESSES IN SCHOOL-BASED HEALTH CENTERS
Guo JJ1, Keller KN2, Jang R1, Cluxton RJ1, 1University of Cincinnati, Cincinnati, OH, USA, 2Health Foundation of Greater Cincinnati, Cincinnati, OH, USA
pg 58 PMH2 COST-EFFECTIVENESS OF OLANZAPINE VERSUS LITHIUM FOR THE PREVENTION OF RELAPSE IN BIPOLAR I DISORDER IN AUSTRALIA
Price N1, Davey P1, Mudge M1, Fitzgerald B2, Rajan N2, Montgomery B2, 1M-TAG Pty Ltd, A Unit of IMS, Chatswood, NSW, Australia, 2Eli Lilly Australia Pty Ltd,
West Ryde, NSW, Australia
pg 58 PMH3 A SYSTEM APPROACH TO RESOLVE DISPUTES IN ADOPTING NEW TECHNOLOGY-USING ALZHEIMER MEDICATION AS AN EXAMPLE
Kao Yang YH1, Kuo SC2, Lin SJ3, 1Cheng-Kung University, Taiwan, 2Pittsburgh University, Pittsburgh, PA, USA, 3Illinois University, Chicago, IL, USA
pg 59 PMH4 ECONOMIC BURDEN OF DEPRESSED PATIENTS IN SHANGHAI
Chen XB1, Ji JL2, Tan-Mulligan A3, Sheng F3, 1Fudan University, Shanghai, China, 2Zhongshan Hospital, Fudan University, Shanghai, China, 3GlaxoSmithKline
pg 59 PMH5 PRICE AND UTILIZATION OF ANTIDEPRESSANTS IN U.S. MEDICAID PROGRAMS
Guo JJ, Jing Y, Chen Y, Kelton CM, Patel N, University of Cincinnati, Cincinnati, OH, USA
pg 59 PMH6 DIFFERENCES IN THE COST OF ANTIDEPRESSANTS ACROSS STATE MEDICAID PROGRAMS
Kelton CM1, Guo JJ1, Rebelein RP2, Ferrand Y1, 1University of Cincinnati, Cincinnati, OH, USA, 2Vassar College, Poughkeepsie, NY, USA
pg 59 PMH7 STATE-BASED DIFFERENCES IN THE USE OF ANTIPSYCHOTIC MEDICATIONS BY HOSPITALS IN AUSTRALIA - 2004
Montgomery WS1, Kulkarni J2, Bradley MN1, 1Eli Lilly Australia, West Ryde, NSW, Australia, 2Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
27
pg 59 PMH8 PRICE AND UTILIZATION TRENDS OF ANTIPSYCHOTICS IN U.S. MEDICAID PROGRAMS
Guo JJ1, Kelton CM1, Jing Y1, Chen Y1, Louder A2, Patel N1, 1University of Cincinnati, Cincinnati, OH, USA, 2Anthem Health Care, Mason, OH, USA
pg 60 PMH9 ANTIPSYCHOTIC UTILIZATION TRENDS AMONG TEXAS VETERANS
Yang M, Barner JC, University of Texas at Austin, Austin, TX, USA
pg 60 PMH10 TIME TO ALL-CAUSE DISCONTINUATION OF ATYPICAL VERSUS TYPICAL ANTIPSYCHOTICS IN THE NATURALISTIC TREATMENT OF SCHIZOPHRENIA
Zhu B1, Swartz M2, Ascher-Svanum H1, Faries DE1, Tunis SL1, Swanson J3, Landbloom R1, 1Eli Lilly and Company, Indianapolis, IN, USA, 2Duke University
Medical Center, Durham, NC, USA, 3Duke University School of Medicine, Durham, NC, USA
pg 60 PMH11 EFFECTIVENESS AND TOLERABILITY COMPARISON OF RISPERIDONE LONG-ACTING INJECTION AND CONVENTIONAL DEPOT ANTIPSYCHOTICS
IN A LARGE CANADIAN PSYCHIATRIC HOSPITAL
Welch RP, Snaterse MH, Alberta Hospital Edmonton, Edmonton, AB, Canada
pg 60 PMH12 COST OF ANTIPSYCHOTIC POLY PHARMACY IN THE TREATMENT OF SCHIZOPHRENIA
Zhu B1, Ascher-Svanum H1, Faries DE1, Correll CU2, Kane JM2, 1Eli Lilly and Company, Indianapolis, IN, USA, 2The Zucker Hillside Hospital, Glen Oaks, NY, USA
pg 60 PMH13 VALUATION OF SCHIZOPHRENIA-RELATED HEALTH STATES BY THE GENERAL POPULATION USING THE ASSESSMENT OF QUALITY OF LIFE QUESTIONNAIRE, TIME TRADE-OFF AND VISUAL ANALOGUE SCALES
Adams J1, Le Reun C2, Crowley S3, Nand V4, Eggleston A4, Schrover R5, 1Medical Technology Assessment Group, Chatswood, NSW, Australia, 2M-TAG Pty Ltd,
Chatswood, Australia, 3University of Melbourne, North Ryde, NSW, Australia, 4Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 5Janssen-Cilag Pty
Ltd/University of Melbourne, North Ryde, NSW, Australia
pg 61 PMH14 ASSESSING THE HEALTH AND ECONOMIC IMPACT OF SCHIZOPHRENIA ON CARERS: A PILOT STUDY
Adams J1, Nand V2, Le Reun C3, Crowley S4, Eggleston A2, Schrover R5, Brown A1, 1Medical Technology Assessment Group, Chatswood, NSW, Australia,
2Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 3M-TAG Pty Ltd, Chatswood, Australia, 4University of Melbourne, North Ryde, NSW, Australia, 5JanssenCilag Pty Ltd/University of Melbourne, North Ryde, NSW, Australia
pg 61 PMH15 PREFERENCE AND WILLINGNESS TO PAY FOR THE TREATMENT OF SCHIZOPHRENIA FROM A CARER’S PERSPECTIVE
Adams J1, Nand V2, LeReun C1, Mudge M1, Crowley S3, Eggleston A2, Schrover R4, Brown A1, 1Medical Technology Assessment Group, Chatswood, NSW,
Australia, 2Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 3University of Melbourne, North Ryde, NSW, Australia, 4Janssen-Cilag Pty Ltd/University of
Melbourne, North Ryde, NSW, Australia
pg 61 PMH16 PREVALENCE AND RECOGNITION OF MENTAL DISORDERS IN PRIMARY CARE
Magruder K1, Frueh B1, Knapp R2, Yeager D2, 1Veterans Administration Medical Center, Charleston, SC, USA, 2Medical University of South Carolina, Charleston,
SC, USA
pg 61 PMH17 AGGREGATION OF RANKED RESPONSES TO QUESTIONNAIRES EXPLORING QUALITY OF LIFE
Lamure M, Auray JP, Duru G, Rico A, University Lyons 1, Villeurbanne, France
NEUROLOGICAL DISORDERS
pg 62 PNL2
EVALUATING HEALTH-RELATED QUALITY OF LIFE OUTCOMES IN STUTTERING: A CRITIQUE OF CONDITION-SPECIFIC INSTRUMENTS
Franic DM, Bothe AK, University of Georgia, Athens, GA, USA
pg 62 PNL3
A COST-EFFECTIVENESS COMPARISON OF RASAGILINE WITH DOPAMINE AGONISTS FOR DELAYING LEVODOPA USE IN EARLY PARKINSONIAN
PATIENTS IN THE UNITED KINGDOM
Roch B, Eckert L, Guelfucci F, Cochran J, François C, H. Lundbeck A/S, Paris, France
OBESITY
pg 62 POB1
PREVALENCE TRENDS OF OVERWEIGHT AND OBESITY AND TREATMENT PATTERNS FOR WEIGHT CONTROL IN THE U.S. POPULATION
Suh DC1, Barone JA1, Choi IS1, Shin HC1, Park J2, Lee C1, 1Rutgers University, Piscataway, NJ, USA, 2Inha University, Incheon, South Korea
pg 62 POB2
FEASIBILITY AND VALIDITY OF A GERMAN CHILD-FRIENDLY VERSION OF THE EQ-5D
Greiner W, Bielefeld University, Bielefeld, Germany
OSTEOPOROSIS
pg 63 POS1
A PREVALENCE-BASED COST EVALUATION OF FRAGILITY FRACTURES IN THE PHILIPPINES
Bonifacio LR1, Dela Rosa M2, Cañete A, 1Philippine Orhopaedic Association, Quezon, Metro Manila, Philippines, 2Philippine Orthopaedic Association, Quezon
City, Manila, Philippines
pg 63 POS2
PRICE AND UTILIZATION OF OSTEOPOROSIS MEDICATIONS IN U.S. MEDICAID PROGRAMS
Knight D, Guo JJ, Shiyanbade H, Kelton CM, University of Cincinnati, Cincinnati, OH, USA
28
RESPIRATORY DISORDERS
pg 63 PRS1
ECONOMIC EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN LOCAL HONG KONG HOSPITALS: A COMPARISON BETWEEN
TIOTROPIUM AND IPRATROPIUM
Lee VWY1, Hui DS2, Cheng HM1, Ho JY1, Li LM1, Wong WW1, Yung GK1, Lee KK1, 1The Chinese University of Hong Kong, Shatin, Hong Kong, China,
2Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
pg 63 PRS2
COST-EFFECTIVENESS OF DOMICILIARY OXYGEN THERAPY FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Shimbo T1, Fukuhara S2, Sato S2, Chin K2, Fukuoka A3, Kimura H3, Akashiba T4, 1International Medical Center of Japan, Shinjyuku-ku, Tokyo, Japan, 2Kyoto
University, Sakyo-ku, Kyoto, Japan, 3Nara Medical University, Kashihara, Nara, Japan, 4Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
pg 63 PRS3
INCORPORATING JAPANESE CULTURAL DIFFERENCES IN DEVELOPING A PATIENT-REPORTED IMPACT OF COUGH AND SPUTUM IN CHRONIC
(OBSTRUCTIVE) BRONCHITIS – SIMULTANEOUS DEVELOPMENT OF THE CASA-Q
Crawford B1, Buie W1, Tetzlaff K2, Monz BU3, Breugelmans R4, 1Mapi Values, Boston, MA, USA, 2Boehringer Ingelheim, Biberach/Riss, Germany, 3Boehringer
Ingelheim International, Ingelheim, Germany, 4Tokyo Medical University, Tokyo, Japan
SMOKING
pg 64 PSM1 COST-EFFECTIVENESS ANALYSIS FOR SMOKING CESSATION THERAPY IN JAPAN
Igarashi A1, Takuma H1, Fukuda T1, Oshima A2, Nakamura M3, Tsutani K, 1Tokyo University, Bunkyo, Tokyo, Japan, 2Osaka Medical Center for Cancer and
Cardiovascular Diseases, Osaka, Japan, 3Osaka Medical Center for Health Science and Promotion, Osaka, Japan
STROKE
pg 64 PST1
EFFICACY OF BOTULINUM TOXIN TYPE A (BONTA) IN THE TREATMENT OF ADULT FOCAL SPASTICITY: A META-ANALYSIS OF RESPONSE RATE
USING INDIVIDUAL PATIENT DATA
Aldridge G1, Frost M2, LeReun C3, Lynch M4, Davey P4, Napier-Flood F5, 1M-TAG Pty Ltd, A Unit of IMS Health, Chatswood, Australia, 2M-TAG, A Unit of IMS
Health, Chatswood, Australia, 3M-TAG Pty Ltd (A Unit of IMS Health), Chatswood, NSW, Australia, 4M-TAG, A Unit of IMS Health, Chatswood, NSW, Australia,
5Allergan Australia Pty Ltd, Gordon, NSW, Australia
pg 64 PST2
RESOURCES USE AND OUTCOMES OF ACUTE CARE FOR FIRST-EVER ISCHEMIC STROKE IN TAIWAN: SHORT VS. PROLONGED STAY PATIENTS
Tseng MC1, Chang KC2, 1National Sun Yat-Sen University, Kaohsiung, Taiwan, 2Chang Gung Memorial Hospital, Kaohsiung County, Taiwan
pg 64 PST3
HEALTH-RELATED QUALITY OF LIFE OF STROKE SURVIVORS IN THE US
Xie J1, Wu EQ2, Zheng ZJ3, Croft JB3, Mensah GA3, Labarthe DR3, 1Center for Disease Control and Prevention, Northrop Grumman, Atlanta, GA, USA, 2Analysis
Group, Boston, MA, USA, 3Center for Disease Control and Prevention, Atlanta, GA, USA
pg 65 PST4
HIGH INCIDENCE AND VARIATION IN INTRACRANIAL ATHEROSCLEROTIC DISEASE (ICAD) IN CHINA - EPIDEMIOLOGY AND TREATMENT OPTIONS
Ho G, Lacey M, Valentin M, Boston Scientific Corporation, Natick, MA, USA
pg 65 PST5
MANDARIN VERSION OF STROKE IMPACT SCALE: ADAPTATION AND VALIDATION
Chang KC1, Tseng MC2, Hung JW1, Lin TK1, Tan TY1, Chen CH1, 1Chang Gung Memorial Hospital, Kaohsiung County, Taiwan, 2National Sun Yat-Sen University,
Kaohsiung, Taiwan
SURGERY
pg 65 PSU1
EARLY ASSESSMENT OF THE LIKELY COST-EFFECTIVENESS OF A NEW TECHNOLOGY: A MARKOV MODEL WITH PROBABILISTIC SENSITIVITY
ANALYSIS OF COMPUTER-ASSISTED TOTAL KNEE REPLACEMENT
Dong H, Buxton M, Brunel University, Uxbridge, London, United Kingdom
pg 65 PSU2
GROWTH OF FREE-STANDING AMBULATORY SURGERY CENTERS AND HOSPITAL SURGERY VOLUME
Bian J, Morrisey MA, University of Alabama at Birmingham, Birmingham, AL, USA
URINARY/KIDNEY
pg 66 PUK1
COST-EFFECTIVENESS ANALYSIS OF ORAL VS INTRAVENOUS IRON GIVEN TREATMENT FOR RENAL ANEMIA PATIENTS
Bi K, Chen W, Fudan University (former Shanghai Medical University), Shanghai, China
pg 66 PUK2
POTENTIAL SAVINGS WITH EVEROLIMUS WITH REDUCED-DOSE CYCLOSPORINE COMPARED TO MYCOPHENOLATE MOTEFIL WITH FULL DOSE
CYCLOSPORINE IN DE NOVO RENAL TRANSPLANT RECIPIENTS IN CHINA
Yang X1, Ethgen O2, Wang W3, Lian R3, Ricci JF1, Spaepen E4, Annemans L5, 1Novartis Pharma AG, Basel, Switzerland, 2University of Liège, Liège, Belgium,
3Novartis Pharma China, Beijing, China, 4IMS Health, Brussels, Belgium, 5IMS Health and Ghent University, Brussels, Belgium
29
HEALTH CARE USE & POLICY STUDIES
pg 66 PHP1
ANALYZING PRODUCT DIFFERENTIATION IN FOUR ARGENTINEAN PHARMACEUTICAL MARKETS
Maceira DA, Center for the Study of the State and Society (CEDES), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
pg 66 PHP2
COMPARATIVE ANALYSIS OF ADVERTISING EFFECTIVENESS BETWEEN NEW AND EARLIER ENTRANTS IN THE PHARMACEUTICAL MARKET
Kwong WJ, University of Georgia, College of Pharmacy, Athens, GA, USA
pg 66 PHP3
STUDY ON PHARMACEUTICAL SETTING IN COMMUNITY HEALTH SERVICE
Cheng X, Fudan University, Shanghai, Shanghai, China
pg 67 PHP4
IDENTIFY GAPS OF EVALUATION OF ESSENTIAL MEDICINES IN CHINA
Sun X, Li Y, The Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
pg 67 PHP5
THE EFFECT OF DRUG POLICY ON THE ADOPTION RATES OF NEW DRUGS IN KOREAN OUTPATIENTS CARE
Choi SE, Kim JH, Health Insurance Review Agency, Seoul, South Korea
pg 67 PHP7
ECONOMIC EVALUATION OF DISEASE MANAGEMENT PROGRAMS
Suh R, Uniformed Services University of the Health Sciences, Vienna, VA, USA
pg 67 PHP8
DISEASE PREVENTION AND PHARMACEUTICAL DRUG INNOVATION: DEREGULATORY POLICY UNDER THE NHI
Yamada T1, Chen CC2, 1Rutgers University, The State University of New Jersey, Camden, NJ, USA, 2Columbia University, New York, NY, USA
pg 67 PHP9
DELIVERY OF DAILY DOSES OF THE DRUGS TO HOSPITAL DEPARTMENTS AS A METHOD OF DRUG RATIONALIZATION AT THE CLINICS IN UNIVERSITY TEACHING CENTRE NOVI SAD
Sabo A, Tomic Z, Faculty of Medicine, Novi Sad, Serbia and Montenegro
pg 68 PHP10 DEMAND NEEDS AND SUBSIDIES IN PHARMACEUTICALS: THE EXPERIENCE OF THE REMEDIAR PROGRAM IN ARGENTINA
Maceira DA, Apella IR, Barbieri E, Center for the Study of the State and Society (CEDES), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
pg 68 PHP11 DETERMINANTS OF CATASTROPHIC EXPENDITURE AND IMPOVERISHMENT OF HOUSEHOLDS IN THAILAND
Prakongsai P1, Tangcharoensathien V2, Limwattananon S3, 1International Health Policy Program, Amphoe Muang, Thailand, 2International Health Policy
Program, Nonthaburi, Thailand, 3Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand
pg 68 PHP12 EXPLORING THE AVAILABILITY & CHARACTERISTICS OF HEALTH CARE COST DATA ACROSS SELECTED ASIAN COUNTRIES
Bindra S1, Duttagupta S2, Chan BS3, Hongxia C4, Cheah SK5, Wei Y4, Zhong J4, Sze-Man Lai J6, Somasundaram S7, Suvarna V7, Nawawi S8, Lee HJ9, Park
HJ9, Nawaz A10, Tranquilino F11, Martin N11, Ramachandran S12, Kulasingham S13, Lam KM14, Li M15, Lin S15, Chu C16, Ponprasit K17, Nganthavee W17,
Pramanik A18, 1Pfizer Asia Regional Office, Hong Kong, 2Pfizer Inc, New York, NY, USA, 3The Chinese University of Hong Kong, Hong Kong, China, 4Pfizer China,
Beijing, China, 5Pfizer Singapore, Singapore, 6Pfizer Hong Kong, North Point, Hong Kong, 7Pfizer India, Jogeshwari, Mumbai, India, 8Pfizer Indonesia, Jakarta,
Indonesia, 9Pfizer Korea, Seoul, South Korea, 10Pfizer Pakistan, West Wharf, Karachi, Pakistan, 11Pfizer Phillipines, Makati City, Philippines, 12Pfizer, Selangor,
Malaysia, 13Pfizer Malaysia, Selangur Darul, Malaysia, 14Pfizer Singapore, Gateway East, Singapore, 15Pfizer Taiwan, Tamsui, Taiwan, China, 16Pfizer Taiwan,
Tamsui, China, 17Pfizer Thailand, Bangkok, Thailand, 18Pfizer Asia, Admiralty, Hong Kong
pg 68 PHP13 A NATIONAL SURVEY OF COST-ANALYSIS OF INPATIENT PHARMACEUTICAL SERVICES IN TAIWAN
Kao Yang YH1, Kuo SC2, 1Cheng-Kung University, Tainan, Taiwan, 2Pittsburgh University, Pittsburgh, PA, USA
pg 69 PHP14 EFFECTS OF USING AN AUTOMATED PRESCRIPTION FILLING SYSTEM ON PHARMACY STAFF UTILIZATION AND PRESRIPTION FILLING LABOR
Lin AC1, Huang YC1, Punches G2, Chen Y1, Qian JJ1, 1University of Cincinnati, Cincinnati, OH, USA, 2Punches Pharmacy Plus, Michigan, MI, USA
pg 69 PHP15 IMPACT OF PHARMACIST’S INTERVENTIONS ON COST OF DRUG THERAPY IN INTENSIVE CARE UNIT
Saokaew S1, Maphanta S2, Thangsomboon P3, 1Naresuan University, Muang, Phayao, Thailand, 2Naresuan University, Muang, Phitsanulok, Thailand,
3Buddhachinaraj Hospital, Muang, Phitsanulok, Thailand
pg 69 PHP16 BARRIERS TO PHARMACEUTICAL CARE IN THAILAND
Ngorsuraches S1, Li SC2, 1Prince of Songkla University, Hatyai, Songkla, Thailand, 2National University of Singapore, Singapore, Singapore
pg 69 PHP18 SURVEY STUDY OF PHARMACOECONOMIC RESEARCH IN THE PACIFIC ASIA REGION
Luo MP, Cifaldi M, Abbott Laboratories, Abbott Park, IL, USA
pg 69 PHP19 ANALYSIS OF PHARMACEUTICAL PRICE CHANGES IN A REGIONAL HOSPITAL SYSTEM
Kelton CM1, Guo JJ1, Rebelein RP2, Ferrand Y1, Dusing ML3, 1University of Cincinnati, Cincinnati, OH, USA, 2Vassar College, Poughkeepsie, NY, USA, 3Health
Alliance, Cincinnati, OH, USA
pg 70 PHP20 ANALYSIS OF THE PRESCRIPTIONS FILLING LABOR IN A MAJOR US DRUGSTORE CHAIN
Lin AC, Qian JJ, Chen Y, University of Cincinnati, Cincinnati, OH, USA
30
pg 70 PHP21 THE EFFECTS OF AUTOMATED PRESCRIPTION FILLING SYSTEM ON THE INVOLVEMENT OF PHARMACY STAFF IN PRESCRIPTION FILLING ACTIVITIES
Lin AC, Huang S, Qian JJ, Chen Y, Ma XQ, University of Cincinnati, Cincinnati, OH, USA
pg 70 PHP22 THE EFFECTS OF TELEPHONE CALLS ON PRESCRIPTION FILLING EFFICIENCY IN A DRUGSTORE CHAIN
Lin AC, Waston W, Chen Y, Qian JJ, University of Cincinnati, Cincinnati, OH, USA
pg 70 PHP23 DRUG UTILIZATION STUDY IN THE AMBULATORY SERVICE OF THE NATIONAL HEALTH INSURANCE IN TAIWAN
Kao Yang YH1, Kuo SC2, Jia SW1, 1Cheng-Kung University, Tainan, Taiwan, 2Pittsburgh University, Pittsburgh, PA, USA
pg 71 PHP24 DEVELOPING A QUANTITATIVE SCORING SYSTEM FOR ADVERSE DRUG REACTION ASSESSMENT USING GENETIC ALGORITHM
Koh Y, Yap CW, Li SC, National University of Singapore, Singapore, Singapore
pg 71 PHP25 MODULAR STUDY FOR MEDICAL SUPPLIES IN SUDDEN PUBLIC HEALTH EVENTS
lulu Z1, Yuan L1, Guoquan R2, 1Second Military Medical University, Shanghai, China, 2General Logistics, PLA, Beijing, China
pg 71 PHP26 HOW DO SURVEY RESPONDENTS INTERPRET AND UTILIZE SYMBOLS USED IN HEALTH VALUATION STUDIES?
Wee HL1, Li SC2, Zhang XH2, Xie F2, Luo N3, Cheung YB4, Machin D5, Fong KY1, Thumboo J1, 1Singapore General Hospital, Singapore, 2National University of
Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer Centre
Singapore,Singapore
pg 71 PHP27 WHAT FACTORS INFLUENCE THE RANKING OF IMPORTANCE OF HEALTH DOMAINS? AN EXPLORATORY STUDY AMONG CHINESE AND INDIAN
SINGAPOREANS
Xie F1, Li SC1, Wee HL2, Zhang XH1, Luo N3, Cheung YB4, Machin D5, Fong KY2, Thumboo J2, 1National University of Singapore, Singapore, 2Singapore
General Hospital, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer
Centre Singapore, Singapore
pg 72 PHP28 THE IMPACT OF TALKING ABOUT DEATH ON HEALTH STATE VALUATION: A STUDY AMONG CHINESE AND INDIAN SINGAPOREANS
Wee HL1, Li SC2, Zhang XH2, Xie F2, Nan L3, Cheung YB4, Machin D5, Fong KY1, Thumboo J1, 1Singapore General Hospital, Singapore, 2National University of
Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer Centre
pg 72 PHP29 DOES RANKING OF HEALTH DOMAINS INFLUENCE HEALTH UTILITIES? AN EXPLORATORY STUDY AMONG CHINESE AND INDIAN SINGAPOREANS
Xie F1, Li SC1, Wee HL2, Zhang XH1, Luo N3, Cheung YB4, Machin D5, Fong KY2, Thumboo J2, 1National University of Singapore, Singapore, 2Singapore
General Hospital, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer
Centre Singapore, Singapore
pg 72 PHP30 THE VALUE PROPOSITION OF OUTPATIENT TOWARDS OUTPATIENT SERVICE.
Sooksriwong CO1, Vijitmakthong A2, 1Mahidol University, Bangkok, Thailand, 2King Chulalongkorn Memorial Hospital, Bangkok, Thailand
pg 72 PHP31 MEASUREMENT AND VALUATION OF HEALTH STATUS EQ-5D WITH TIME TRADE-OFF IN SOUTH KOREA
Jo MW1, Yun SC2, Hwang IA1, Lee SI1, 1University of Ulsan College of Medicine, Seoul, South Korea, 2Asian Medical Center, Seoul, South Korea
31
SPEAKER BIOGRAPHICAL INFORMATION
Tony, Yen-Huei Tarn MS, PhD
After 24 years service in the Military School of Pharmacy, National
Defense Medical Center (NDMC), Taiwan, Dr. Tarn retired and changed
his career path to the hospital practice as the Director General of the
Department of Pharmacy, Taipei City Hospital in Taipei, Taiwan. Dr. Tarn
received his BS degree in Pharmacy from NDMC in 1980, MS degree in
Clinical/Hospital Pharmacy program from University of Iowa in 1886,
and PhD degree in Pharmacy Administrative and Behavioral Science
from University of Arizona in 1993. His major interests are: pharmaceutical care practice,
pharmacoeconomics and outcomes research, quality of life measurement, and creating
stages for professional pharmacy practice. He is now the President of Taiwan Society of
Pharmacoeconomics and Outcomes Research (TaSPOR) and a board member of the
Western Pacific Pharmaceutical Forum of the Federation International Pharmaceutical (FIP).
Shanlian Hu MSc. MD
Dr. Shanlian Hu is Professor of Health Economics, Health Management
and Epidemiology. At present, he is holding the position of Director of
Training Center for Health Management at School of Public Health,
Fudan University (the former Shanghai Medical University), Director of
Pharmacoeconomics Research and Evaluation Center of Fudan
University. The Deputy Director of National Health Economic Institution
of MOH and the Coordinator of China Network of Training and
Research in Health Economics and Financing, which has been supported by the World
Bank and Ministry of Health since 1991.
Professor Hu has many other appointments in the academic and policy research field. He
is a member of MOH Advisory Committee of Health Policy and Administration since 1996.
He is one of the leading Professors in the key discipline of Social Medicine and Health
Management approved by National Education Committee. He was appointed as member of
Certification Committee of National Eradication of Poliomyelitis (1998-), Expanded Program
of Immunization (1997-), Shanghai Advisory Committee of Health Reform and
Development (1998-), National Medical Degree Education Committee (2000-), member of
Advisory Committee on new type rural cooperative medical system (2004-). He was also
invited as a Visiting Professor both in Zhejiang University and Southeast University.
In 1997, the WHO West Pacific Regional Office nominated him as a member of the
Committee of Health System Research. and re-elected as member of Steering Committee,
Alliance of Health Policy and System Research in 2004.. Over the past decade, he was
doing temporary consultant for the World Bank, UNDP and AUSAID in China, WHO in West
Samoa, and UNICEF in Myanmar. He jointed the advisory group of World Bank to do the
sector report “Financing Health Care: Issues and Options for China” in 1996, and wrote the
health and nutrition chapter of 1997 China Human Development Report for UNDP.
Recently, he joined the Health Sector Report for the World Bank in China.
In the recent years, Professor Hu has been working in various research projects supported
by MOH, MOLSS, Shanghai Bureau of Health, UNICEF, World Bank, WHO/TDR and Merck
International Foundation. He is interested in urban health insurance reform, new rural
cooperative medical system in impoverished areas, health access in urban poor, health
system performance, evaluation epidemiology, drug policy and pharmacoeconomics, etc.
Isao Kamae MD, DrPH
Isao Kamae is a physician, Professor of Applied Medical Statistics
and Health Decision Science, and Director of Information Center at
Kobe University Graduate School of Medicine, and Kobe University
Research Center for Urban Safety and Security since February 1997.
He is also a Committee member for PE guidelines in Ministries of
Japanese Government. He is recognized as one of the leaders in
Japan for interdisciplinary research and education on innovative
issues in pharmacoeconomocs and outcomes research.
His educational record includes a master degree in information science, Kyoto University
in 1979, a MD, Kobe University School of Medicine in 1985, a Master degree of Public
Health in biostatistics, Harvard School of Public Health in 1988, where he was also the
first Japanese to be awarded a Doctor of Public Health in health decision sciences of
Harvard University in 1995.
ISPOR is one of his major societies, honoring him with a representative of the conference
co-chairs at the ISPOR First Asia-Pacific Conference in Kobe, Japan in 2003. He is currently on 2004-2006 Board of Directors in ISPOR and the President of ISPOR Japan Chapter.
He is also a founding member of ISPOR Asia Consortium.
32
He has been enjoying many opportunities to speak to the international community. In
November 2004, Peking University, China, invited him as an adjunct professor in the graduate Department of Health Economic and Management. He is also on the editorial board
for PharmacoEconomics and the Journal of Medical Economics.
Bong-Min Yang PhD
Bong-Min Yang is a Professor of the School of Public Health at Seoul
National University, Korea. He received his BA (Economics) from Seoul
National University and his Ph.D. in Economics from Penn State
University in 1982. He had been Takemi Fellow at Harvard School of
Public Health during 1989-90 and 1995-96 periods. He currently is
the Dean of the School of Public Health, Seoul National University.
Professor Yang has written extensively in health economics and health care system in
Korea and East Asia. His recent publication includes, "Cost of Chronic Hepatitis B in South
Korea,” Journal of Clinical Gastroenterology (2004), "Cost-effectiveness of Long-term Care
Services in South Korea,” in Archives of Gerontology and Geriatrics (2005), “Impact of Outof-pocket Payment in Outpatient Care in Korea” (2005) in Health Policy.
In addition to his research and publication, Professor Yang has worked as short-term consultant at WHO, UNDP, and the World Bank. For the Korean government, he served as a
member of the Presidential Commission on Policy and Evaluation (1992-96), and
Chairperson of Health Insurance Reform Committee (2003-2004). He currently is serving
as Chairperson of the Pharmaceutical Pricing and Reimbursement Committee, Government
of Korea, a research consultant to KIHASA, and a member of Executive Board of NHIC
(National Health Insurance Corporation).
Shu Chuen Li PhD, MBA, MApplSc, BPharm,
Cert Health Econ., Grad Dip Bus (Tech Mgt)
Shu Chuen Li is an Associate Professor at National University of
Singapore and Consultant and Visiting Specialist at the Centre for
Pharmaceutical Administration, Health Sciences Authority, Republic of
Singapore. Dr. Li is currently lecturing in clinical pharmacy practice at
Department of Pharmacy, National University of Singapore (NUS). His
main research interest is in the area of drug policy, pharmacoeconomics and outcomes
research, especially in the area of HRQoL.
Before taking up the current appointment with NUS, Dr. Li had served as Acting Director
and Deputy Director of Pharmaceutical Evaluation Section, Pharmaceutical Benefits
Branch, Commonwealth Department of Health and Family Services in Australia. Australia
is the first country that applies pharmacoeconomic principles to drug regulation and introduced mandatory cost-effectiveness requirement for reimbursement of pharmaceuticals.
In addition to lecturing at NUS, Dr. Li also serves as a member of the Singapore Ministry of
Health Drug Advisory Committee (DAC), and as a consultant to Centre for Pharmaceutical
Administration (CPA), Health Sciences Authority (HSA), Republic of Singapore. Dr. Li has
also been engaged by the Pharmacy and Therapeutics Committee of National Healthcare
Group (NHG) (a cluster of hospitals providing healthcare for half of the population in
Singapore) as a consultant.
Besides his experience in applied pharmacoeconomics, drug regulation and healthcare
policy, Dr. Li has many years of experience in clinical pharmacy practice, especially in the
areas of drug information, clinical trial and applied pharmacokinetics.
Viroj Tangcharoensathien PhD
After medical graduate from Mahidol University in 1979 Dr. Viroj
Tangcharoensathien worked as medical officer and administrator in
several remote district hospitals in Ubon Ratchatani Province for the
period of 1980-87. Professor Prawase Vasi supported him through a
Rockefeller Foundation Grant to pursue his Ph.D. in health economics
and financing at the London School of Hygiene and Tropical Medicine
in 1980-90. Upon returning from the UK, he worked in the Health Planning Division of the
Ministry of Public Health (1991-94) before being seconded by the Ministry of Public Health
to work as a full-time health policy researcher at the Health Systems Research Institute.
He got Woodruff Medal 1991 Award for the outstanding Ph.D. thesis of the London School
of Hygiene and Tropical Medicine, University of London, for his thesis title: Community
Financing : the Urban Health Card in Chiang Mai. Thailand.
He served in several positions in international forums such as the Member, Science and
Technical Advisory Committee of UNDP/World Bank/ WHO Special Program for Research
SPEAKER BIOGRAPHICAL INFORMATION
and Training in Tropical Diseases 1998-2000, Editorial Board member: Health Policy and
Planning Journal, London School of Hygiene and Tropical and Tropical Medicine,
Reproductive Health Matters, anonymous referee in international peer review journals i.e.
Social Science and Medicine (1997-), Health Policy and Planning (1999-), the Bulletin of
World Health Organization (200-), Human Resource Development Journal (1998-) and several other national Thai journals (1992-.)
He was Chairperson of an Independent Review Committee for the Global Alliance on
Vaccine and Immunization (GAVI); UNICEF -Geneva; (2000-04) and chair of Independent
Review Committee of Health Metric Network (2005-)
He got a Senior Research Scholar Institutional Grant on Health Economics and Financing,
funded by the Thailand Research Fund (1998-2005). He is head of International Health
Policy Program for which more than ten young committed researchers were mentored and
supported to the Ph.D. level; three post-doctoral researchers were affiliated with the
Program. The program aims to build up health policy and systems research capacity and
ensure evidence were translated into policy and practices.
Aamir Hameed MBBS, BSc, FCPS (Internal
Medicine), FCPS (Cardiology)
Dr. Aamir Hameed is a Senior Instructor and Consultant Cardiologist
at the Aga Khan University, Karachi, Pakistan. He is currently, the
Medical Director of the Coronary Critical care Units (CCU) of the
Department of Medicine at the Aga Khan University Hospital. His area
of research interest is hypertension, cardiac arrhythmias and evaluation of syncope. He is member of the Pakistan Hypertension League (PHL) and the
Pakistan Cardiac Society (PCS), where he has been active on the scientific council on atherosclerosis and thrombosis of the PCS and has was one of the key members of the task
force that helped write the first National guidelines on Unstable Angina/Non ST elevation
myocardial Infarction. He is also consultant to the Smart Heart Program, which is the preventive cardiology program of the University and the Aga Khan Health services and has
helped write guidelines and design, coordinate and facilitate workshops on various topics
to disseminate preventive cardiology knowledge to primary care physicians and health
care workers. He has contributed to scientific journals regularly and has been an invited
speaker on many occasions. He has also contributed to newspapers on health awareness
issues and health matters. In appreciation of his over all service he was awarded the
“best cardiology faculty award 2005”. He has recently been accepted as member on the
Executive Committee of the Asia Consortium of the International Society of
Pharmacoeconomics and Outcomes Research.
Syed Mohamed Aljunid PhD, MD,
MSc, FAMM
Dr. Syed Mohamed Aljunid is Professor of Health Economics and
Senior Consultant in Public Health Medicine. Presently, he is the Head
of Department of Community Health, Faculty of Medicine, Universiti
Kebangsaan Malaysia (UKM). He obtained his MD from UKM, Master
of Science in Public Health from National University of Singapore and
PhD in Health Economics and Financing Programme, London School of Hygiene and
Tropical Medicine. He is a Fellow of Academy of Medicine Malaysia. He served as consultants to World Health Organisations in WPRO, SEARO and EMRO on a number of occasions
on health economics and financing. He is involved in a number of research projects in
health economics and financing. These include Case-Mix Methodology for Resources
Allocations, Research on Impact of Managed Care on Primary Care Services, Socio-economic Impact of Psychiatric Disorders, Cost Effectiveness Analysis of Management of
Schizophrenia, Cost-effectiveness of Trauma Services in Malaysia and Economic
Evaluation of OPV/IPV Immunisation. He has published widely in referred journals both
local and abroad in areas of health economics and public health in general. He is currently
the Chief Editor of Journal of Community Health and has served in editorial board of
Journal of Public Health Medicine.
Renuka Kulkarni Munshi MD (Pharmacology)
Dr. Renuka Kulkarni Munshi is Senior Lecturer at Department of
Clinical Pharmacology, TN Medical College & BYL Nair Charitable
Hospital, Mumbai, India. She sas conducted a number of GCP based
clinical studies as well as experimental projects on a number of
drugs, both allopathic as well as herbal. Is actively involved in a number of projects for WHO & Government organizations. She is actively
involved in promoting rational drug use among medical students and practitioners and has
co-organized several training programmers on rational drug use in Mumbai for medical
students, medical teachers, pharmacists and medical officers. In addition she has coorganized and served as faculty on courses pertaining to Good Clinical Practices, research
methodology and scientific communications. She has also helped prepare the Standard
Treatment Guidelines for outdoor and admitted patients for the Municipal Corporation of
Greater Mumbai.
Dr. Munshi has participated in various WHO training courses such as the 2nd ICIUM held in
Chiang Mai,Thailand in 2004; Pharmacovigilance course, WHO, Uppsala Sweden 2003;
Drugs and Therapeutic Committee, WHO course, Mumbai, 2002; and Pharmacoeconomics
course, WHO, Delhi & Jaipur 2002.
Dr. Munshi's research areas include Rational use of drugs, antitubercular effects of Indian
Medicinal Plants, clinical research and new drug development, Pharmacovigilance and
Therapeutic drug monitoring. Has attended and presented original research papers at a
number of workshops and conferences. She has been on the Organising Committee for
various workshops and conferences like the ICMR workshop in Clinical Pharmacology
being held at the department of Clinical Pharmacology every year and Update Ayurveda
which is held every 4 years.
Wen Chen PhD, MD
Dr. Wen Chen is Professor and graduate student advisor. He received
his PhD degree in social medicine and health management from the
Shanghai Medical University in 1998. He attended the University of
California at Berkeley in 2000 as a research fellow. Currently he
serves as the Deputy Dean of the School of Public Health at Fudan
University. His main research interests include health insurance, pharmaceutical economics and policy, and the economics of prevention. He has conducted
projects sponsored by the National Natural Science Foundation of China, the Alliance for
Health Policy and Systems Research, and the Ministry of Health. He has published more
than 50 academic papers.
Michael Drummond BSc, MCom, DPhil
Dr. Michael Drummond is Professor of Health Economics and former
Director of the Centre for Health Economics at the University of York.
His particular field of interest is in the economic evaluation of health
care treatments and programmes. He has undertaken evaluations in
a wide range of medical fields including care of the elderly, neonatal
intensive care, immunization programmes, services for people with AIDS, eye health care
and pharmaceuticals. He is the author of two major textbooks and more than 500 scientific papers, has acted as a consultant to the World Health Organization and was Project
Leader of a European Union Project on the Methodology of Economic Appraisal of Health
Technology. He has been President of the International Society of Technology Assessment
in Health Care, and a board member of the International Society for Pharmacoeconomics
and Outcomes Research. He is currently a member of the Guidelines Review Panels of the
National Institute for Clinical Excellence (NICE) in the UK, and is also Vice-President
(European Operations) of Innovus Research Inc. From July 2006 he will be President of
the International Society for Pharmacoeconomics and Outcomes Research.
Suzanne Hill PhD
Dr. Suzanne Hill has recently taken up the position of Secretary to the
WHO Expert Committee on Essential Medicines, at the World Health
Organisation in Geneva. Prior to that she was Associate Professor in
Clinical Pharmacology at the University of Newcastle, Australia. In the
position she was director of the Newcastle Evaluation Group, which
provided pharmacoeconomics advice to the Pharmaceutical Benefits
Advisory Committee of the Australian Department of Health.
Dr. Hill's research interests are the public health aspects of clinical pharmacology, including drug regulation and pharmacoeconomics and she has many publications in relation to
these topics. In addition she has provided international post-graduate short course training programs for health care workers in the use of economic evaluation in improving
access to medicines in South Africa, Thailand, India and Hungary and the Baltic States.
Dr. Hill has worked as consultant for the World Health Organization in a number of countries, including South Africa, Bulgaria, the Baltic countries, and Vietnam, in areas relating
to national medicinal drug policy, including essential drugs lists, drug regulation and
pharmacoeconomics, and developing international standard treatment guidelines for
hypertension and malaria.
33
WORKSHOP PRESENTATIONS
WORKSHOP SESSION I
14:00-15:00 MONDAY, 6 MARCH 2006
HEALTH POLICY
W1: DRUG PRICING AND REIMBURSEMENT ISSUES USING HEALTH ECONOMICS
AND OUTCOMES RESEARCH IN DRUG REIMBURSEMENT - WHICH WAY FORWARD FOR THE ASIAN REGION Shanghai Room 1
Discussion Leaders: Peter Davey BA(Ec), MA(Ec), Director, M-TAG Pty Ltd, A Unit
of IMS Health, Chatswood, Australia; Meaghan Lynch BSc, MSc, Economist, MTAG, A Unit of IMS Health, Chatswood, NSW, Australia; Koji Makino BCom, MCom,
Economist; M-TAG Pty Ltd, A Unit of IMS Health, Chatswood, NSW, Australia
Workshop Purpose: To discuss drug pricing and reimbursement issues using
health economics and outcomes research in drug reimbursement in Asia.
Workshop Description: Since it was first formally integrated into drug policy in
1993, pharmacoeconomics has developed as an important policy tool to improve
efficiency in health spending in Western countries. The Asian region is now at the
cusp of applying pharmacoeconomics principles in drug policy development. The
Republic of Korea will be the region's first country to establish pharmacoeconomic
guidelines and mandatory requirements. Several other countries in the region have
recognised the benefits of pharmacoeconomics and have discussed their introduction, but have yet to develop formal pharmacoeconomic guidelines. The Korean
experience, global trends, and above all, burgeoning drug costs could well advance
the adoption of formal pharmacoeconomic requirements in the region. Alternatively,
failure of the approach in Korea, government inertia and disinclination to move
beyond draconian cost containment measures may exclude or delay pharmacoeconomics from playing a meaningful role in drug policy development. The authors
have examined the experience in the use of pharmacoeconomics in countries where
this is established policy. We suggest a formula for sensible adoption of pharmacoeconomics in the Asian region. The formula addresses the concepts and needs for
both the guidelines requirements and management and maintenance of the working
system. Guideline scope, level of prescriptiveness and complexity are key concepts.
Operational issues include appropriate resourcing by industry and government, as
well as the impact on the funding process and communication and consultation
requirements.
W2: USE OF PHARMACOECONOMICS IN SELECTION OF NATIONAL ESSENTIAL
MEDICINES Auditorium (Chinese translation available)
Discussion Leaders: Lin Yan PhD, Center for Drug Reevaluation, State Food and
Drug Administration, Beijing, China; Jie Ming Zhou MD, Deputy Chief, Center for
Drug Reevaluation, State Food and Drug Administration, Beijing, China; Gang Cheng
PhD, Chief, Center for Drug Reevaluation, State Food and Drug Administration,
Beijing, China; Li Ya Cao Master, Director, Center for Drug Reevaluation, State Food
and Drug Administration, Beijing, China
Workshop Purpose: To discuss the issues hindering the use of pharmacoeconomics in the selection of national essential medicines (EM) and propose the resolution
scheme.
Workshop Description: EM are those that satisfy the priority health care needs of
the population. This concept was initially proposed by the WHO and has now been
adopted by 156 Member States as a key component of National Drug Policy. In
China, the first-edition list of EM was published in 1994, and has been revised every
two years. Since EM is an important means to allocate limited health resources, PE
property of medicines must be considered as important as safety and efficacy, but
the economic evaluations of medicines have not currently been used routinely in EM
selection processes. The issues hindering the use of PE are as follows: 1.) Quality: A
34
survey which assessed the PE literature published in Chinese academic journals
showed that the quality of these studies was not satisfactory and results were difficult to adopt. Due to lack of PE guidelines in China, common standards about key
points of PE study are deficient. 2.) Reliability: Sponsors of PE studies often bring
reliability problems. Research funded by pharmaceutical companies are more likely
to report favorable outcomes than those by other sources, and 3.) Applicability:
Many factors influence the applicability of PE studies: firstly, regional limitations, differences in health care costs between city and countryside; east area and west
area; and coast cities and inland towns; secondly, the extensive use of assumptions
and the extrapolation of benefits in PE study; thirdly, different prices for the same
drug. Additionally, selection of EM emphasized affordability, but good cost-effectiveness doesn't equal good affordability. In order to promote PE use in EM selection,
it's necessary to improve the quality of PE information, develop clear guidelines and
strengthen education on PE evaluations in China’s health care sector.
W3: HEALTH TECHNOLOGY ASSESSMENT - ISSUES ON ITS USE BY EUROPEAN
DECISION-MAKERS WITH ADDITIONAL INSIGHTS INTO THE GERMAN HEALTH
CARE SYSTEM – LESSONS FOR ASIA Shanghai Room 5
Discussion Leaders: JM von der Schulenburg PhD, Professor, University of
Hanover, Hanover, Germany; Wolfgang Greiner PhD, Professor, University of
Bielefeld, Bielefeld, Germany; Thomas Mittendorf MSc, University of Hanover,
Hanover, Germany
Workshop Purpose: The aim of the workshop is to present and discuss recent
developments in the understanding and use of health economic studies by European
decision-makers.
Workshop Description: The workshop will introduce the audience to Health
Technology Assessment (HTA) in Europe. Furthermore the formal process currently
undertaken by German authorities will be presented. Nowadays, health economic
models are standard instruments in the evaluation of cost-effectiveness ratios of
novel pharmaceutical products. Little information is published on how decision makers in health care and administration use such data structured via HTA. In a second
step, results from two studies on the knowledge of health economics and the use of
such data by decision-makers undertaken in eight European countries will be discussed. The first study was undertaken in 2000, the second in 2004. Since identical
variables were being evaluated, a structured look on the developments in this
important issue within policy decision-making can be analyzed. Participants will get
a detailed look at the use of health economic information by decision-makers in
several European countries. The example of Germany as one of the most important
markets will add some hints for pharmaceutical companies on how the preparation
of health economic data should be organized for the European market.
W4: ADAPTING MODELS TO ASIA Shanghai Room 6
Discussion Leaders: Bruce Crawford MA, MPH, Senior Project Director, Mapi
Values, Boston, MA, USA; Takashi Fukuda PhD, Associate Professor, University of
Tokyo, Tokyo, Japan; Eui Kyung Lee PhD, Director, Korea Institute for Health and
Social Affairs (KIHASA), Seoul, South Korea
Workshop Purpose: Economic models are frequently developed in the US or
Europe, but these results cannot be readily applied to Asia. This workshop will
review principles of modeling, international modeling, and methods for adapting
existing models to the local setting. Examples will be provided from recent models
and at the conclusion, attendees should be able to understand how to evaluate and
structure a model for adaptation.
Workshop Description: This session is directed at individuals who are responsible
for the design and conduct of economic evaluations. Individuals who need to interpret study results will also benefit from this workshop. The increase in economic
evaluations to provide evidence of product value has spurred the interest and
necessity of model development. However, most economic models are developed in
the US or Europe and provided to local researchers. These models are not readily
applicable to the local setting, and therefore the models must be reconstructed or
adapted to the local setting. This is partly caused by the difference in health care
settings and practice patterns in Asia. This workshop will review the principles of
modeling, international modeling (use of a core model for adaptation), and several
strategies for adapting models to the local setting. Parameters used in the models
will also be discussed including QOL measurement.
W5: ASIAN-PACIFIC ISSUES IN MEASURING HEALTH-RELATED QUALITY OF LIFE
Shanghai Room 2
Discussion Leaders: Wolfgang Greiner PhD, Professor, Bielefeld University,
Bielefeld, Germany; Rosalind Rabin, Executive Officer, EuroQoL Group, Rotterdam,
The Netherlands
Workshop Purpose: This workshop will consider uses of EQ-5D (a generic measure
of health-related quality of life) in the Asian-Pacific Region with particular reference
to issues related to adaptation and translation. Researchers will discuss their experience of using a generic measure developed outside the Region and that has distinct European/North America origins. The principal workshop objective is to define
the type of adaptation and testing that is considered most useful to users in the
Region.
Workshop Description: Many of the most widely used generic measures of healthrelated quality of life have been developed by European or North American
researchers. EQ-5D is one such measure and was developed by the EuroQoL Group
(an international network of researchers) and it has been translated into many of the
languages relevant for the Asian-Pacific Region. The workshop will include summary
presentations by researchers from China, Korea, Singapore and Taiwan who have
used EQ-5D. These studies include measurement of population health, valuation of
EQ-5D health states and use in economic evaluation. Researchers will comment on
both the application and their experience in using EQ-5D. Translation procedures
will be examined interactively with workshop participants. After completion of the
workshop, participants should be entirely familiar with procedures for the translation
and adaptation of EQ-5D as a specific example of a more general question that
applies to most measures used for measuring health outcomes.
WORKSHOP SESSION II
15:15-16:15 Monday, 6 March 2006
HEALTH POLICY
W7: OUTCOMES RESEARCH FOR THE ASIAN MARKET: APPLICATIONS AND COMMUNICATIONS Auditorium (Chinese translation available)
Discussion Leaders: Bruce Crawford MA, MPH, Director, Patient-Report Outcomes
and Regulatory Consulting, Mapi Values, Boston, MA, USA; Lillian Yu-Jen Wang
MSc, Health Economics and Market Access Manager, Boehringer Ingelheim Taiwan
Limited, Taipei, Taiwan; Michael Stanley BA, Director, Adelphi Targis, Tokyo, Japan
Workshop Purpose: To understand the practical application of outcomes research
by industry, be able to explain outcomes studies to other internal customers and
understand how results may be influential and provide a framework for developing
communication strategies (beyond publications) to further disseminate health economic and outcomes research.
Workshop Description: This session is directed at individuals who are responsible
for the implementation and use of outcomes studies. Individuals who need to perform or interpret study results will also benefit from this workshop. Outcomes
research can provide compelling data to help support the development, reimburse-
ment, and uptake of health care technologies. This workshop will discuss the various applications of health economics and patient-reported outcomes research for
internal decision-making, reimbursement, and marketing. Examples will be provided
to illustrate “real world” applications of data with discussions on educating the enduser on how to use the data. This workshop will also discuss how to collect local
data in the “real world” setting, timing of data collection with respect to product
launch, how to prepare/augment the submission dossier with data availability, how
to interpret the outcomes studies and support marketing and other media for “noise
making” such as using generalist as well as specialist journals, monographs, roundtables, symposia, interactive software, and web pages.
W8: PAYOR-ORIENTED EVIDENCE GUIDELINES Shanghai Room 5
Discussion Leader: Joseph Singer MD, Co-Chair VBR POEM Working Group,
HealthCore Inc, Wilmington, DE, USA
Workshop Purpose: This will be the second panel discussion for the Value-Based
Reimbursement Special Interest Group of ISPOR, discussing the nature and scope of
outcomes research that payors are requesting to make formulary placement and
reimbursement desicions. The first panel was held in Florence and the EU perspectives were discussed. This panel will discuss the Asian and Pacific perspectives. The
May 20, 2006 panel in Philadelphia will discuss North American payor perspectives.
Workshop Description: Health care payors are now requiring expanded dossiers
for new products to be considered for formulary placement and reimbursement consideration. Their previous expectations often have been limited to efficacy and unit
cost information. Current expectations have been expanded to include more detailed
pharmacoeconomic data, predictive modeling, an expanded scope and scale of
valuing new products in a "real world" setting and outcomes data reflecting the
effectiveness of new products in a "real world" setting. This panel will discuss the
perspectives of payors in the Asian and Pacific region regarding the scope, scale
and forms of outcomes research that they need to see for the entry of new products
into their markets.
W9: INTERPRETATION OF COST-EFFECTIVENESS RESULTS IN ASIA
Shanghai Room 1
Discussion Leaders: Bruno Jolain MD, Director, Health Economics Intercontinental
Region, Sanofi-Synthelabo, Gentilly Cedex, France; Bong-Min Yang PhD, Professor
of Economics and Dean, School of Public Health, Seoul National University, Seoul,
South Korea; Nathorn Chaiyakunapruk PharmD, PhD, Assistant Professor,
Department of Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand
Workshop Purpose: To review the criteria used to interpret cost-effectiveness
results in Western countries, to discuss the experiences of researchers having presented cost-effectiveness results in Asia, and to discuss how to improve the criteria
to help interpretation in Asia.
Workshop Description: Cost-benefit analysis (CBA) provides a clear decision rule:
undertake an intervention if the monetary value of benefits exceeds the costs. But
as we know, health benefits are difficult to measure in monetary terms, and most
economic evaluations of health care interventions are cost-utility (CUA) or costeffectiveness (CEA) approaches. Analysts have suggested setting a threshold value
for the cost per QALY, or per life-year saved, that represents the willingness of society to pay for such benefits. Different thresholds exist in countries with a long tradition of performing economic evaluations of health technologies. What should be
done in Asian countries that have a more recent history of performing economic
evaluations? The workshop will start with an introductory overview of the question,
including a review of the criteria used in Western countries (Dr. Jolain), followed by
a presentation by two Asian experts (Prof. Yang and Prof. Chaiyahunapruk) of their
experience to present and interpret results in their country, and then by a discussion
with the audience.
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W10: MEASURING TREATMENT ADHERENCE USING PAID CLAIMS RECORDS AND
APPLICATION OF LATENT CLASSIFICATION ANALYSIS (LCA) IN PATIENTS WITH
SCHIZOPHRENIA Shanghai Room 2
Discussion Leaders: Lizheng Shi PhD, Assistant Professor, Tenure Track, Tulane
University, New Orleans, LA, USA; Jeonghoon Ahn PhD, Assistant Professor,
University of Southern California, Los Angeles, CA, USA
patients have access to the latest pharmaceutical products, or whether the health
system is slow in approving new drugs. Slowness of approval is usually an attempt
to contain the cost of pharmaceuticals. We compare these pharmaceutical policies
for four countries in the Asia-Pacific Region: China, Japan, Korea, and the US.
Workshop Purpose: The participants of this workshop will gain an understanding of
definition and analysis of treatment adherence (i.e., compliance and persistence)
using different methods (e.g., paid claims records). We will briefly present a case
study to introduce the latent classification analysis which assigns antipsychotic
adherence casemix memberships among patients with schizophrenia.
Workshop Description: Poor outcomes have been associated with non-adherence
to medication treatment, which may precipitate relapse and can result in significant
increases in total costs of care. Researchers generally suggest that treatment
adherence reflects both treatment compliance and persistence. The ISPOR
Medication Persistence Compliance Special Interest Group has recommended the
working definitions for compliance and persistence. “The unit of measure for compliance is administered doses per defined period of time (i.e., a proportion of prescribed doses taken at the prescribed time interval). Medication persistence is the
accumulation of time from initiation to discontinuation of therapy.” As a latent variable, treatment adherence needs to take into account the information on both treatment compliance and persistence. LCA is a versatile methodology, assuming a
latent index which can be used to distinguish latent classes. We apply the LCA to
identify non-adherence, partial adherence, and adherence casemix classes by multiple observable indicators for compliance and persistence in the California Medicaid
(Medi-Cal) patients treated with antipsychotic agents. While the concept of adherence casemix is emerging as an aid to understand population characteristics, we
need to be cautious to the pitfalls to ensure better use of adherence casemix in the
clinical care for patients with schizophrenia.
Shanghai Room 2
WORKSHOP SESSION III
12:00-13:00 Tuesday, 7 March 2006
W12: INTERPRETING “REAL WORLD” PHARMACOECONOMIC INTERVENTIONS DIFFICULTIES ARISING FROM UNFORESEEN ACCESS EFFECTS
Discussion Leader: Jeonghoon Ahn PhD, Assistant Professor, University of
Southern California, Los Angeles, CA, USA
Workshop Purpose: The participants of this workshop will gain an understanding of
difficulties in interpreting the impact of pharmacoeconomic policy changes. Special
emphasis will be on the issue of unforeseen access effects, which may generate
either overuse of formulary expanded items or underuse of formulary restricted
items. Potential solutions will be sought with the audience.
Workshop Description: Many pharmacoeconomic studies are used to establish
cost-effective formulary in the real world. Even in the simple cases of formulary
expansion or restriction, unforeseen access effects may distort the expected economic outcomes and may cast doubt on the usefulness of pharmacoeconomic interventions. This workshop will use an example of unforeseen access effect in
California Medicaid. Open access (lifting the requirement of prior authorization) of
2nd generation antipsychotics in October 1997 showed sharp increases in cost
outcomes. However, these increases are difficult to interpret since many patients
who did not use any service came back to the Medicaid system as a result of open
access. In other words, open access has changed the characteristics of the average
patient using services and the average cost of treating patients well. The advantages and disadvantages of time trend analysis and other solutions such as matching methods, which can help interpret the correct impact of pharmacoeconomic
intervenention in the case of unforeseen access effects, will be discussed with the
audience. Finally, alternative possibilities of the unforeseen access effect will be discussed with the audience, for example, closed access (employing prior authorization
requirement) of Proton Pump Inhibitors may restrict access to PPI's even for the
necessary patients.
HEALTH POLICY
W11: ISSUES IN DRUG PRICING, REIMBURSEMENT, AND ACCESS IN THE ASIAPACIFIC REGION Auditorium (Chinese translation available)
Discussion Leaders: Stuart O. Schweitzer PhD, Professor of Health Services,
UCLA School of Public Health; Yingyao Chen PhD, Professor of Hospital
Management, Fudan University School of Public Health,
Workshop Purpose: Three issues define national policies toward pharmaceuticals:
The prices paid to pharmaceutical manufacturers, the extent of patient or third-party
payment for drugs, and access to new products.
Workshop Description: The price paid for pharmaceuticals is determined by health
authorities, either public or private. Often a formula is used to set these prices based
upon the price paid in other countries. This is called “reference pricing”. The price
can be set according to either of two objectives. A “Health Policy” perspective will
attempt to minimize expenditures so as to contain total health care costs. A “Health
Industry Policy” will also consider the effect of drug prices on the pharmaceutical
research climate in the country The second issue is the question of who pays for
drugs. Some health systems impose very high user fees, or cost-sharing on patients,
while in other countries the cost of drugs is more heavily subsidized by the insurance
program. In some countries, most notably the US, cost-sharing is part of a broader
attempt to bring economic incentives into the pharmaceutical marketplace. In these
programs patients face lower prices for drugs that are determined to be a particularly
good value to the health plan, while consumer prices are considerably higher for
products that are thought to be less cost-effective. Lastly, we consider whether
36
Outcomes Research Methods
W14: PHARMACOECONOMICS: EVALUATING FREE SOFTWARE ON THE INTERNET
FOR COST-EFFECTIVENESS ANALYSIS, DECISION ANALYSIS AND NUMBER NEEDED TO TREAT CALCULATIONS Shanghai Room 6
Discussion Leader: William McGhan PharmD, PhD, Professor of Pharmacy &
Health Policy, University of the Sciences, Philadelphia, PA, USA
Workshop Purpose: The purpose of this workshop is to demonstrate and evaluate
calculators and freeware on the Internet that could be useful for individual patient
assessment and population-based calculations by clinicians and government agency
personnel in Asia. These interactive tools allow a range of tasks from basic costeffectiveness analysis, decision-making, and Number Needed to Treat (NNT) calculations.
Workshop Description: Innovative calculators and freeware are becoming more
widely available on the internet that can be useful at various levels from government agencies to individual patient care. Pharmacoeconomic software and Internet
offerings allow data and results to be examined from different policy perspectives:
1) patients; 2) practitioners; 3) hospitals; and 4) government. Software options can
also allow the assessment of health interventions or services from different quantitative perspectives: 1) cost of illness; 2) cost minimization; 3) cost benefit; 4) cost
effectiveness; and 5) cost utility. Calculators, spreadsheets, and software approaches will be demonstrated and reviewed. Internet and software applications can assist
in analyzing data, presenting findings, or educating providers and patients. Creative
software is becoming increasingly available that facilitates pharmacoeconomic eval-
uations and incorporation of cost- effectiveness into therapy decisions and treatment protocol implementation. Questions that should be asked in evaluating tools
include: how much of the engine is validated with rigorous clinical trial data, have
the tools been peer reviewed and field-tested, is the information well- referenced?
Pros and cons of diverse analytical, implementation, hardware, and software
approaches will be examined and critiqued.
W15: RETROSPECTIVE DATABASES IN THE UNITED STATES, EUROPE AND ASIA
Shanghai Room 1
Discussion Leaders: Diana Brixner PhD, Associate Professor, University of Utah
College of Pharmacy, Salt Lake City, UT, USA; Gary M Oderda PharmD, MPH,
Professor, University of Utah College of Pharmacy, Salt Lake City, UT, USA
Workshop Purpose: This workshop has two goals: 1) To describe and compare
restrospective databases in the United States, Europe and Asia that are used for
outcomes research, and 2) to describe the challenges of conducting retrospective
outcomes research using and combining multi-national databases.
Workshop Description: Choice of the appropriate databases depends on the
research question being asked. For example, EMR databases are ideal to answer
questions that require specific patient-level information such as BMI, blood pressure, lab tests, etc. Although EMRs include drug orders, they are not appropriate to
examine compliance or persistence since data on prescription fills is not available.
Commercial claims databases in the United States have access to data on millions
of patients and include medical and prescriptions claims. These databases are ideal
for examining prescription drug use, since drug claims are available. Medical claims
ICD-9 codes that can be used to determine diagnoses. Faculty members will be
added from Europe and Asia to describe available databases for outcomes research
in those areas. In addition to a description of available databases, faculty will briefly
present representative data from studies completed using the databases of interest.
Faculty will also address the challenges of using data from multiple countries in a
single research project. An interactive opportunity will be provided through posing
various research questions and exploring the best database options within the major
markets.
WORKSHOP SESSION IV
14:45-15:45 Tuesday, 7 March 2006
tion in health promotion and disease prevention programs will be discussed
throughout. Those relationships should have a similar impact among the Asian
countries, although among them the governments, in general, are the main payor of
the health care costs. To individual workers, better health and the participation in
the health promotion and disease prevention programs will enhance personal health
and improve their vitality and quality of life. To employers, a healthy workforce and
the providing of the programs will improve their productivity and reduce their health
care payments due to employees' unhealthy behaviors. To the main health care
payors in Asian countries, the government, a healthy workforce and promotion of
these programs will result in improved population health and financial savings in
national health care costs. Therefore, there are incentives for both government and
employers to develop and implement health promotion and disease prevention programs and for individuals to participate in those programs to improve their health
and quality of life, reduce their morbidity, and out-out-package expenses for personal health. Workshop participants will be asked to share experiences and practices
about the implementation of those programs and their battles with the increase in
health care expenditure within their country.
W17: HOW ARE PHARMACEUTICAL PRICES AND ACCESS SET IN COUNTRIES IN
THE ASIA-PACIFIC REGION; COMPARING “HEALTH POLICY” AND “HEALTH
INDUSTRY POLICY” Shanghai Room 2
Discussion Leader: Marco R. Di Tommaso PhD, Professor, University of Ferrara,
Ferrara, Italy
Workshop Purpose: Comparing “Health Policy” and “Health Industry Policy”.
Workshop Description: Health Policy is commonly used to determine cost of and
access to new health services. Health Policy attempts to minimize the cost of health
services, while maintaining an acceptable level of health in the community. A new
perspective suggests that treating the health system as an “industry” leads to a different set of policies toward health prices and access. The difference is that Health
Industry Policy recognizes that a strong health industry stimulates high-tech industrial growth throughout an economy, while a policy that merely tries to minimize
health expenditures not only reduces the incentive to invest in R&D in new health
technologies, but retards overall expansion of high-tech industrial growth. Policies
toward the pharmaceutical sector in countries of the Asia Pacific Region will be
compared, to identify which countries are merely trying to minimize health expenditures, and which are taking advantage of these economic spillovers between pharmaceuticals and other high tech sectors.
HEALTH POLICY
W19: CURRENT DEVELOPMENTS AND ISSUES ABOUT DRUG SAFETY
W16: ECOMONIC BENEFITS OF WORKSITE PROMOTION & DISEASE PREVENTION
IN THE USA: LESSONS FOR ASIA Shanghai Room 6
Discussion Leaders: Louis Yen PhD, Research Scientist and Director, International
Research and Development, Health Management Research Center, The University of
Michigan, OH,USA; Dee W Edington PhD, Director and Professor, The University of
Michigan, OH, USA
Discussion Leaders: Jeff Jianfei Guo PhD, Associate Professor, University of
Cincinnati, Cincinnati, OH, USA; Yong Hua Jing MS, Research Assistant, University
of Cincinnati, Cincinnati, OH, USA; Wenmin Du PhD, Deputy Director, Shanghai
Adverse Drug Reaction Monitoring Center, Shanghai, China
Workshop Purpose: Through the review of the programming experiences, evaluation methods, and research findings from various worksite health promotion and
disease prevention studies conducted in the United States, the presentation will discuss what lessons the Asian decision-makers and health practitioners can learn.
Workshop Description: In the United States, the overall health expenditures totaled
over 1.5 trillion and accounted for over 14% of gross domestic product (GDP), this is
significantly higher than that of any industrialized country. Employers, the major
payor of the health care costs in the U.S., have increasingly faced the challenges to
pay their employees' health care and have almost reached the limitation of their
affordability. The worksite health promotion and disease prevention programs have
been positioned as the only positive solution to solve the crisis of the increases in
health care costs in the U.S. During the workshop, the relationships between health
care costs and productivity to personal health, change in health risks, and participa-
Workshop Purpose: To review and discuss current developments and issues about
risk management and drug safety.
Workshop Description: More than a dozen of high profile pharmaceuticals, such
as, Vioxx (rofecoxib), Seldane (terfenadine), Rezulin (troglitazone), and Propusid (cisapride), were withdrawn from marketing in the past decade. Pharmaceutical regulators are increasingly calling for risk-benefit assessment for both new and existing
pharmaceutical products. The risk management for pharmaceutical products is a
multidisciplinary method to document, monitor, and evaluate adverse drug events
(ADE), and plan interventions. It applies to the life of a drug from investigation new
drug (IND), new drug application (NDA), post-marketing, and event removal from
marketing. The US risk management guideline includes Premarketing Risk
Assessment, Development and Use of Risk Minimization Action Plans (RiskMAP), and
Good Pharmacovigilance Practices and Pharmacoepidemiologic Assessment. The
Auditorium (Chinese translation available)
37
commonly used research methods for risk management include case report/case
series, case-control study, cohort study, meta-analysis, and causal analysis of randomized clinical trials. In this workshop, we will review the recently released United
States Food & Drug Administration (FDA) Risk Management Guidance, the European
Medicines Agency (EMeA) Guideline on Risk Management Systems for Medicinal
Products for Human Use, as well as the current issues about risk management and
drug safety in Asian countries or regions. We will use several cases to illustrate the
concepts and methods of risk management. Finally, we will discuss what we can
learn from past experiences, and what common issues and differences about pharmacovigilance and drug safety between Western and Asian countries and regions.
W20: EQ-5D AND OTHER GENERIC MEASURES OF HEALTH Shanghai Room 1
Discussion Leaders: Frank De Charro, Executive Director, EuroQoL Group, Centre
for Health Policy and Law, Rotterdam, The Netherlands; Paul Kind, Principal
Investigator, Outcomes Research Group, York, UK
Workshop Purpose: This workshop provides an overview of the design and development of EQ-5D, a widely used generic measure of health-related quality of life.
The workshop will be led by founder members of the EuroQoL Group who will
describe the current status of EQ-5D, including information on application studies as
well as on future plans.
Workshop Description: Health-related quality of life (HrQoL) measurement is
essential for a variety of applications that include the evaluation of healthcare as
38
well as monitoring outcomes in patients and populations. EQ-5D is a generic measure of HrQoL that has become one of the most widely used instruments for measuring health outcomes. Based on 5 key dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression, EQ-5D defines a system of 243 health
states. The relative value of these states can be determined by collecting social
preferences from the general population or from specific patient or population subgroups. These weights enable EQ-5D data to be summarised into a single index of
health status that can be used to measure health outcomes. EQ-5D was designed
as a low-burden/high-yield measure and attendees will be given direct experience
by self-completion in the workshop. Participants will be encouraged to discuss their
own potential applications of this measure. After completion of the workshop participants can expect to have full information and knowledge regarding the current status of EQ-5D as well as an understanding of future development plans. Workshop
participants will be encouraged to consider participation with the research activities
of the EuroQoL Group.
POSTER PRESENTATION ABSTRACTS
ARTHRITIS
PAR1: ARE THEY RELEVANT? A CRITICAL EVALUATION OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH CORE
SETS FOR OSTEOARTHRITIS FROM THE PERSPECTIVE OF PATIENTS WITH
KNEE OSTEOARTHRITIS IN SINGAPORE
Xie F1, Thumboo J2, Fong KY2, Lo NN2, Yeo SJ2, Yang KY2, Li SC1, 1National
University of Singapore, Singapore, 2Singapore General Hospital, Singapore
OBJECTIVE: To determine the extent to which health items identified from the perspective
of patients with knee osteoarthritis can be linked with the ICF; and to critically evaluate the
ICF Comprehensive and Brief Core Sets for osteoarthritis. METHODS: Items identified from
a focus group study were linked independently by two researchers based on the 10 a priori linking rules. Both percentage agreement and kappa statistics were calculated to
measure inter-observer agreement. Any disagreements were resolved by reaching a consensus among the researchers. The categories linked with all items were compared with
the Comprehensive Core Set, while the categories linked with those items reported as
important by over 30% of subjects within each of three local ethnic groups (Chinese,
Malay, and Indian) were compared with the Brief Core Set. Both comparisons were made
only at the second level of the ICF. RESULTS: Totally 74 items were linked with 44 different ICF categories through 105 linkages with generally very good inter-observer agreement. The 69 items were linked with the ICF at the third or fourth levels. Both commonalities and disparities were found through comparison between the categories linked with
these items and both Core Sets for osteoarthritis. CONCLUSIONS: All items could be successfully linked with the ICF. The Comprehensive Core Set demonstrated general conceptual validity, while the Brief Core Set needs to be supported by more empirical evidence in
various socio-cultural contexts. This study specifically complemented the development and
refinement of both Core Sets from the perspective of patients with knee osteoarthritis.
PAR2: COST-EFFECTIVENESS ANALYSIS OF TREATMENT OPTIONS FOR
METHOTREXATE-RESISTANT RHEUMATOID ARTHRITIS IN KOREA
Lee EK1, Park EJ1, Sung YK2, Park SJ1, Kim JJ3, Bae SC2, 1Korea Institute for
Health and Social Affairs (KIHASA), Seoul, South Korea, 2Hanyang University
Hospital, Seoul, South Korea, 3Sook-myung Women’s University, Seoul, South Korea
OBJECTIVE: Treatment options for rheumatoid arthritis (RA) have become diverse in Korea
since the introduction of new disease-modifying antirheumatic drugs (DMARDs) such as
etanercept. This study aimed to analyze the cost-effectiveness of the major treatment
options for methotrexate (MTX)-resistant rheumatoid arthritis in Korea with a time horizon
of six months. METHODS: A cost-effectiveness analysis was performed to compare six
major strategies in Korean medical practice for patients with MTX-resistant RA : 1) MTX
only, 2)Etanercept only, 3)Etanercept +MTX, 4)Cyclosporin+MTX, 5)Leflunomide(20mg)
only, 6)Leflunomide(10mg)+ MTX. Data for efficacy for the patients with methotrexateresistant rheumatoid arthritis were extracted from the published clinical trials searched
from Pubmed. ACR20 were employed as the measurements of effectiveness. The direct
medical costs including medication cost, monitoring and dispensing cost were estimated
based on Korean National Health Insurance reimbursement fee schedule. RESULTS:
Etanercept monotherapy, Cyclosporin+MTX, and Leflunomide(20mg) monotherapy cost
more, but either were not more efficacious or had a high incremental CE ratio than the
next most expensive option (i.e., they were dominated). For the least expensive option,
Leflunomide(10mg)+MTX, ICER with MTX monotherapy was 2,066,000 Won (Korean currency)/ ACR 20. The most efficacious option, Etanercept+MTX showed the ICER of
29,634,000 Won per ACR20 response. CONCLUSIONS: Leflunomide+MTX was evaluated
as a cost effective option for MTX resistant RA in achieving ACR20 over a 6 month period.
The most efficacious option, Etanercept+MTX, incurs much higher incremental costs per
ACR20 than other options analyzed. Whether Etanercept+MTX compared with MTX is cost
effective depends on whether ICER value over a six month period is considered acceptable. In the future, it is also needed to analyses long-term cost effectiveness using Markov
modeling and to include indirect cost for RA in order to apply for health insurance policy.
PAR3: DIRECT MEDICAL COST OF RHEUMATOID ARTHRITIS IN HONG KONG
Lee VWY1, Lee KK1, Li EK2, Chan CW1, Chan LH1, Ng TS1, Tam LS2, 1The Chinese
University of Hong Kong, Shatin, Hong Kong, China, 2Rheumatology/Faculty of
Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
OBJECTIVE: To evaluate the direct medical cost in the management of rheumatoid arthritis (RA) as well as the extent of resource use in current practice from the perspective of
public health organization in Hong Kong. METHODS: This study was a retrospective
design. Subjects recruited must have RA diagnosed and attended the follow-up visits,
receiving RA treatment in the Prince of Wales Hospital (PWH) between the period of 1st
January 2002 to December 31, 2002. Data was collected by medical chart review. The
direct medical costs included inpatient care, outpatient visits, laboratory monitoring, radiological procedure, drug cost and side effects management. RESULTS: A total of 147
patients were included in our study. The average age and the duration of disease of our
subjects were 54.7 years old (SD: 10.9) and 12.6 year (SD: 7.0) respectively. The annual
direct medical cost per each RA patient was HK$18,657 (US $ 1 = HK $ 7.8). The inpatient
care contributed 43.8% of the total, which was the highest. The cost for laboratory monitoring was the second (19.2%) where the outpatient cost ranked the third (15.4%). The
cost for RA-related drugs accounted for 9.8%. The cost for the management of the side
effects shared 3.1% of the total. Based on a local epidemiological study, the RA prevalence
rate was 0.3%. The annual direct medical cost for the management of RA in Hong Kong
would be HK$443 million, which shared 1.4% of the total healthcare budget in 2002.
CONCLUSIONS: This study demonstrated that RA was a significant economic burden to
the healthcare budget of Hong Kong.
PAR4: RELATIONSHIP BETWEEN HEALTH-RELATED QUALITY OF LIFE AND
CLINICAL IMPAIRMENT IN TAIWANESE PATIENTS WITH RHEUMATOID
ARTHRITIS
Lin HY1, Huang VWH2, Tarn TH3, Su KYJ4, Huang KYC4, 1Taipei Veterans General
Hospital, Taipei, Taiwan, 2Protech Pharmaservices Corporation, Taipei, Taiwan,
3Taipei City Hospital, Taipei, Taiwan, 4Protech Pharmaservices Corporation, Taipei,
Taiwan
OBJECTIVE: Improvements in disease-related symptoms and health-related quality of life
(HRQoL) are the desired key outcomes of medical management in rheumatoid arthritis
(RA). The relationship between quality of life and clinical impairment must therefore be
investigated. METHODS: A total 225 RA patients (87% female; mean age 54 years) were
enrolled prospectively from October 2004 to March 2005. Patients were evaluated with a
generic questionnaire, Short-Form 36 (SF-36), quality of life instruments, the Health
Assessment Questionnaire (HAQ) Disability Index and the HAQ pain scale, as well as the 28
joint Disease Activity Score (DAS28) measuring functional activity and functional impairment. Multivariate regression analyses were used to identify factors predicting HAQ
scores. RESULTS: Among the 225 patients, 25% were inactive, 40% were moderately
active and 35% were very active. The low scores on the HAQ pain scale may be because
the fact that the majority of patients were receiving medication. HAQ scores were moderately correlated with DAS28 scores (r=0.60, p<0.0001) and SF-36 PCS(r=-0.70,
p<0.0001) but only weakly correlated with SF-36 MCS (r=-0.39, p<0.0001). In addition,
regression analyses showed that SF-36 PCS, MCS, and DAS28 scores were significantly
contributors to the prediction of HAQ Index score (R2 = 0.59, p < 0.001). CONCLUSIONS:
Our data indicate that currently used clinical endpoints do not fully assess the quality of
life in RA patients. We suggest that multidimensional scales may significantly improve the
measurement precision and accuracy of QOL instruments.
PAR5: DIRECT MEDICAL COST OF ANKYLOSING SPONDYLITIS IN SOUTHERN
CHINESE
Tam LS1, Li EK1, So SW2, Chan BM2, Kan KW2, Hwang WW1, Lee KK2, Lee VWY2,
1Rheumatology/Faculty of Medicine, The Chinese University of Hong Kong, Shatin,
Hong Kong, China, 2The Chinese University of Hong Kong, Shatin, Hong Kong, China
OBJECTIVE: To determine the direct medical cost of ankylosing spondylitis (AS) in Hong
Kong according to disease severity based on the Bath Ankylosing Spondylitis Disease
Activity Index (BASDAI) score. METHODS: This is a retrospective, cross-sectional study.
39
Subjects were recruited from the rheumatology clinic. Information on the public care was
collected by chart review. A special questionnaire to elicit patients of demographic, clinical,
current disease state, health-care and private resource consumption related to AS over the
previous 12 months period was completed during a telephone interview. RESULTS: The
mean SD age of the 70 subjects was 41.4 ± 11.3 years. The male to female ratio was 3:
1, with mean disease duration of 9.6/8.0 years. The median (interquartile range (IQR))
BASDAI score was 4.8 (3.4 - 6.7). Forty-nine percent of patients had active disease with
BASDAI ≥a 5 (group 1) and 51% had less active disease with BASDAI < 5 (group 2). The
median total direct cost per AS patient per year was significantly higher in group 1
(HK$12,355 (9,250 - 20,690) compared with group 2 (HK$ 8,488 (6,319-11,615))
(p=0.01). This was mainly due to a significantly higher cost to the government in group 1
(HK$ 12,135 (8,920 - 19,980) compared to group 2 (HK$ 8,293 (6,063- 11,073) (p=0.01).
Three patients were hospitalized last year in group 1. The outpatient cost was also significantly higher in group 1 (HK$11,475 (8,770-19,980)) compared to group 2 (HK$8,293
(6,062-11,072)) (p=0.02). The patients of total out of pocket cost were significantly higher
in group 1 (HK$ 400 (310-840) compared to group 2 HK$ 265 (192-355)(p=0.13). CONCLUSIONS: Ankylosing spondylitis patients with high disease activity appear to require
more in-patient and out-patient care, resulting in higher medical costs than those with
less severe disease.
ASTHMA
PAS1: ESTIMATING ECONOMIC BURDEN OF CHILDHOOD ASTHMA IN KOREA
USING THE NATIONAL HEALTH INSURANCE CLAIMS DATA
Kang HY1, Park CS2, Bang HR3, Kocevar VS4, Kim CJ3, 1Yonsei University, Seoul,
South Korea, 2Korea University, Seoul, South Korea, 3MSD Korea LTD, Seoul, South
Korea, 4Merck & Co., Inc, Whitehouse Station, NJ, USA
OBJECTIVE: To determine asthma-related healthcare utilization and costs among children
with asthma in Korea. METHODS: We conducted a burden-of-illness study of childhood
asthma from the societal perspective. Asthma-related claims in 2003 were extracted from
the Korean National Health Insurance claims database. Children (1 to 14 years old) were
included in the study if they had two or more medical claims with diagnosis of asthma and
prescription for anti-asthma medicines. The total asthma-related cost was the sum of the
direct healthcare costs, transportation costs for visits to healthcare providers, and caregivers’ opportunity costs for the time spent on hospital or outpatient visits. Direct healthcare costs included the costs of outpatient visits, emergency department (ED) visits, hospital admissions, and pharmaceuticals. RESULTS: A total of 319,714 children with asthma
were identified, yielding a one-year asthma prevalence of 3.5%. Asthmatic children had
average of 7.82 outpatient visits, 0.02 ED visits, 0.01 admissions, and 0.05 inpatient days
per year were recorded. The total cost of insured healthcare services used to treat asthma
was $39 million, representing 0.25% of the total expenditure on insured healthcare services in Korea. Outpatient care accounted for 52.6% of the total expenditure on insured services, inpatient care for 2.1%, ED visits for 0.3%, and prescribed medicines for 45.0%.
Direct healthcare costs accounted for 84.6%, transportation costs for 8.5%, and time
costs for 7.0% of the $66.8 million total cost of treating childhood asthma. CONCLUSIONS: Most of the societal economic burden of childhood asthma was attributable to
direct healthcare expenditures, with outpatient visits and medications emerging as the
largest component costs. Hospitalizations and ED visits represented a smaller fraction of
the cost of childhood asthma in Korea than in other countries. Key words: Asthma, burden
of illness, claims data, health care utilization
PAS2: IS IT WORTH TO USE INHALED CORTICOSTEROIDS TO CONTROL
MILD-TO-MODERATE ASTHMA UNDER THE THAI HEALTH CARE CONTEXT?
Limwattananon C1, Limwattananon S1, Saklertsakul D1, Phumas P2, 1Khon Kaen
University, Amphoe Muang, Khon Kaen, Thailand, 2Mahasarakham University,
Amphoe Muang, Mahasarakham, Thailand
OBJECTIVE: To determine an incremental cost-effectiveness ratio (ICER) for budesonide,
an inhaled costicosteroid (ICS), used with salbutamol, a short acting beta-2 agonist inhaler,
compared with salbutamol alone in patients with mild or moderate asthma. METHODS:
Data on drug effects were obtained from Asthma Policy Model. Cost data were abstracted
from databases of hospitals in Thailand. Under health care provider perspective, a Markov
model estimated life expectancy adjusted by quality of life and health care cost over a tenyear period. RESULTS: For a patient aged 18-35 years with mild asthma and no prior hospitalization, use of ICS in addition to beta-2 agonist extended the patient life by 2.78 quali40
ty-adjusted life month (QALM) and saved health care cost of 7,328 Baht in total (40 Baht =
1 USD). A gain in QALM associated with the ICS use did not vary across variations in
patient age, asthma severity, and prior experience of hospital admission. The amount of
saving increased with respect to an increase in ages, asthma severity, and frequency of
admissions. The most cost saving strategy was the use of ICS in patients over 35 years
who had moderate asthma and had been admitted to hospitals more than once, where the
cost saving increased to 43,373 Baht. Cost difference between the competing drugs was
also sensitive to duration of drug use. For 3 years of drug use, an additional one qualityadjusted life year (QALY) gained due to the ICS use was offset by an increase of 3,255
Baht, on average, in the health care cost. CONCLUSIONS: Adding ICS to beta-2 agonist is
cost-effective for treatment of mild and moderate asthma in Thai context based on a
threshold of three times of per capita income (GNI of 2,190 USD for Thailand) as suggested by the World Health Organization’s Commission on Macroeconomics and Health.
PAS3: FIVE-YEAR CLAIM DATABASE ANALYSIS OF ASTHMA IN TAIWAN
Lu CH1, Tarn YH2, 1Armed Forces Beitou Hospital, Taipei, Taiwan, 2Taipei City
Hospital, Taipei, Taiwan
The National Health Insurance (NHI) program was officially launched on March 1th, 1995,
in Taiwan for ten years. The balance of revenues and expenditure was stable initially, but a
deficit was shown since 1998. Health-related retrospective databases, in particular claims
databases, continue to be an important data source for outcomes research. OBJECTIVE:
1) To compare the asthma prevalence from the consecutive claimed-database to published
results. 2) To understand trends of medical resources utilization of asthma in Taiwan. 3) To
understand the improvement of asthmatic care in Taiwan. METHODS: During the year
1998 to 2002, claims with primary and secondary diagnosis of asthma in their ICD-9-CM
code and A-code were obtained and then sorted per person to obtain their whole medical
resource utilization. Those data files included ambulatory care expenditures by visits,
details of ambulatory care orders, inpatient expenditures by admissions and details of
inpatient orders. The STATA 8.0 and SAS 8.2 computer softwares were used to perform
the analysis. RESULTS: 1) The prevalence of asthmatic patients form 1998 to 2002, from
primary diagnosis, was 8.84%, 3.48%, 2.24%, 2.20% and 2.15%, respectively. 2)Number
of Outpatient visited per person per year was from 2.07(1998) to 3.17(2002). Average prescription days per person: from 7.25(1998) to 12.08(2002). Number of hospitalization per
person per year: from 0.02(1998) to 0.07(2002). Number of emergency visited per person
per year: from 0.05(1998) to 0.14(2002). 3)Total cost per year: US$ 10, 7.2, 5.9, 6.3 and
6.9 million dollars. 4) The ratio of drug costs/total costs about 45%. CONCLUSIONS:
Condition of asthmatic outpatient care was improving and inpatient care was worsen. The
ratio of drug costs plays an important role in asthmatic care.
PAS4: THAI PATIENTS’ EXPERIENCE OF THE BURDEN OF ASTHMA: QUALITATIVE STUDY
Sirimai P1, Limwattananon C2, Limwattananon S2, Tangcharoensathien V3,
Boonsawat W4, Schommer JC5, 1Prachuapkhirikhan Hospital, Prachuapkhirikhan,
Thailand, 2Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand,
3International Health Policy Program, Nonthaburi, Thailand, 4Khon Kaen University,
Khon Kaen, Thailand, 5University of Minnesota, Minneapolis, MN, USA
OBJECTIVE: To describe the burden of asthma among Thai patients. Design: Qualitative
study with semi-structured in-depth interviews. METHODS: A secondary hospital in the
upper south of Thailand. Participants: 52 asthmatic patients aged 18-60 years experiencing in emergency department visits in 2003. RESULTS: The burden of asthma affecting
Thai patients on mainly four categories relating to daily life including physical and emotional impact, employment, financial, and partners relationships. Suffering from asthma
symptoms was stated in most participants with poorly controlled asthma. Emotions of fear
and panic appeared from asthma attack in all patients. Suicidal idea from disease and
financial problems took place in some participants. In persistent asthmatic patients, feelings of exhaustion and tiredness frequently happened and caused of omitting therapy in
some participants. Financial problems occurred from losing or changing jobs or losing
income affecting patients who were chief of the family. Partner relationships could end up
with divorce due to financial problems. The cost of asthma medication was not an issue in
most patients since universal coverage was implemented at a nationwide scale. CONCLUSIONS: Our current understanding of the patients’ experience of the burden of asthma
contributes to improving the management and control of asthma and enabling patients to
live full, active and productive lives.
CANCER
PCN1: COST-EFFECTIVENESS OF PEMETREXED PLUS CISPLATIN VERSUS
CISPLATIN ALONE IN THE TREATMENT OF MALIGNANT PLEURAL MESOTHELIOMA
Davey P1, Cordony A1, Rajan N2, Arora B2, Pavlakis N3, 1M-TAG, A Unit of IMS
Health, Chatswood, NSW, Australia, 2Eli Lilly Australia Pty Ltd, West Ryde, NSW,
Australia, 3University of Sydney, St Leonards, NSW, Australia
OBJECTIVE: To determine the value-for-money offered by pemetrexed (Alimta) plus cisplatin therapy for patients with malignant pleural mesothelioma (MPM), relative to cisplatin
monotherapy, in Australia. MPM is an uncommon, locally invasive and rapidly fatal malignancy. There is currently no other drug reimbursed by the Australian National Formulary
specifically for the treatment of mesothelioma. METHODS: A comprehensive literature
search revealed one randomised head-to-head trial of pemetrexed plus cisplatin therapy
versus cisplatin monotherapy (N = 448) by Vogelzang et al. (2003). Median survival for the
intention-to-treat (ITT) population was 12.1 months for the pemetrexed plus cisplatin arm
versus 9.3 months for the cisplatin arm (hazard ratio = 0.77, p = 0.020). Although there
was greater toxicity with the combination regimen, quality of life was not negatively
impacted. Mean survival time for each treatment arm was estimated from Kaplan-Meier
survival curves. Resource use was applied as per the trial and costed accordingly. Study
drug utilisation, concomitant medications, supplementary medication (dexamethasone,
folic acid, and vitamin B12), post-study chemotherapy, and care for serious and treatmentemergent adverse events were costed. RESULTS: Patients received a mean of 4.7 treatment cycles in the pemetrexed plus cisplatin arm, and 4.0 cycles in the cisplatin
monotherapy arm. The combination therapy required more supportive care for toxicities.
The additional mean cost of pemetrexed plus cisplatin therapy, over cisplatin monotherapy,
was A$14,032.78 per patient. The mean and median survival gain with pemetrexed plus
cisplatin therapy was found to be 0.191 and 0.233 years, respectively, relative to cisplatin
monotherapy, over the 27-month period of observation. The cost per life-year saved was
A$73,470.04 for mean and A$60,226.52 for median incremental survival. CONCLUSIONS:
This survival benefit is a highly patient-relevant outcome. This economic evaluation found
that pemetrexed plus cisplatin therapy offers an acceptable cost-effectiveness ratio for a
small population of MPM patients in Australia.
PCN2: A COST-EFFECTIVENESS ANALYSIS OF ADJUVANT CHEMOTHERAPY
FOR NODE POSITIVE EARLY BREAST CANCER IN KOREA: DOCETAXEL, DOXORUBICIN AND CYCLOPHOSPHAMIDE (TAC) VERSUS 5-FLUOROURACIL,
DOXORUBICIN AND CYCLOPHOSPHAMIDE (FAC)
Lee SG1, 2Jee YK, 3Chung HC, 4Kim SB, 5Ro J, 6Im YH, 7Im SA, 8Seo JH, 9Lee SM,
1Dankook University, College of Medicine, Cheonan, Chungnam, South Korea,
2Pochon CHA University, College of Medicine, Seongnam, Gyunggi, South Korea,
3Yonsei University, College of Medicine, Seoul, South Korea, 4University of Ulsan,
College of Medicine, Seoul, Seoul, South Korea, 5Korean National Cancer Center
Hospital, Goyang, Gyeonggi, South Korea, 6Sungkyunkwan University, College of
Medicine, Seoul, South Korea, 7Seoul National University, College of Medicine,
Seoul, South Korea, 8Korea University, College of Medicine, Seoul, South Korea,
9Yonsei University, Graduate School, Seoul, South Korea
OBJECTIVE: The aim of this study was to determine the incremental cost-effectiveness
and cost-utility ratios of the TAC treatment compared with the FAC treatment following primary surgery for node positive breast cancer patients in Korea. METHODS: An economic
analysis was performed using a Markov model. The model allowed assessments from the
start of adjuvant chemotherapy until death. Clinical data introduced into the model were
mainly obtained from the long term (5years) randomized controlled trial, BCIRG001 and
some Korea-specific clinical data were obtained from the existing literature. The model
allowed projecting the lifetime costs and effectiveness of both regimens beyond the time
scope of the trial. Costs were evaluated from the combined view of the national health
insurance and the patient; only direct medical costs were included. The local treatment
patterns and their costs were estimated from 3-hospital survey. Utility data were extracted
from existing foreign literature. A discount rate of 5% was used for costs, and alternatively
0%, 3%, and 5% for effectiveness. All costs were expressed in Korean Won (KW).
RESULTS: The base case and subsequent sensitivity analyses showed that TAC was more
costly per patient but yielded higher health benefits than FAC. According to the discount
rate of effectiveness, the ICER (cost per life year saved) were 3,383,182 KW, 5,848,447
KW and 8,112,362 KW and the ICUR (cost per QALY gained) were 3,849,233 KW,
6,560,432 KW and 8,981,543 KW, respectively (1026 KW = 1 US$). CONCLUSIONS: The
results indicate that additional life-years with a modest increase in costs could be
achieved by the use of TAC compared with FAC as adjuvant chemotherapy for node positive breast cancer patients in Korea, thus TAC appears to be cost-effective in the management of early breast cancer in Korea.
PCN3: INCREMENTAL LIFETIME COST OF LIVER CANCER- NCIDENCE-BASED
APPROACH
Lang HC, University of California at Berkeley, Moraga, CA, USA
OBJECTIVE: Liver cancer is the third common cancer in Taiwan, only after cervical and
breast cancer (2000). For male in Taiwan, it is the most dangerous cancer with both highest incidence and mortality rate. This study estimated the lifetime cost of care for Taiwan
patients with a diagnosis of liver cancer. METHODS: The estimation of the lifetime cost
based on incidence approach sourced from 1994-2002 cancer registry statistics of
patients with liver cancer and the claim data from Taipei Veterans General Hospital (TVGH).
Totally we have 2,873 liver cancer patients. Besides, the research applied population claim
data from The National Health Research Institutes (NHRI) 1996-2002 as the comparison
group. The probabilities of survival, dying of cancer and dying of other causes were estimated through Cancer Registry statistics offered by the Bureau of Health Promotion. We
divided the whole disease process into initial, continue and terminal three phases.
Therefore, there is no need to follow up the whole progress of the cases from diagnosis to
death. The cost of cancer is the sum of the average cost of each phase. Lifetime costs of
cancers were estimated from the costs calculated above incorporate survival rates of the
cancers. RESULTS: The results showed 895 patients survived less than one year and each
patient spent NT$204,430 during this period. For those survived more than one year, terminal phase resulted in the highest costs which was NT$353,910. The initial phase cost
for each patient is NT$181,923 and the monthly cost for continuing phase is NT$9,239.
For liver cancer patient the 5 year lifetime cost is NT$409,813 and 10 year lifetime cost is
NT$569,809. CONCLUSIONS: Exploring the lifetime cost of cancer will benefit not only the
health policy making but also the clinical decision-making.
PCN4: ECONOMIC EVALUATION OF A NEW DIAGNOSTIC METHOD FOR
DETECTING THE METASTASIS OF BREAST CANCER
Miyake K, Kamae I, Yanagisawa S, Kobe University, Kobe, Hyogo, Japan
The metastasis to the sentinel lymph nodes (SLN) is a key to determine whether or not a
dissection of axillaries lymph nodes should be performed at the early stage of breast cancer, which significantly affects the prognosis and HRQOL of a patient. OBJECTIVE: To evaluate the cost-effectiveness of OSNA (One Step Nucleic Acid Amplification)-based new
diagnostic method for navigation surgery of the SLNs developed by Sysmex Corporation,
Kobe, Japan. METHODS: A decision analytic model was constructed regarding treatments
of breast cancer at the early stage. One arm of the decision tree was based upon the conventional pathological examinations for SLNs. The intra-operative pathological examinations show relatively low sensitivity of diagnosis with less than 80%. Hence, it was
assumed that some patients should have additional surgery to remove metastasized axillaries lymph nodes preceded by dissecting the primary tumors and the SLNs. The other
arm was for the OSNA-based testing, which is expected to achieve high sensitivity and
rapid detection. We employed more than 95% sensitivity and almost 100% specificity
reported by the OSNA clinical studies at Japanese institutions. Utilities and costs in each
arm were obtained from English and Japanese literature. The cost of OSNA-based testing
were assumed to be equal to those of conventional examinations since the OSNA is not
yet available in the market due to developing. RESULTS: The average cost per unit utility
of a patient for the OSNA-based test (US$17,405) was slightly lower, with US$60, than that
of the conventional pathological examinations (US$17,465) in five-year following-up duration with the endpoint of recurrence. CONCLUSIONS: The newly developed OSNA-based
test for detecting the metastasis of breast cancer showed an advantage of lower average
cost per utility of a patient comparing to the conventional pathological examinations. It is a
promising technology for efficiently detecting the early-stage metastases of breast cancer.
PCN5: DOCUMENTATION OF PHARMACY COST IN THE PREPARATION OF
CHEMOTHERAPY INFUSIONS IN ACADEMIC AND COMMUNITY-BASED
ONCOLOGY PRACTICES
Brixner D, Oderda GM, Nickman N, University of Utah College of Pharmacy, Salt Lake
City, UT, USA
41
OBJECTIVE: Significant changes in Medicare reimbursement for outpatient oncology services are included as part of the Medicare Modernization Act of 2003. The objective of this
study was to identify the “true cost” associated with the drug-related handling for the
preparation and delivery of chemotherapy doses. METHODS: Two academic medical outpatient infusion centers (Universities of Utah and Wisconsin) and two community cancer
centers in the U.S. (Fairfax, Virginia and Montgomery, Alabama) provided data used to estimate all “fixed costs” associated with the preparation of chemotherapy including drug
storage, space, insurance management, inventory and waste management, pharmacy staff
payroll, equipment, supplies, information resources and shipping. These costs were annualized and then divided by the number of chemotherapy doses given at each site per year.
A Time-and-Motion study was also performed to determine what tasks were conducted by
pharmacy staff and how much time was spent in the preparation of the top fifteen
chemotherapeutic drugs and regimens used across the four sites. Pharmacy staff were
observed as to the time spent in each task relative to the total time in an average shift to
determine the proportion of total work hours dedicated to the preparation of the selected
chemotherapy drugs. RESULTS: The total average fixed costs for the preparation of
chemotherapy doses across all sites was $36.03 (range $32.08 for Virginia and $67.19 for
Utah). Data from the four centers was projected to the 3,990,495 million estimated
chemotherapy infusions administered to a national Medicare population in 2003 resulting
in a total annual cost to Medicare for chemotherapy preparation of $143,777,535.
Pharmacists were observed to spend the majority of their day (90 % or higher) on tasks
directly related to the preparation of these agents. CONCLUSIONS: Preparation costs for
chemotherapy are significant and need to be considered in determining reimbursement
rates for administration.
for advanced non-small cell lung cancer (NSCLC) showed similar efficacy for pemetrexed,
versus docetaxel, but key safety benefits. A study in the United Kingdom (UK) and France
was conducted to determine patient value associated with individual toxicity profiles.
METHODS: A discrete choice conjoint analysis was used to quantify patient preference
and willingness-to-pay (WTP) for chemotherapy. Trial data plus expert opinion identified
clinically meaningful toxicities that were statistically significantly different. Levels of risk
of: febrile neutropenia (requiring hospitalisation) and nausea, neuropathy, alopecia, were
evaluated. A sample size of 70 pre-treated NSCLC patients per country was calculated following a pilot. Patients considered unique, randomly generated sets of 10 pair-wise choice
scenarios representing levels for toxicity attributes plus cost, designed to elicit trade-offs.
Logistic regression analysis was applied to the stated scenario preferences against the
individual attribute levels. RESULTS: Patients (N=140) were predominantly male; mean
age 61 years and Stage III disease (60%). Pemetrexed was preferred to docetaxel at zero
cost, with a probability of 0.81 in the UK and 0.90 in France. Overall WTP was in favour of
pemetrexed, driven primarily by the risk of febrile neutropenia in the UK, odds ratio (OR)
4.4. In France, preference was driven by a reduced risk of febrile neutropenia (OR 3.2) and
neuropathy (OR 3.2). Cost was not a significant determinant of choice in France; however
in the UK, cost was significant determinant of choice. CONCLUSIONS: NSCLC patients prefer the enhanced toxicity profile with pemetrexed, which translates to valuable quality-oflife gains in the second-line setting. These data provide sensitive strength of preference
measures and may be useful for decision-making purposes by patients, clinicians, and formulary committees.
PCN6: IMPACT OF BREAST CANCER TREATMENT ON HEALTH RELATED
QUALITY OF LIFE
Fukuda T1, Mouri M2, Hirose N2, Ohsumi S3, Mukai H4, Morita S5, Imai H6,
Watanabe T7, Shimozuma K8, Ohashi Y1, 1University of Tokyo, Bunkyo, Tokyo,
Japan, 2Japan Clinical Research Support Unit, Bunkyo, Tokyo, Japan, 3Shikoku
Cancer Center, Matsuyama, Kagawa, Japan, 4National Cancer Center, Kashiwa,
Chiba, Japan, 5Kyoto University, Kyoto, Japan, 6Asahikawa Medical College,
Asahikawa, Hokkaido, Japan, 7Hamamatsu Oncology Center, Hamamatsu, Shizuoka,
Japan, 8University of Marketing and Distribution Sciences, Kobe, Japan
Raetai K, Pratheepawanit N, Weerapreeyakul T, Khon Kaen University, Khon Kaen,
Thailand
OBJECTIVE: Breast cancer is the second most common cancer in Thai women. Current
treatments for breast cancer have shown increasing survival rate as well as side effects.
This study presents HRQOL outcome of breast cancer treatment using two designs. First,
through a cross-sectional study, 167 breast cancer patients receiving care at Khon Kaen
Hospital were recruited into three groups: I) newly diagnosed without treatment (n=57), II)
undergoing chemotherapy (n=80), and III) completed chemotherapy (n=30). Patients mean
age was 51 years (range 31-82) with the majority (76.5%) in early stage. METHODS:
HRQOL was assessed using Thai Functional Assessment of Cancer Therapy-Breast (FACTB) version 4, consisting of five domains: Physical (PWB), Social (SWB), Emotional (EWB)
and Functional (FWB) well-beings plus a breast cancer subscale (BCS). Linear regression
analysis of QOL scores among the three groups, adjusting for age, disease stage, concomitant disease and hotflush showed patients in group II had lower HRQOL scores than
those in group I in most domains, particularly in BCS (beta = -1.6). RESULTS: By contrast,
patients group III showed better HRQOL than those in group I and II. HRQOL was greater
than before treatment, significant in PWB (beta = 2.2), EWB (beta = 3.4), FACT-G (beta =
8.5) and FACT-B (beta = 9.0). The results of side effects were further evaluated in the second study, where HRQOL was evaluated at the treatment initiation and after six months
(N=24). Significantly lower HRQOL scores during the treatment were found. Adjusting for
age, disease and side effects, mucositis caused a significant decline in PWB (beta = -12.9)
and EWB (beta = -10). CONCLUSIONS: The findings suggest that breast cancer treatment
improves patient’s HRQOL, with a temporary reduction of HRQOL scores in the breast cancer subscale while receiving treatment. Side effect management, especially for mucositis,
could lead to improved HRQOL of these patients.
PCN7: PATIENT PREFERENCE AND WILLINGNESS-TO-PAY FOR PEMETREXED
VERSUS DOCETAXEL IN THE SECOND-LINE TREATMENT OF ADVANCED
NON-SMALL CELL LUNG CANCER: A DISCRETE CHOICE CONJOINT ANALYSIS
Brown A1, Aristides M2, Fitzgerald P3, Liepa A4, Boyer M4, Clarke S5, 1Medical
Technology Assessment Group: A Unit of IMS Health, Chatswood, NSW, Australia,
2M-TAG, a division of IMS Health Economics and Outcomes Research, London,
United Kingdom, 3M-TAG, A division of IMS Health Economics and Outcomes
Research, London, United Kingdom, 4Eli Lilly and Company, Indianapolis, Indiana,
USA, 5Sydney Cancer Centre, Camperdown, Australia
OBJECTIVE: The value of health-related quality-of-life assessments is established and
inclusion in clinical decision-making is increasing. A phase III trial in second-line therapy
42
PCN8: METHODS OF COST DATA COLLECTION FOR PHARMACOECONOMIC
STUDY ALONG WITH A CLINICAL TRIAL IN JAPAN
OBJECTIVE: Though cost data is essential for pharmacoeconomic study, the method of
cost data collection is not standardized in Japan. We started cost data collection along
with a clinical trial on breast cancer treatment(National Surgical Adjuvant Study of Breast
Cancer: N-SAS BC02). The trial has been supported by Comprehensive Support Project for
Oncological Research of Breast Cancer. The aim of this study is to demonstrate our
approach for both direct and indirect cost data collection and discuss some issues raised
through the process. METHODS: N-SAS BC02 is a randomized controlled trial of two regimens for breast cancer. From a societal perspective, both direct and indirect cost has been
collected from a sample of 100 participants of the trial upon consent. For direct medical
cost, we collected health insurance claims which were issued every month from each hospital for one year. Even though unit price of each medical procedure and drug is determined by the government, total cost of treatment is unsure, mainly because combination
of procedures are different among health care providers. Direct non-medical cost includes
cost for transportation and supportive devices. Indirect cost was defined as labor loss for
participants. Direct non-medical cost and labor loss days were asked through a selfadministered questionnaire from each participant. RESULTS: Electric data which were kept
in a hospital for making health insurance claims were not easy to use because data format
was not standardized. We propose to use standardized health insurance claim format for
electronic submission. CONCLUSIONS: Though electronic submission is not common yet,
it will be the best way to collect paper-based claims and put the electronic code for each
procedure and drug for a while. Because it is difficult to collect those data retrospectively,it
will be important to consider cost data collection especially direct non-medical and indirect cost along with a clinical trial.
CARDIOVASCULAR DISEASE
PCV1: COST-EFFECTIVENESS ANALYSIS OF CLOPIDOGREL IN ACUTE CORONARY SYNDROMES IN SOUTH KOREA BASED ON CURE TRIAL
Ko S1, Park D2, Yang BM2, 1Health Insurance Review Agency, Seoul, South Korea,
2Seoul National University, Seoul, South Korea
OBJECTIVE: This study was carried out to evaluate the long-term cost-effectiveness of
clopidogrel in addition to aspirin in Acute Coronary Syndromes (ACS) in South Korea.
METHODS: A cost-effectiveness analysis was conducted from the societal perspective and
incremental cost-effectiveness ratios (ICER) were estimated using a long-term Markov
process model, in which transition probabilities were estimated through the survival analysis using the Korean health insurance claims and the cause of death registers data.
Treatment effects were based on the ‘Clopidogrel in Unstable Angina to prevent Recurrent
ischemic Events (CURE)’ trial and it was assumed that patients were treated for one year.
The costs included direct and indirect costs as well as cost in added years of life and were
estimated from the Korean health insurance claims and the National Health and Nutrition
Survey. Both costs and effectiveness were discounted by 5 percent. Sensitivity and subgroup analyses were conducted on the discounting rate and on the baseline population
structure to test the robustness of the results. RESULTS: In the base case scenario, the
model predicted a longer survival in the ‘clopidogrel in addition to aspirin’ arm (7.705
years vs. 7.439 years incremental LYG=0.266 years) and higher costs in the ‘aspirin alone’
arm (6,944,249 vs. 6,876,536 Korean Won; incremental costs=67,713 Kwon)(US $1 =
approximately 1000 Korean won). The cost was lower while the effectiveness was better;
therefore, the ‘clopidogrel in addition to aspirin’ arm was dominant over ‘aspirin alone’ arm
in cost-effectiveness. Sensitivity and subgroup analyses showed that ‘clopidogrel in addition to aspirin’ remained cost effective regardless of the population structure and discount
rate change. CONCLUSIONS: The combination clopidogrel with aspirin is cost effective in
patients with ACS in South Korea compared to aspirin alone.
PCV2: COST-EFFECTIVENESS ANALYSIS OF SINGLE VS. DUAL CHAMBER
PACEMAKERS IN THE TREATMENT OF BRADYCARDIA IN SPAIN.
Mercader-Cuesta J1, Rodriguez JM2, Serrano-Contreras D2, Caro JJ3, Ward AJ3,
Malik F4, 1Hospital de Granollers, Granollers, Barcelona, Spain, 2Medtronic Iberica,
Madrid, Spain, 3Caro Research Institute, Concord, MA, USA, 4Medtronic S.A,
Tolochenaz, Morges, Switzerland
Implantation of pacemakers has become an established approach to bradycardia due to
sinoatrial node disease or atrioventricular block and is becoming a more common procedure. Two different types of pacemakers are available to treat bradycardia, single and dual
chamber pacemakers. Despite dual chamber pacemaker have shown to have a better cardiac rhythm control, it use is nowadays limited in Spain. OBJECTIVE: To adapt an existing
economic model of managing bradycardia with a dual vs. single chamber ventricular
pacemaker to estimate the long-term economic and health impact of these devices in
Spain. METHODS: A discrete event simulation model was adapted for the Spanish setting.
A cohort of 1,000 patients was created, characteristics were assigned to each individual
and then each patient is cloned. One clone received a dual chamber device, the other a
single chamber one. During the simulation, each patient may develop different clinical
events, complications and adverse events. Clinical data were retrieved from published trials, and resource use and costs were obtained from the Hospital of Granollers. Time horizon contemplated was 5 years. The perspective of the analysis was the NHS, so only direct
costs were included. Costs and benefits were discounted at 3%. RESULTS: Based on 100
replications, the mean costs per patient in the dual chamber arm exceeded in 331
respect single chamber patients. The dual chamber patients were predicted to increase
the discounted QALY by a mean 0.09 years. The mean cost-effectiveness ratio was 3,678
per discounted QALY. Sensitivity analyses showed the results to be consistent over broad
ranges. CONCLUSIONS: The use of dual chamber devices in patients with bradycardia due
to sinoatrial node disease or atrioventricular block, is an efficient technology compared to
single chamber, in the Spanish setting, with a C/E rate below the accepted Spanish
threshold (30,000/QALY).
PCV3: COST-EFFECTIVENESS OF EPLERENONE IN PATIENTS WITH HEART
FAILURE AFTER ACUTE MYOCARDIAL INFARCTION WHO WERE TAKING
BOTH ACE INHIBITORS AND ?-BLOCKERS: RESULTS FROM EPHESUS
Zhang Z, Weintraub WS, Christiana Care Health System, Newark, DE, USA
OBJECTIVE: The EPHESUS trial showed that the use of eplerenone in the setting of heart
failure after acute myocardial infarction is highly cost-effective. This analysis considers the
cost-effectiveness of eplerenone in patient population who were taking both ACE
inhibitors/ARBs and blockers at baseline from EPHESUS. METHODS: A total of 6632
patients were randomized to eplerenone 25-50 mg/day (n=3319) or placebo (n=3313)
used concurrently with standard therapy and followed for up to 2.5 years. Of these, 4359
(66%) patients (eplerenone: 2162; placebo: 2197) were taking both ACE inhibitors/ARBs
and ?-blockers at baseline. Trial wide efficacy and resource utilization were used in the
analysis. Resources included hospitalizations, outpatient services, and medications.
Eplerenone was priced at $3.6/day. The incremental cost-effectiveness of eplerenone in
cost per life-year gained (LYG) and cost per quality-adjusted life year (QALYs) gained was
estimated using data from the Framingham, Saskatchewan and Worcester studies to project long-term survival. Both costs and effectiveness were discounted at 3%. RESULTS: As
in the overall study population, the costs tended to be similarly higher in the eplerenone
arm for patients who were taking both ACE inhibitors and ?-blockers (cost difference=$1697). The number of LYG with eplerenone was 0.1637 based on Framingham,
0.0970 with Saskatchewan, and 0.2121 with Worcester data. The incremental cost-effectiveness ratio (ICERs) was $10,372 per LYG with Framingham (99% under $50,000 per
LYG), $17,493 with Saskatchewan, and $8,003 with Worcester. The ICERs are systematically higher when calculated in cost per QALY gained ($15,021, $25,283, and $11,499 per
QALY gained, respectively), as the utilities were below 1 with no difference between the
treatment arms. CONCLUSIONS: As was for the entire EPHESUS population, aldosterone
blockade with eplerenone is effective in reducing mortality and, is cost-effective in
increasing years of life for EPHESUS subgroup patients who were taking both ACE
inhibitors and ?-blockers.
PCV4: A HEALTH ECONOMIC EVALUATION OF ASPIRIN IN THE PRIMARY
PREVENTION OF CARDIOVASCULAR DISEASE
Lamotte M1, Annemans L2, Evers T3, Kubin M3, Hu S4, 1HEDM - IMS Health,
Brussels, Belgium, 2IMS Health and Ghent University, Brussels, Belgium, 3Bayer
Healthcare AG, Wuppertal, Germany, 4Fudan University (former Shanghai Medical
University), Shanghai, China
OBJECTIVE: Low-dose Aspirin is standard care in patients with a history of cardiovascular
disease (CVD). In primary prevention the use of low-dose Aspirin is not yet fully established
although meta-analyses and US and European guidelines support its use in persons at
increased CVD risk. This study assessed the health-economic consequences of the use of
low-dose Aspirin in the primary prevention of CVD in China. METHODS: Based on results
(benefits and harms) reported in the meta-analyses of Hayden and Eidelman, a Markov
model was developed to predict the cost-effectiveness of low-dose Aspirin in the primary
prevention of CVD. The model consists of 5 health states: no history of CVD, history of
stroke, history of myocardial infarction, history of CVD and death. A 10-year time horizon
and 1-year cycles were used. Secondary prevention data were derived from the Aspirin
group of the CAPRIE-study (1996). Direct costs (years 2000-2003) from the payer’s perspective were used (sources: Chinese Ministry of health for acute and a Delphi-panel for
follow-up costs). Effects were expressed in Life-Years (LY) and Quality-Adjusted-Life-Years
(QALY). Utility data (TTO) were obtained from published data. Discounting was applied (3%
on effects and costs). One-way and Probabilistic sensitivity analysis was applied.
RESULTS: For subjects with a 10-year risk of coronary heart disease (CHD) of 15% the
model results in a 10-year cost (±StErr) of 11,233±1,995Yuan (1,060±188 ) without and
10,304±1,537Yuan (972±145 ) with Aspirin. Low-dose Aspirin treatment saves on average 929±781Yuan (88±74 ) per patient. LY were respectively 8.33±0.01 and 8.36±0.02,
QALY 8.20±0.02 and 8.24±0.03. Monte Carlo analysis showed Aspirin-dominance in
87.1% of cases. Savings start in the fourth year. CONCLUSIONS: Administering low-dose
Aspirin to individuals with a ten-year risk of CHD of 15% and more is life and cost-saving
from the Chinese health care payer’s perspective. Sensitivity analyses (CHD risk and
bleedings) proved the results robustness.
PCV5: FACTORS AFFECTING COST OF STATIN THERAPY IN HONG KONG
Cheng C1, Chan JC2, Tomlinson B2, Woo KS3, You JH4, 1Chinese University of Hong
Kong, Shatin, Hong Kong, 2The Chinese University of Hong Kong, Hong Kong, China,
3The Chinese University of Hong Kong, Shatin, Hong Kong, 4The Chinese University
of Hong Kong, Shatin, N.T, Hong Kong
OBJECTIVE: Aim of present study was to identify factors affecting direct medical cost
associated with statin therapy in Chinese patients at high risk of coronary heart disease
(CHD). METHODS: Chinese patients at high risk of CHD who had been initiated on statin
monotherapy for 12 months were recruited at the outpatient clinics of a public teaching
hospital in Hong Kong. Patients’ demographic information and clinical characteristics were
collected at the entry of study. Patient adherence was assessed by the Medication Event
Monitoring System over six months. The target types of healthcare resources included
clinic visits, statin medications, laboratory tests on lipids and management of CHD events
if any. Total direct medical cost per member per month (cPMPM) for each patient was cal43
culated. A multiple regression model was used to identify demographic, clinical factors and
patient adherence with significant association to cPMPM. RESULTS: 83 patients were
included in the analysis. The mean age was 60 +/- 13 years and 51 (61%) of the patients
were male. The median cPMPM of all 83 patients was USD43 (25th–75th percentile =
USD38-45). Association between adherence levels and cPMPM was determined by backward multiple regression, controlling for other covariates. Nine factors identified by the
model were male gender, monthly household income, primary education (< 6 years), dosetime adherence to statins, history of diabetes mellitus, congestive heart failure, coronary
atherosclerosis, coronary artery bypass graft and percutaneous transluminal coronary
angioplasty. Male gender, history of diabetes mellitus, congestive heart failure and coronary atherosclerosis were significantly associated with higher consumption of healthcare
resources. CONCLUSIONS: Male gender, history of diabetes mellitus, congestive heart failure and coronary atherosclerosis were significantly associated with higher consumption of
healthcare resources. Adherence to statin therapy did not appear to affect the cost of
treatment.
PCV6: TREND ANALYSIS OF PRICE AND UTILIZATION OF STATIN DRUGS IN
U.S. MEDICAID PROGRAMS
Jing Y, Chen Y, Kelton CM, Guo JJ, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: Statins are used to treat abnormal blood lipids for reducing cholesterol and
are prescribed for the elderly and other high-risk populations. The objective of this study is
to compare drug price, cost, utilization, and market-share trends across statin drugs in
order to shed light on the effects of both interbrand and generic competition in the market
for statins. METHODS: Using data from First DataBank, we calculated the monthly average
wholesale price (AWP) per daily dose for each branded and generic statin drug over the
period 1989-2002. We also analyzed national Medicaid pharmacy data to construct quarterly prescription numbers (and market shares by dividing by total number of statin prescriptions) and per-prescription reimbursement figures for each drug from 1991-2004.
RESULTS: Total expenditure by U.S. Medicaid programs on statin drugs increased from
$41.8 million in 1991 to $1.37 billion in 2003. The top three drugs reimbursed by
Medicaid in 2004 included Lipitor, Zocor, and Pravachol, with market shares of 49.0%,
29.1%, and 9.7%, respectively. Whereas Zocor, Mevacor, and Pravachol have a relatively
high AWP per daily dose (between $4.00 and $6.50 since 1993), the AWP for Lipitor is
much lower. A rapid increase of Lipitor prescriptions was observed from 2290 in 1st quarter 1997 to two million in 2004. The average reimbursement per statin prescription in
Medicaid increased from $68.70 in 1991 to $101.90 in 2004. When the generic lovastatin
was introduced at two-thirds the branded AWP, there is no drop in the price of Mevacor,
though Medicaid does face a lower cost per Mevacor prescription. CONCLUSIONS: Our
results give little indication of effective interbrand competition in the statin market. Neither
price nor utilization of other branded medications falls in response to new branded entry.
Use of a branded drug does fall following generic entry.
PCV8: ANALYSES FOR PRICE AND UTILIZATION OF CALCIUM CHANNEL
BLOCKERS IN US MEDICAID PROGRAMS
Chen Y, Guo JJ, Jing YH, Wigle P, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: To analyze price and utilization trends for Calcium Channel Blockers (CCB)
drugs, and to compare the price difference between brand-name and generic CCB drugs
over a specific time interval. METHODS: CCB drugs with an indication for hypertension
were selected for this study. The First DataBank® drug files and National Medicaid
Pharmacy data were used to calculate the monthly Average Wholesaler Prices (AWP),
quarterly prescription use and reimbursement. Descriptive time-series trend analyses were
performed to assess price trends and drug utilization patterns. The market shares were
calculated as the proportion of total number of prescriptions. RESULTS: The average AWP
per daily dose for CCBs included three tiers: the highest with $2 or more per day for
Cardizem®, Plendil®, and Procardia XL®, the lowest with $1 or less per day for Isoptin®
and verapamil, and middle for Norvasc ® and Cardene®. The generic dilatizem AWP
decreased from $0.84 in 1996 to $0.34 in 2004, while its brand Cardizem AWP increased
over time. Use of branded drugs (Calan®, Procardia, and Cardizem) decreased while use
of generics (verapamil, nifedipine, and diltiazem) increased. The utilization of the dihydropyridine CCBs (e.g. Norvasc®, Procardia®) was about two-fold that of the non-dihydropyridine CCBs in 2004. Total expenditure for brand name drugs increased from $28.87
million per quarter in 1991 to $1.15 billion per quarter in 2004. The market-share of
44
Procardia ® decreased sharply from 64.26% in 1991 to 3.9% in 2001, while Norvasc®
increased from 5.78% in 1993 to 73.98 % in 2004. CONCLUSIONS: The generic AWP
decreased due to competition, but there was little impact on its brand-name AWP.
Increased use of Norvasc® might be associated with its safety profile. Decreased use of
brand-name CCBs might be due to Medicaid policy of generic drug use.
PCV9: DRUG PRICE AND UTILIZATION OF BETA BLOCKERS IN US MEDICAID
PROGRAMS
Jing Y, Chen Y, Wigle P, Guo JJ, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: Beta-blockers (BB) were the fifth most widely prescribed class of medications
in 2004. The objective of this study was to analyze the drug price trends of brand-name
and generic beta blockers, and to assess drug utilization and market-share competition in
US Medicaid Programs. METHODS: The monthly average wholesale price (AWP) per daily
dose for each antihypertensive beta-blocker available between 1986 and 2002 was evaluated using data extracted from First DataBank. National Medicaid pharmacy data files
were also analyzed to construct the quarterly prescription numbers and per-prescription
reimbursement figures for each drug in the time frame of 1990 through 2004. The market-share of beta-blockers was calculated based on numbers of prescriptions. RESULTS:
Since 1993, the average AWP for brand-name drugs increased over time, while generic
drug prices decreased or changed slightly. The only exception was propranolol.
Reimbursement cost per prescription showed a similar pattern. The expenditure for BBs in
US Medicaid programs in 2003 was $206 million (114.8 million for brand-name drugs,
91.6 million for generics). While the market share of brand-name BB prescriptions dropped
from 63.1% in 1991 to 25.5 % in 2003, Toprol prescriptions has increased sharply to
870,037 in 2nd quarter 2004 since entry to the market in early 1992. The prescriptions for
Tenormin and Lopressor decreased over time due to availability of generic products. The
prescriptions of atenolol and metoprolol increased sharply after they were introduced into
the market. CONCLUSIONS: Large increases in BB expenditures paralleled the increased
number of prescriptions. The increased use of BB might be due to the blood pressure benefit for diabetic patients and mortality benefit for post-MI patients with heart failure. The
market share competition between brand-name and generic drugs was observed in U.S.
Medicaid programs.
PCV10 : PHYSICAL INACTIVITY IS ASSOCIATED WITH INCREASED HEALTHCARE USE AND EXPENDITURES IN INDIVIDUALS WITH HYPERTENSION
Iyer R1, Modi A2, 1University of Appalachia College of Pharmacy, Grundy, VA, USA,
2Purdue University, Indianapolis, IN, USA
The importance of physical activity in reducing morbidity and mortality is well established,
but the effect of physical inactivity on direct medical costs is less clear. OBJECTIVE: To
examine the health care use and health care expenditure associated with physical inactivity in hypertensive patients. An additional objective was to compare differences in the perceived physical health and perceived mental health in these patients. METHODS: Crosssectional analysis of the 2001 Medical Expenditure Panel Survey that included US civilian
men and non-pregnant women aged 15 and older who were not in institutions in 2001.
Patients with hypertension were identified by ICD-9-CM code of 401.00. The outcome
measures were health care use health care expenditure. We used analysis of covariance to
determine differences in health care use and expenditures, adjusting for age, sex, race,
marital status, and income status. RESULTS: After adjusting for covariates the expenditures for prescription medications were higher in physically inactive individuals than in
physically active individuals with hypertension ($ 736 vs. $621, p = 0.0003). There were
no statistically significant differences in other expenditure categories. The total direct cost
were significantly different for hypertensive patients who were physically active and those
who were not. ($806.80 vs $ 687.04, P = 0.006). Of the individuals with hypertension,
those who were physically active reported being in good to excellent health compared to
their counterparts who were physically inactive. (56 vs. 39%, P = 0.009). Similarly, physically inactive hypertensive patients reported poor mental health (31 vs. 13%, P = 0.002)
than physically active hypertensive patients. CONCLUSIONS: The mean net annual benefit
of physical activity in hypertensive patients was $ 120 per person in 2003 dollars. Our
results suggest that increasing participation in regular moderate physical activity among
these patients could reduce the annual national health care spending by a significant
amount.
PCV11: STATINS UTILIZATION FOR SECONDARY PREVENTION IN PATIENTS
WITH ACUTE MYOCARDIAL INFARCTION IN HONG KONG
Lee VWY1, Chan WK2, Lee BS3, Tomlinson B4, Chong AC5, Wong JC3, Lee KK1,
1The Chinese University of Hong Kong, Shatin, China, 2Department of Medicine &
Geriatrics, United Christian Hospital, Kwun Tong, China, 3Department of Pharmacy,
Prince of Wales Hospital, Shatin, China, 4Department of Medicine & Therapeutics,
The Chinese University of Hong Kong, Hong Kong, China, 5United Christian Hospital,
Kwun Tong, China
The use of statin therapy for secondary prevention of coronary heart disease is highly efficacious and cost-effective in high-risk patients. OBJECTIVE: The current study was to
investigate the local utilization pattern of statin for secondary prevention in patients with
history of myocardial infarction (MI) and the low-density lipoprotein cholesterol (LDL-C)
goal attainment. METHODS: Patients who had admitted to the United Christian Hospital
and Prince of Wales Hospital due to acute MI between September 1, 2001 to December
31, 2001 were recruited. Retrospective chart review was conducted for a period of 2
years, starting from the date of hospital admission. Patients’ demographics, baseline and
follow-up cholesterol laboratory values and statins treatment data were collected.
RESULTS: A total of 292 patients (209 males; mean age 65.2 ± 12.7 years; mean baseline
LDL-C 3.26±1.09 mmol/L) were included. Statins were prescribed in 66% patients and
1% were prescribed gemfibrozil. Among those receiving statins, simvastatin was the most
commonly prescribed statin and it was utilized in 47% of patients. Low-dose statin (simvastatin 10 mg or lower potency) was given in 45% of patients as initial regimen. At the
end of 2-year study period, 42% of them were on low-dose statin therapy. LDL-C goal of
<2.6 mmol/L was reached in 52% of patients at the end of 2-year study period; 20% of
them were not at goal. The mean final LDL-C was 2.27± 0.65 mmol/L. The LDL-C levels at
the end of study period were not documented in 28% patients. Of the 292 patients, recurrent MI and stroke occurred in 13% and 5% respectively. Adverse effects associated with
statin therapy were found in 3% of patients. CONCLUSIONS: Overall lipid-lowering management was encouraging but there is room for improvement. Routine cholesterol laboratory measurements dosage titration of statin should be made according to individual LDLC level.
PCV12: THE COST-EFFECTIVENESS OF CRYOPLASTY IN THE TREATMENT OF
FEMOROPOPLITEAL ARTERIAL DISEASE
Audi S, Coles T, Boston Scientific Ltd, St. Albans, United Kingdom
OBJECTIVE: To analyze the treatment cost and cost-effectiveness of cryoplasty, a minimally invasive treatment for peripheral arterial disease (PAD), compared to angioplasty
treatment in patients with Femoropopliteal Arterial Disease in the UK at 12-months. METHODS: A decision-analytic model combining clinical data from several sources on patency
rates with UK unit costs for medical resources. RESULTS: The total average per patient
hospital cost at 12-months were ≤3,433 for cryoplasty and ≤3,922 for angioplasty. The
total cost included initial treatment cost, stenting cost post-procedure, and reintervention
costs. Although the initial treatment and stenting costs with cryoplasty were higher
(≤2,835 vs. ≤2,233 for angioplasty), these costs were outweighed by the savings from
lower reintervention costs of cryoplasty (≤599 vs. ≤1,690 for angioplasty). Because cryoplasty offered improved clinical patency at a lower cost, it was a dominant treatment.
CONCLUSIONS: Endovascular treatment options for patients with Femoropopliteal Arterial
Disease offer a clinical alternative to surgery and, in severe cases, amputation. Cyroplasty
may offer an improvement in clinical patency compared to angioplasty, and may do so at a
lower cost. As these results depend on local treatment practices, centers must apply their
own data to understand local impact.
PCV13: COST-SAVING OF PHARMACIST INTERVENTION ON WARFARIN
THERAPY IN PATIENTS WITH MECHANICAL HEART VALVES.
Rojsutee S, Musikachai P, Pongchareonsuk P, Chaikledkaew U, Mahidol University,
Bangkok, Thailand
OBJECTIVE: To evaluate the cost-saving of pharmacist intervention on warfarin therapy in
Thai patients with mechanical heart valves from provider perspective. METHODS: Decision
tree model was used to estimate the cost saving of pharmacist intervention on warfarin
therapy. Only direct cost was used in the simulations. Estimates were based on the study
evaluating the impact of education and counseling by clinical pharmacists on anticoagulation therapy in patients with mechanical heart valves of Siriraj Hospital cost data were
obtained from Siriraj Hospital. RESULTS: The mode estimates that pharmacist intervention
can save cost on warfarin therapy in Thai patients with mechanical heart valves 12,049.89
baht ( $301.25 ) per patient per year (3,313,172.43 baht ( $82829.31 ) for total per year)
CONCLUSIONS: Pharmacist intervention can provide substantial saving and present a
favorable economic profile in the treatment of warfarin therapy in Thai patients with
mechanical heart valves
DIABETES
PDB1: PREVALENCE OF DIABETES MELLITUS AND TREATMENT PATTERNS
BASED ON CLASSIFICATION OF BODY MASS INDEX AMONG ADULTS
Suh DC1, Choi IS1, Shin HC1, Barone JA1, Park J2, Vo L1, 1Rutgers University,
Piscataway, NJ, USA, 2Inha University, Incheon, South Korea
OBJECTIVE: To examine trends of diabetes mellitus (DM) prevalence in adults and to
investigate treatment patterns and HbA1c control according to their body mass index (BMI)
classification. METHODS: This study used the Third National Health and Nutrition
Examination Survey (NHANES III for 1988-1994) and NHANES 2001-2002, representing a
national sample of the non-institutionalized civilian US population. Study patients were
identified if they were ≥20 years old, were previously diagnosed with DM by a physician or
is currently using DM therapy (insulin or a hypoglycemic agent). DM patients were classified as normal(BMI<25), overweight(BMI:25-29), or obese(BMI≥30). Data were analyzed
using SAS and SUDAAN statistical software. RESULTS: The age-adjusted prevalence of DM
significantly increased from 5.4% in 1988-1994 to 7.1% in 2001-2002 (increase of 1.7%:
p<0.05). In 2001-2002, DM was more prevalent in overweight patients (6.1%) and obese
patients (10.5%) than in normal weight patients (4%). These trends were similar in 19881994. More DM patients (80% of overweight and 87% of obese patients) received treatment in 2001-2002 than during 1988-1994 (70% and 78%) (increases:p=0.05 respectively). Patients were treated with oral antihyperglycemics only most frequently (56%), followed by insulin only (17%), and with both insulin and an oral agent (9%). Overall, mean
HbA1c decreased from 7.7% (57% of DM-patients:HbA1c„d7%) in 1988-1994 to 7.5%
(50% of DM-patients:HbA1c„d7%) in 2001-2002 (p=0.24). CONCLUSIONS: Over the past
decade, DM has become more prevalent in US adults, more overweight and obese DM
patients have received treatment, yet 20% of overall DM patients still have not received
treatment. In 2001-2002, half of diabetic patients did not control their HbA1c level and
diabetic patients who were obese were less likely to control their HbA1c compared to
patients who were normal weight.
PDB2: A POPULATION APPROACH TO COMPARE DIABETES IN THE US AND
IN TAIWAN
Chang HY1, Hsu CC1, Chiang CY1, Hung BS2, 1National Health Research Institutes,
Maoli, Taiwan, 2Bureau of Health Promotion, Taichung, Taiwan
OBJECTIVE: Diabetes has been one of the leading causes of death since 1983. The death
rate increased sharply in past ten years. The mortality was 44.4 per 100,000 in 2003,
about 72% increment from 25.7, the death rate in 1993. The mortality in 2003 was almost
10 times of Japan, over three times of US, and two times of Korea’s mortality. The purpose
of this study is to investigate the differences of diabetes in the US population and the
Taiwanese population. METHODS: We used two national surveys to identify diabetes in the
population, the 1999-2002 NHANES and the 2002 Taiwan Survey on Hypertension,
Hyperglycemia and Hypercholesterolemia. The definition of diabetes was those (a) who
reported to be told to have the disease; (b) who reported to take medications for the disease, or (c) with fasting glucose over 126 mg/dL. Their demographic characteristics, lipid
profiles, blood pressures, health behaviors and complications were compared. Descript
statistics were used to compare the diabetes patients directly. SUDAAN was used to estimate the design effect after accounting for the complex survey scheme. RESULTS: There
were 350 whites, 594 blacks and 478 Taiwanese were identified as diabetes in the surveys. The average ages for males were around 55-58 years, while those for females were
55-65 years. The HbA1c was best control in US whites. Both white males and females
were under 8%. On the other hand, it was over 8% for the Taiwanese females and all
blacks. Taiwanese had the lowest BMI and highest DBP among these three groups of people. The proportions of exercise, smoking and hypertension in Taiwanese were the lowest.
CONCLUSIONS: The possible reasons for the differences between these populations are
genetic makeup, public health education and treatments.
45
PDB3: COST OF MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN HONG
KONG CHINESE
Chan BS1, Tsang M2, Lee VW1, Lee KK3, 1The Chinese University of Hong Kong,
Hong Kong, China, 2United Christian Hospital, Hong Kong, China, 3The Chinese
University of Hong Kong, Shatin, Hong Kong, China
OBJECTIVE: Despite the recent increase in incidence and prevalence of Type 2 diabetes
mellitus (T2DM) in Hong Kong (HK), the economic impact of the disease has never been
investigated. This study aimed to estimate the total economic burden of a group of T2DM
patients attending a public hospital in HK using a bottom-up, prevalence-based cost-of-illness approach. METHODS: A retrospective cohort observational study was conducted. The
direct medical costs incurred at the public hospital were collected from a hospital electronic database. The other costs were estimated using a standard Chinese questionnaire.
The figures obtained were extrapolated to estimate the total burden for the whole T2DM
population in HK. The study was conducted from the perspective of a public hospital.
RESULTS: Two hundred and four patients with T2DM were randomly selected to join this
study and 147 were subsequently enrolled. Annual total direct medical cost per patient
was US$1,492 in which the Government was shouldering 90.6%, while the patients only
paid for the remaining 9.4%. Among these, specialist outpatient clinic visit costs and inpatient costs were the major cost drivers, which contributed up to 39.6% and 43.0% of the
overall cost paid by the Government, respectively. The direct medical cost paid by the
Government jumped dramatically, by 1.3 times, if the patient had complications. The total
government direct medical cost for those without complication was US$1,254/patient/year,
which would jump to US$1,692/patient/year for patients developing both microvascular
and macrovascular complications.T2DM was found to have significant impact to the local
health care budget. It contributed to 5.0% of the total HK health care expenditure and
8.2% of the total Government healthcare expenditure. CONCLUSIONS: This study confirmed T2DM and its complications posed a significant burden on the HK health care
budget. Slowing the progression of the disease to the more advanced and costly states
should be cost-saving.
PDB4: HEALTH-RELATED QUALITY OF LIFE (HRQOL) IN THAI DIABETIC
PATIENTS
Thavorncharoensap M, Pongcharoensuk P, Chaikledkaew U, Suksomboon N, Mahidol
University, Rajathevi, Bangkok, Thailand
OBJECTIVE: To assess Health Related Quality of Life (HRQOL) among patients with diabetes mellitus in Thailand. METHODS: Cross-sectional survey was conducted during
September - November 2004. Three hundred and thirty three patients selected from 5
hospitals in Thailand were interviewed using Thai-version of the Medical Outcome Study
Short Form (SF-36). Also, utility value was measured using Visual Analog Scale (VAS).
RESULTS: Average score on 8 SF-36 subscales ranged from 48.37 (S.D. = 21.43) in
General Health (GH) subscale to 82.05 (S.D. = 22.87) in Social functioning (SF) subscale.
Concerning health transition, as compared to previous year, patients reported that their
general health was about the same (32.1%), somewhat worse (29.2%), somewhat better
(23.4%), much better (8.1%), and much worse (7.2%). Utility value of the patients ranged
from 0 to 100 with an average of 66.59 and the S.D. of 19.57. When looking at the demographic characteristics, it was found that those with low income had lower score on all 8
SF-36 subscales and VAS than the others. Patients recruited from outpatient department
had higher HRQOL than those recruited from inpatient department. No significant difference across gender on their HRQOL and utility value was found except in the Physical
Functioning (PF) subscale. It was found that male had marginally higher score in PF subscale than female. No significant difference in HRQOL and utility value across smoking status and drinking status was found. For clinical characteristic, it was found that those who
had co-morbidity had lower score in Physical Functioning (PF) subscale and Role emotional (RE) subscale than those who did not have co-morbidity. CONCLUSIONS: Diabetes
Mellitus negatively affects HRQOL of the patients in several domains. Specific attention
should be paid to these patients to improve their HRQOL especially for the patients who
had low income and those with co-morbidity.
Singapore, Singapore, Singapore, 4Singhealth Polyclinics, Singapore
OBJECTIVE: To evaluate if diabetes knowledge is associated with health-related quality of
life (HRQoL)among English-speaking subjects with diabetes in Singapore. METHODS:
English-speaking subjects (aged >21) with self-reported diabetes were recruited by convenience sampling at a public event organized by Diabetic Society of Singapore to commemorate the World Diabetes Day. Correlation between diabetes knowledge (measured
using the General Diabetes Knowledge Test (GDKT), range 0-100) and HRQoL (measured
using the Audit of Diabetes-dependent Quality of life (ADDQoL), range 0-100; EQ-5D, range
–0.594 to 1 and the SF-6D, range 0.26-1) were studied using Pearson correlation coefficients. The relationship between diabetes knowledge and HRQoL was studied using three
separate multiple linear regression (MLR) models with HRQoL scores as dependent variable and GDKT score as independent variable while adjusting for age, gender, ethnicity,
education, housing type, smoking status and presence of acute/ chronic medical conditions and diabetes complications. RESULTS: Data from 42 subjects with complete
responses were analyzed (mean (SD) age: 53.0(9.61) years, 45.0% female, 90.0% with >6
years of education, 64.3% with other chronic medical conditions, 40.5% with diabetes
complications). Mean (SD) GDKT, ADDQoL, EQ-5D and SF-6D scores were 33.1(3.53),
46.9(18.56), 0.9(0.15) and 0.8(0.14) respectively. Correlations between diabetes knowledge and ADDQoL, EQ-5D and SF-6D scores were 0.26, 0.30 and 0.21 respectively.
Although none of the independent variables was associated significantly with HRQoL
scores in any of the MLR models (p>0.05), a trend of association was nevertheless
observed. CONCLUSIONS: Our results showed diabetes knowledge to be weakly correlated with both diabetes-specific and generic health-related quality of life. In addition, diabetes knowledge may be positively associated with diabetes-specific HRQoL but further
studies utilizing larger sample size would be required to confirm the observation.
PDB6: OBESITY’S IMPACT ON DIABETES PATIENTS’ HEALTH-RELATED
QUALITY OF LIFE IN THE U.S.
Cremieux PY1, Xie J2, Greenberg P1, Wu EQ3, Castor AR1, 1Analysis Group Inc,
Boston, MA, USA, 2The University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA, 3Analysis Group, Boston, MA, USA
OBJECTIVE: To assess obesity’s impact on the health-related quality of life (HRQL) of diabetes patients in the U.S. METHODS: Adults (age >= 18) with diabetes (ICD9CM = 250) in
the 2000 and 2002 Medical Expenditure Panel Survey (MEPS) were classified as underweight (BMI<18), normal weight (BMI:18-24.9), overweight (BMI:25-29.9), or obese (BMI:
>=30). Underweight individuals were excluded from the study sample. HRQL was
assessed using SF-12 physical, SF-12 mental and EQ-5D index scores. These scores were
used to compare obese vs. normal weight and overweight vs. normal weight populations.
Stratification matching methods were employed to control for demographic differences
between comparison groups (e.g. age, sex, race, and geographic location). Differences in
HRQL scores are reported using both absolute difference and effect sizes (ES). Individual
MEPS weights were used to achieve U.S. nationally representative estimates. RESULTS: A
total of 2,777 adults with diabetes are included in the study, of which 497 are of normal
weight, 903 are overweight, and 1,377 are obese. SF-12 physical and EQ-5D index scores
for the obese sample were 4.35 and 0.06 lower (4.35% and 6.27%; ES = 0.35 and 0.19,
respectively) than the normal weight sample (p<.05). All differences reported control for
age, sex, race, and geographic location. There were no statistically significant differences
in the SF-12 mental scores between the obese and normal weight samples. Similarly, SF12 mental, SF-12 physical and EQ-5D index scores were statistically no different between
the overweight and the normal weight populations. CONCLUSIONS: Obesity is associated
with a statistically significant reduction in physical HRQL and overall health utility among
diabetic patients in the United States but does not seem to affect their mental health. On
the other hand, overweight leaves physical, mental and overall health utility scores
unchanged relative to a normal weight population.
PDB7: IMPACT OF OBESITY AND DIABETES ON HEALTH-RELATED QUALITY
OF LIFE
Iyer R, University of Appalachia College of Pharmacy, Grundy, VA, USA
PDB5: IS DIABETES KNOWLEDGE ASSOCIATED WITH HEALTH-RELATED
QUALITY OF LIFE AMONG ENGLISH-SPEAKING SUBJECTS WITH DIABETES
IN SINGAPORE?
Zhang XH1, Wee HL2, Tan K3, Tan HH4, Thumboo J2, Li SC1, 1National University of
Singapore, Singapore, 2Singapore General Hospital, Singapore, 3Diabetic Society of
46
How obesity affects health-related quality-of-life (HRQOL), particularly in patients with diabetes, is less clear. OBJECTIVE: The objective of this study is to examine the relationship
between obesity and HRQOL in diabetic patients. An additional objective was to examine
the difference in total costs and prescription costs in these patients. METHODS: The data
for this study came from the 2002 Medical Expenditure Panel Survey. Respondents > 17
years were classified as normal, overweight or non-obese based on BMI. HRQOL was
measured by the 12-item Short Form physical and mental summary scores (PCS-12 and
MCS-12, respectively). Non-diabetic patients greater than 17 years with demographic
characteristics matched to the diabetic group were used for comparison. Analysis of variance was used to compare the four study groups (diabetic/obese, diabetic/non-obese,
non-diabetic/obese, and non-diabetic/non-obese). Expenditures were adjusted for inflation
with the consumer price index. RESULTS: The total sample consisted of 4020 patients.
Mean scores for obese diabetics were lower than mean score for non-obese diabetics in
all eight health-related quality of life scales. The physical component summary scores
were significantly higher in normal non-diabetic patients than in obese diabetics (40.145
vs. 34.543, p = 0.0004). The difference in the total expenditure between normal non-diabetic and diabetic groups was $3145 (p=0.0007). Expenditure for prescription medication
was significantly different in the two groups $1594(p = 0.0000). There was no significant
difference in the mental component summary scores among the four groups. CONCLUSIONS: Patients with obesity had significantly lower HRQOL than those who were normal
weight. Counseling for exercise, importance of nutrition, and optimal management of diabetes in these patients could improve their quality of life and reduce the national healthcare spending.
PDB8: PERCEIVED SELF-EFFICACY TRAINING (PSET) PROGRAM IN TYPE 2
DIABETES
Suksomboon N1, Poolsup N2, Hoharitanon S3, Luckanajantachote P3, 1Mahidol
University, Rajathevi, Bangkok, Thailand, 2Silpakorn University, Nakornprathom,
Thailand, 3Samutsakorn Hospital, Samutsakorn, Thailand
OBJECTIVE: To evaluate the effects of perceived self-efficacy training program in type-2
diabetes. METHODS: A total of 54 diabetic patients were randomized to the intervention or
control group at primary care unit, Samutsakhon Hospital, Thailand. Patients in the intervention group entered perceived self-efficacy training program, those in the control group
did not. The patients’ perceived self-efficacy, self-care behaviors, and knowledge in diabetes were assessed using questionnaires at the beginning and at three months after
entering the training program. RESULTS: There were 27 patients in each group. No significant differences between the two groups were found at the beginning of the study with
respect to perceived self-efficacy, self-care behaviors, and knowledge in diabetes. After
the program, self-care behaviors of patients in the intervention group were better than
those in the control group (56.00 ± 5.54 points VS 50.85 ± 5.99 points, P = 0.002).
Perceived self-efficacy and knowledge in diabetes in the intervention group also improved,
but not significantly so, compared to the control group. CONCLUSIONS: Although the perceived self-efficacy training program does not affect the perceived self-efficacy of type-2
diabetes, it significantly improves their self-care behaviors. It has yet to be seen as to
whether these behaviors are sustainable and for how long.
PDB9: COSTS OF DIABETES PATIENTS IN THAI GOVERNMENT HOSPITALS
Pongcharoensuk P1, Kongsaktrakool B1, Tantivipanuwong S1, Sema-ngern K1,
Chaiyakunapruk N2, 1Mahidol University, Bangkok, Thailand, 2Naresuan University,
Muang, Phitsanulok, Thailand
OBJECTIVE: To determine direct medical cost of diabetes mellitus (DM) patients with and
without complications and co-morbidity in government hospitals in Thailand. METHODS: A
cross-sectional, prevalence based study of costs of diabetes was done. Electronic financial
databases of four purposively selected hospitals (one teaching and three general) were
retrieved for fiscal year 2003. Diabetes patients were identified by ICD10 diagnosis code of
E10 to E14 and further classified into five categories as: 1) DM only; 2) DM + co-morbidity
(hypertension and dyslipidemia); 3) DM + microvascular (nephropathy, neuropathy,
retinopathy, foot ulcer, renal failure, blindness, etc); 4) DM + macrovascular (coronary
artery disease, cerebro-vascular disease, and peripheral vascular disease); and 5) DM +
micro-macrovascular complications. Both outpatient and inpatient resource uses (lab, xrays, hospitalization, drugs and medical supplies, etc.) were aggregated and costs as
charge were determined for each individual. For data accuracy, diagnosis electronic data
were cross-validated with 962 patient chart review and results revealed that microvascular complications and co-morbidity were under-diagnosed, sometimes as much as 95%.
RESULTS: Overall, 24,053 DM patients were identified (1% type I), with 59 years average
age and two-thirds female. Forty percent was DM only and 25% each with microvascular
and with co-morbitity, 6%, and 4% with macrovascular and micro-macrovascular complications respectively. Twenty-five percent of patients had at least one hospital admission.
For average annual direct medical costs per capita, DM only incurred $281 ($1 = 40 Thai
baht), and increased to 1.2-fold ($332), 2.1-fold ($584), 4.6-fold ($1292), and 5.7-fold
($1611), with co-morbidity, microvascular, macrovascular and micro-macrovascular complications respectively. Patients with hospitalization accounted for 51% of total costs. CONCLUSIONS: Diabetes complications has high prevalence in Thailand and incurred higher
health resources, therefore, long-term prevention strategies should be implemented for
better disease management and overall health care cost reduction.
PDB10: WEIGHT GAIN IN MIDDLE AGE AND DIABETES-RELATED MEDICAL
UTILIZATION AND COSTS IN OLDER AGE
Yan LL, Wang R, Liu K, Garside DB, Carnethon MR, Metzger B, Daviglus ML,
Northwestern University, Chicago, IL, USA
OBJECTIVE: To determine the relation of weight gain in middle age with diabetes-related
medical utilization and costs in older age. METHODS: Study cohort included 1,063 men
from the Chicago Western Electric Study: ages 40-55, not underweight (body mass index
<18.5 kg/m2) and free of coronary heart disease, diabetes, and cancer at baseline (19578) and eligible (65+) for Medicare benefits from 1984 (the first year Medicare data were
available for research use) to 2002. Height and weight were measured at baseline and
annually thereafter until 1968. Participants were classified by average annual weight
change: weight losers (<0 lb), moderate gainers (0-2 lbs), and heavy gainers (>2 lbs).
Main outcome measures based on Medicare claims data were diabetes-related
(International Classification of Diseases 9th revision code 250) inpatient and outpatient
diagnoses and average annual charges (as surrogates for costs). RESULTS: The percentage of participants with diabetes diagnosis in older age was 20.9%, 19.0%, and 12.7% for
weight losers, moderate gainers, and heavy gainers. After adjusting for race, education,
and baseline age and body mass index, the odds ratio (95% confidence interval) for having a diabetes diagnosis was 1.15 (0.77, 1.71) for moderate gainers and 2.38 (1.44, 3.95)
for heavy gainers compared to weight losers (p value for linear trend = 0.002). Adjusted
average diabetes-related annual charges were $400, $600, and $1000 for the 3 groups
respectively (p-trend = 0.03). CONCLUSIONS: In this cohort of primarily Caucasian men
who survived to age 65 or older, weight gain in middle age was strongly associated with
diabetes-related medical utilization and costs in older age. Our finding adds to existing
evidence on the impact of obesity and weight gain on diabetes and has profound implications for Medicare expenditure given the rise in obesity and diabetes epidemic.
PDB11: THE CORE DIABETES MODEL – SIMULATING LONG-TERM EFFECTS
OF IMPLEMENTING HEALTH POLICIES FOR MANAGEMENT OF DIABETES
Palmer A1, Valentine WJ1, Ray JA1, Lurati FM1, Foos V1, Minshall ME2, Roze S1,
1CORE - Center for Outcomes Research, Binningen, Switzerland, 2CORE - Center for
Outcomes Research, Fishers, IN, USA
OBJECTIVE: We developed an Internet-based simulation model to determine the long-term
health and economic outcomes associated with type 1 and type 2 diabetes and the effects
of different treatment policies. The model performs real-time simulations to account for
insulin therapy, new devices and delivery systems, oral hypoglycemic medications, screening and treatment strategies for micro- and end-stage complications and multi-factorial
interventions. METHODS: The model is based on a series of inter-dependent, linked submodels that simulate diabetes-related complications (cardiovascular disease, retinopathy,
hypoglycemia, ketoacidosis, nephropathy, neuropathy, and non-specific mortality). Each
sub-model isa Markov-based model using time, state and diabetes type dependent probabilities derived from published sources. Cohorts can be defined in terms of age, gender,
baseline risk factors and pre-existing complications. First- and 2nd-order Monte Carlo
simulation using tracker variables confers memory within the model, and accounts for
uncertainty in multiple input parameters. Cohort definitions, economic and clinical data in
the disease management module can be edited by the user, allowing for the inclusion of
recently available data, country-, HMO- or provider-specific perspectives as well as hypothetical analyses. A program is currently collecting Thai epidemiology and cost data for
future analyses. Time horizon can be varied from 1-year to patient lifetimes. Clinical and
economic outcomes calculated by the model include life expectancy, quality-adjusted life
expectancy, incidence, prevalence and time to onset of diabetes-related complications,
direct and indirect medical costs and incremental cost-effectiveness ratios. The CORE
Diabetes Model has been peer-reviewed, thoroughly validated and documented. It is widely used to generate health economic outcomes for submission to decision-makers globally.
CONCLUSIONS: The CORE Diabetes Model allows results obtained from short-term trials
47
to be extrapolated to long-term outcomes. Diabetes management strategies can be compared in different patient populations in a variety of clinical settings, allowing investigations geared towards improving the quality of care for diabetes patients.
PDB12: SYSTEMATIC REVIEW OF ECONOMIC STUDIES ON INSULIN
GLARGINE
Tang Z1, Hu Y2, 1School of Public Health, Fudan University, Shanghai, China,
2Zhongshan Hospital, Fudan University, Shanghai, China
OBJECTIVE: The increasing prevalence of diabetes (DM) in China is generating a large
economic burden for health care systems. This study aims at reviewing cost analysis and
cost-effectiveness data on the long-acting basal insulin analogue, insulin glargine and provides experience from other countries concerning GLAR economic aspects. METHODS: A
systematic literature review of GLAR versus NPH economic studies through the public and
internal database was performed. Original papers and conference abstracts providing cost
comparison or cost-effectiveness results were included. RESULTS: Ten studies (one manuscript and nine abstracts) met the inclusion criteria. Five were cost analysis studies comparing resource used in one year in insulin users or patients transferred to GLAR. Costs
were not completely detailed since most studies were reported in abstracts. Five studies
from Spain, Norway, Australia, and Switzerland were cost-effectiveness evaluations, based
on Markov model simulation that allow to project long term costs and effects (9 to 30
years) on short-term and long-term complications due to DM. Three studies were performed in type-1 and two in type-2 patients. HbA1c results obtained from short-term comparative clinical trials were the main driver of projected differences in long-term complications and associated costs. The quality of model-based studies is not clear due to the limited information from abstracts. CONCLUSIONS: Results of short-term cost-analysis suggest that the cost of diabetes could be decreased with GLAR by reducing the cost of hypoglycemia treatment and hospitalization as compared to NPH. Results from long-term
analysis indicate that GLAR is a cost-effective alternative to NPH in patients with type-1
and type-2 diabetes in countries where the analyses were performed. The economic
impact of insulin glargine use in China remains to be evaluated.
PDB13: TYPE 2 DIABETES MODELS THAT DO NOT ACCOUNT FOR
MICROVASCULAR DISEASE SCREENING RATES AND IMPORTANT CONCOMITANT MEDICATION USE MAY LEAD TO SUBSTAINTIAL MISREPRESENTATION
OF COST-EFFECTIVENESS OF NEW MEDICATIONS
Palmer AJ1, Valentine WJ1, Ray JA1, Minshall ME2, Roze S1, 1CORE - Center for
Outcomes Research, Binningen, Basel, Switzerland, 2CORE - USA, LLC, Fishers, IN,
USA
OBJECTIVE: A number of diabetes models have recently been published. They are often
used to assess the cost-effectiveness of new interventions and to generate health economic arguments for reimbursement submissions. The majority of these models do not
account for rates of screening for important diabetes-related microvascular (eye, renal and
foot) disease, nor do they consider the rates of use of important concomitant medications
like ACE inhibitor/angiotensin-2-receptor inhibitors, statins, or aspirin. Our aim was to test
the hypothesis that not accounting for these important factors may substantially influence
projected long-term cost-effectiveness of new interventions. METHODS: A published and
validated diabetes model was used to project the long-term cost-effectiveness of a hypothetical intervention that lowered HbA1c by 0.4%-points, and which cost an additional
$500/patient/year, versus no intervention. Quality-adjusted life years (QALY) and lifetime
direct medical costs were calculated for each treatment arm, assuming: A) no screening
for- and appropriate treatment of diabetes-related complications; and B) screening rates
and concomitant medication use as seen in a typical type 2 diabetes population in the US.
RESULTS: If screening rates and concomitant medication use were not considered, the
hypothetical intervention was dominant to no intervention, with 0.214 QALYs gained (discounted 3% annually), and discounted lifetime direct cost savings of $165/patient. When
screening rates and concomitant medication rates were accounted for, the intervention led
to smaller improvements in QALYs, and increased costs, with incremental costs/QALY
gained of $34,024. CONCLUSIONS: Health economic models of diabetes must account for
the costs and clinical effects of screening for- and appropriate treatment of important diabetic microvascular complications, and the costs and effects of important concomitant
medications. Failure to account for these factors may lead to inaccurate assessment of the
cost-effectiveness of new interventions in type 2 diabetes patients.
48
PDB14: PHARMACOECONOMIC EVALUTIONS REGARDING TYPE-2 DIABETES
IN ASIA-PACIFIC
Shimaya M1, Li C2, Yanagisawa S2, Kamae I2, 1Harvard University, Boston, MA,
USA, 2Kobe University, Kobe, Hyogo, Japan
OBJECTIVE: To review and assess the literature of phamacoeconomic evaluations conducted in the Asia-Pacific region regarding type-2 diabetes focused on oral agents to clarify in order the current situation of pharmacoeconomic and outcomes research and then to
identify the gaps between the information obtained and anticipated phamacoeconomic
activities in Asia. METHODS: We searched the PubMed and Japanese databases to find
the articles regarding economic evaluation for type-2 diabetes. The information obtained
from the literature was critically appraised and summarized into key elements such as the
type of economic evaluation, randomization, and so on. RESULTS: The literature identified
was very limited: In Japan 23 articles (2 in English, 21 in Japanese), in Taiwan 3 (1 CEA
(cost-effectiveness analysis), 2COIs (cost of illness)), in India 2 (1COI, 1 descriptive), in
Bangladesh 1 CEA, in Hong Kong 1COI, and no article from Korea and Singapore. Only the
Kumamoto Study in Japan reported a randomized control trial evaluating cost and effectiveness of insulin therapy. Most of the articles were review/COI articles with no evidence
on cost-effectiveness to support the claims of health economics and outcomes research
focused on oral agents. CONCLUSIONS: Evidence on effectiveness and cost of oral agents
in prospective studies is lacking in the Asia-Pacific region. To overcome the gaps, we identified actions to do: 1) to perform a modeling study by employing the evidence on oral
agents in the English literature, and 2) to conduct a prospective study to evaluate the oral
agents, and then combine the resulting data with those of the Kumamoto Study. Also, we
suggest that a cost-utility analysis remains for future investigation, particularly including
the end-stages of diabetes such as dialysis or impaired vision.
PDB15: FACTORS ASSOCIATED WITH HEALTHCARE COSTS AND HOSPITALIZATIONS IN PATIENTS WITH DIABETES IN THAI PUBLIC HOSPITALS
Chaikledkaew U1, Pongchareonsuk P2, Thavornchareonsap M2, Suksomboon N3,
Tantivipanuwong S2, 1Mahidol University, Bangkok, Thailand, 2Mahidol University,
Payathai, Bangkok, Thailand, 3Mahidol University, Rajathevi, Bangkok, Thailand
OBJECTIVE: To investigate factors associated with health care cost and hospitalization in
patients with diabetes in Thai public hospitals. METHODS: A retrospective study was conducted by using claims data from October 1, 2001 to September 30, 2003. Dependent
variables were total health care costs and hospitalizations. Independent variables such as
demographic factors, health care utilization, complications, comorbidities, and payment
system were used as independent variables. Univariate and multivariate statistical analyses were applied. RESULTS: Patients with older age [Parameter Estimate (PE) = 0.008; p
< 0.0001], male gender [PE = -0.286; p < 0.0001], type 1 diabetes [PE = -0.333; p <
0.0001], and admitted to teaching hospital [PE = 0.325; p < 0.0001] had a significant
impact on an increase in health care costs and hospitalizations. Complications (i.e.,
nephropathy [PE = 0.264; p < 0.0001]) and comorbidities (i.e., hypertension [PE = 0.040;
p < 0.0003], coronary artery diseases [PE = 0.141; p < 0.0001], glaucoma [PE = 0.111; p
< 0.0309], and cancer [PE = 0.071; p < 0.0492]) were positively associated with higher
health care costs. In addition, diabetic complications or comorbidities were associated with
hospitalizations. However, diabetic patients with hyperlipidemia [PE = -0.119; p < 0.0001;
Odds Ratio (OR) = 0.73; p < 0.0001] had significantly lower health care costs and hospitalizations. Patients with longer length of stay [PE = 0.006; p < 0.0001], more outpatient
visits [PE = 0.016; p < 0.0001], and taking insulin [PE = 0.330; p < 0.0001] had a significant impact on health care costs. Payment system (fee-for-service) [PE = 0.425; p <
0.0001] was significantly associated with higher health care costs. CONCLUSIONS: Factors
associated with health care costs and hospitalizations may help health care providers intervene to improve patient management and possibly reduce health care costs.
ENDOCRINE DISORDER
PEN1: BUDGET-IMPACT OF THYROIDS DISEASE IN GERMANY
Vauth C, University of Hanover, Hanover, Germany, Greiner W, Bielefeld University,
Bielefeld, Germany
OBJECTIVE: To determine the disease related costs of thyroids dysfunction in Germany
from a payer and social perspective with regard to thyroid induced cardial arrhythmia.
METHODS: Retrospective analysis of a german compulsory health insurance between
January 2000 und December 2002. Identification of thyroid patients via ICD-10 diagnosis
and typical thyroid pharmaceuticals. Included costs: outpatient care, inpatient care, pharmaceuticals, indirect costs as productivity losses. RESULTS: 115,399 up to 116,262 thyroid patients have been identified and analysed. Using database prevalence to extrapolate
the findings to the german population this results in 1.28 up to 1.37 billion EURO direct
costs and 167 up to 182 million EURO indirect costs per year. CONCLUSIONS:
Approximately 1% of german compulsory health insurance expenditures have to be spend
on thyroids disease. Thus, new economic evaluations of primary prevention programs or
the cost-effectiveness of pharmaceuticals used are requested.
EYE
PEY1: EFFECTS OF PILOCARPINE ON QUALITY OF LIFE OF THAI PATIENTS
WITH GLAUCOMA
was a prognostic factor addressing heterogeneity in loss of HBeAg across trials. Shortterm effect (<26 wks) of lamivudine plus antiviral was superior to antivral alone (OR=4.01,
95%CI: 1.83-15.8, P=0.000), but this effect disappeared in pronged duration (>26 wks,
OR=0.61, 95%CI: 0.78-1.54). Ethnicity projected clinical difference in loss of HBV-DNA
across trials. The combination of lamiuvdine with antiviral in Chinese patients produced
significant loss of HBV-DNA (OR=3.58, 95%CI: 2.48-5.16). However, combination of
lamivudine with interferon was not better than interferon alone. The combined therapy was
superior to antiviral montherapy alone in normalization of ALT (OR=1.49, 95%CI=1.121.98). Loss of HBsAg was better in combined therapy (OR=1.72, 95%CI=1.05-2.81).
Seroconversion were also better in combination therapy (OR=1.55, 95%CI=1.10-2.18), but
this was not seen specifically in lamivudine plus interferon against interferon alone. CONCLUSIONS: Lamivudine is clinically useful to improve the antiviral effects in chronic hepatitis B patients.
Tripop S1, Pratheepawanit N1, Asawaphureekorn S1, Anutangkoon W2, Inthayung
S1, 1Khon Kaen University, Khon Kaen, Thailand, 2Khon Kaen Hospital, Khon Kaen,
Thailand
PGI3: COST-EFFECTIVENESS OF THE INTRAVENOUS PROTON PUMP
INHIBITORS COMPARED WITH HISTAMINE-2 RECEPTOR ANTAGONISTS IN
THE TREATMENT OF NON-VARICEAL UGIB
OBJECTIVE: Due to collective evidence of pilocarpine interfering with patients’ activities
and reducing compliance, it is considered a third line drug and reserved when the first and
second line drugs have failed. Pilocarpine is, however, more commonly used in Thailand’s
general hospitals partly due to its availability as one of a two group A (generally available)
topical drugs for treating glaucoma on the Thai national essential drug list. This study
examines the effects of pilocarpine on health related quality of life (HRQOL) of Thai glaucoma patients. METHODS: Glaucoma patients were interviewed using the Thai Visual
Function Questionnaire 28, consisting of 28 items in 11 domains, ranging from 0 to 100
with higher domain scores indicating better QOL. This questionnaire has good reliability,
with Cronbach’s alpha above 0.7 in all domains. The validity was established using visual
acuity (VA) and visual field (VF). Multivariate analysis using linear regression was conducted. RESULTS: Of 367 patients recruited, 218 were female (59.4%), the mean age was 61
years (range 18-86). Patients using pilocarpine (N=67) had significantly lower visual function, education, and income than those without pilocarpine (N=242). Univariate analysis
shows that patients using pilocarpine had significantly lower HRQOL scores in all domains.
After adjusting for patients characteristics (age, sex), disease (VF, VA, duration of disease,
other eye diseases), and treatment (surgery, number of drugs, frequency of administration), patients using pilocarpine showed significantly lower HRQOL scores in distance
activities (beta = -13.03), social (beta = -13.72), mental (beta = -16.29), dependency
(beta = -21.22), color vision (beta = -16.04), and peripheral vision domains (beta = 12.90). CONCLUSIONS: Pilocarpine was associated with a significant decline in HRQOL
scores of up to 21 points. Adjustment of the national essential drug list to make more
drugs avialable in group A for glaucoma treatment could be warranted in Thailand.
Chen Y, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
GI DISORDERS
PGI1: THE ADDITIVE CLINICAL VALUE OF LAMIVUDINE IN ANTVIRAL THERAPY FOR PATIENTS WITH CHRONIC HEPATITIS B
Sun X1, Wang X2, Liu X2, Li Y3, Guyatt G4, 1The Chinese Cochrane Centre, West
China Hospital, Sichuan University, Chengdu, China, 2Sichuan University, Chengdu,
Sichuan, China, 3Chinese Evidence-Based Medicine Center, West China Hospital,
Chengdu, Sichuan, China, 4Department of Clinical Epidemiology and Biostatistics,
McMaster University, Hamilton, Ontario, Canada
OBJECTIVE: To investigate whether addition of lamivudine to other antivirals was superior
to single use of antivirals for patients with chronic hepatitis B. METHODS: Systematic
review and meta-analysis of randomized trials were conducted. Medline, Cochrane Trial
Register, Current Contents, SCI-E and CBMdisc were searched. References of included
studies was also conducted. Randomized trials that compared lamivudine plus antiviral
with single use of antiviral for patients with chronic hepatitis B were eligible. Studies that
included patients with co-infection of HCV and HIV, and with decompensate liver diseases
were excluded. Egger’s regression was used to identify publication bias. Meta-regression
and subgroup analysis were used to investigate heterogeneity. Type of comparison, duration, doses, and ethnicity were considered for heterogeneity. RESULTS: Fourteen trials
were included, 78.6% of which were moderate to high quality. Ten trials studied addictive
effect of lamivudine in interferon therapy, two in thymocin therapy, and two in other therapies. No publication bias was identified (coefficient=2.73, 95%CI=-0.96-6.42). Duration
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization all over the world including in Taiwan. Patients with NVUGIB in general practice are
often treated empirically with a standard dose of IV proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs). Despite clinical evidence in favour of IV PPIs, FDA
has not yet been proved PPIs in this indication. OBJECTIVE: To compare the cost effectiveness of IV PPIs and H2RAs in the treatment of NVUGIB, we assessed the rebleeding rate of
initial medication choice (IV PPIs or H2RAs) and direct medical cost using healthcare
claims data in Taiwan . METHODS: We designed a two-year retrospective longitudinal
analysis between January 1, 2002, and January 31, 2004 to compare the 60-days
rebleeding rate from the healthcare claims in southern Taiwan, with about three million
members. We constructed a decision tree model comparing two strategies: IV PPIs and IV
H2RAs started in the NVUGIB patients following endoscopic therapy. The model was evaluated the rebleeding to initial therapy and the rebleeding prevented by competing different
strategies. Sensitivity analysis was used in the decision to evaluate the strategies.
Charlson comorbidity score was used to adjust for severity. RESULTS: After endoscopic
therapy, severely rebleeding is still common in Taiwan need for further endoscopic
haemostasis or surgery. Analysis showed that the cost-effectiveness ratios for IV PPIs and
H2RAs groups were NT46761.18 and NT45107.88, respectively, in averting one episode of
recurrent bleeding in one patient after initial hemostasis was achieved. CONCLUSIONS: It
is common in Taiwan to administer IV H2RAs to patients with UGIB. The analysis suggest
that the use of IV PPIs in conjunction with endoscopy haemostasis in a standard dose was
not superior effectiveness based on the probability determination used in the sensitivity
analysis.
PGI4: ECONOMICS EVALUATION OF LAMIVUDINE IN THE TREATMENT OF
CHRONIC HEPATITIS B
Lu XZ1, Chen W2, Tan-Mulligan A1, 1GlaxoSmithKline (China) Investment Co Ltd,
Shanghai, China, 2Fudan University (former Shanghai Medical University), Shanghai,
China
Chronic hepatitis B (CHB) is one of the most common infectious diseases in the world with
approximately 350 million carriers of the hepatitis B virus (HBV). In China, it was reported
that the rate of HBV infection was as high as 57.63%, i.e., there were at least 600 million
people who were infected with HBV. Approximately 120 million carriers, with the prevalence rate of HBV carriers 9.75%, accounted for one third of that in the world. OBJECTIVE:
This study aims to measure the cost-effectiveness of Lamivudine, a once-daily oral antiviral treatment, of different treatment durations compared with placebo in the treatment of
CHB from a long-term perspective. METHODS: A life-time Markov model was used to estimate the cost and clinical effectiveness of Lamivudine compared to placebo in treating
CHB patients. Transition probabilities and relevant costs for each state in Markov model
were from China clinical trials, literature and expert consultation method. Long-term costs
and outcomes were discounted by 5% per annum to represent future consequences in
present-value terms. RESULTS: In a long term perspective, the incremental cost per life
year gained from Lamivudine of different treatment durations compared to placebo was
less than 23,800 yuan (US$2,850), varying from 2,814 yuan (US$340) to 23,790 yuan
(US$2,850), which is cost-effective. CONCLULSIONS: The incremental cost per life year
49
gained from longer Lamivudine treatment is cost effective especially when compared to
the GDP per capita of Shanghai (2002) which was often regarded as the benchmark for
the health care resource allocation in China. In particular, the 4-year Lamivudine treatment
for CHB patients could bring about the prolongation of life years at the relative expense of
less than 25,000 yuan per year (US$3012). It can be concluded that longer term
Lamivudine treatment is a more cost-effective treatment for CHB patients.
PGI5: AUSTRALIAN ECONOMIC EVALUATION OF PEGASYS (PEGINTERFERON
ALFA-2A) VERSUS LAMIVUDINE FOR THE TREATMENT OF CHRONIC
HEPATITIS B
Todd CJ1, Patel KK2, Adena M3, Veenstra DL4, 1Roche Products Pty Limited, Sydney,
New South Wales, Australia, 2Hoffmann-La Roche, Nutley, NJ, USA, 3Covance Pty Ltd,
Canberra, ACT, Australia, 4University of Washington, Seattle, WA, USA
OBJECTIVE: To estimate the cost-effectiveness of peginterferon alfa-2a (PEG-IFN alfa-2a)
180mcg once-weekly for 48 weeks versus long-term lamivudine (LAM) 100mg once-daily
for chronic hepatitis B (CHB) from the Australian health care system perspective. METHODS: The efficacy and safety of PEG-IFN alfa-2a versus LAM for 48 weeks were assessed
in two randomised phase III studies in HBeAg-positive and HBeAg-negative CHB. Modelled
evaluations linked the clinical outcomes measured in the studies (HBeAg seroconversion in
HBeAg-positive CHB and combined virological and biochemical response in HBeAg-negative CHB) to life-years and quality-adjusted life-years (QALYs) gained. The models comprised the disease states: CHB; response/HBeAg seroconversion; cirrhosis; decompensated cirrhosis; hepatocellular carcinoma; liver transplantation; post-liver transplantation; and
death. In clinical practice, LAM is not discontinued at week 48; therefore, end-of-treatment
response rates from the studies were included in the models and published long-term
data used to extrapolate response beyond week 48. End-of-follow-up response rates were
used for PEG-IFN alfa-2a. In Australia, LAM is continued for 6-12 months post-seroconversion in HBeAg-positive CHB, otherwise indefinitely until resistance develops. According to
clinicians, the majority of PEG-IFN alfa-2a failures would receive LAM, and LAM failures
adefovir dipivoxal. Resource use was based on Australian clinical practice. Transition rates,
costs, and utilities for CHB-related disease states were identified from the literature and
validated using expert opinion. RESULTS: In the HBeAg-positive model, PEG-IFN alfa-2a
was associated with additional lifetime costs (study drug, salvage therapy and medical
care costs) of $A5,434 per patient and an increase of 0.39 QALYs, resulting in an incremental cost-effectiveness ratio of $A13,985 per QALY gained. In the HBeAg-negative
model, PEG-IFN alfa-2a was associated with lifetime cost savings of $A1,617 per patient
and an increase of 0.52 QALYs. Results remained favourable to variation in multiple
parameters in sensitivity analyses. CONCLUSIONS: Compared with LAM, PEG-IFN alfa-2a
is cost-effective in HBeAg-positive and HBeAg-negative CHB.
PGI6: PHARMACOECONOMICS OF CHRONIC HEPATITIS C IN SLOVAKIA
Bielik J1, Huzicka I2, 1Trencín University, Trencín, Slovak Republic, 2ScheringPlough, Bratislava, Slovak Republic
OBJECTIVE: There was no evidence about pharmacoeconomical outcomes of chronic hepatitis C (CHC) in Slovakia or in other central and est European countries.. This study offers
results obtained from the first Slovak cost of illnes study in patients suffering from CHC.
METHODS: Pharmacoeconomics of CHC was studied in a group of 70 patients with CHC
using our own “CHC pharmacoeconomical Questionnaire”. RESULTS: There were 46 men
and 24 women. The average age of patients was 48 years. The direct costs were established for following forms of CHC: a, HCV negative patient after treatment- 283 USD, b,
mild CHC – 295 USD, c, moderate CHC – 880 USD, d, cirrhosis without ascites – 970 USD,
e, non refractory ascites – 1165 USD, f, refractory ascites – 13973 USD, g, hepatic
encephalopathy (first year) – 5247 USD, h, hepatic encephalopathy (second year) – 3869
USD, i, variceal hemorrhage (first year) – 8201 USD, j, variceal hemorrhage (second year)
– 4461 USD, k, hepatocellular carcinoma – 3159 USD, l, liver tranplantation – 10565 USD.
The indirects cost were established for one patient per year – 3095 USD. CONCLUSIONS:
The treatment with pegintron and rebetol (by body weight) reaches 19421 USD in patients
with genotype 1 resp. 13694 in patients with genotypes 2 and 3. This treatment is costeffective in Slovakia.
PGI7: VALUING HEALTH STATES USING UTILITY WEIGHTS TO CAPTURE THE
IMPACT OF DISEASE PROGRESSION IN CHRONIC HEPATITIS B (CHB)
Lam CL1, Levy A2, Lozano-Ortega G2, Tafesse E3, Mukherjee J3, Iloeje U4, Briggs
AH5, 1The University of Hong Kong, Hong Kong, China, 2Oxford Outcomes,
50
Vancouver, British Columbia, Canada, 3BMS, Wallingford, CT, USA, 4Bristol-Myers
Squibb Company, Wallingford, CT, USA, 5University of Glasgow, Glasgow, United
Kingdom
OBJECTIVE: Approximately 8% of people in Hong Kong are chronically infected with the
hepatitis B virus (HBV). Without treatment, infected individuals may progress through
increasingly severe disease states before death. Utility weights are useful for estimating
the combined impact of morbidity and mortality and estimate quality adjusted life years
(QALYs) in cost-effectiveness analyses. The objective was to elicit utility weight estimates
associated with six hepatitis B-related disease states. METHODS: Three hepatologists
characterized the typical effects of HBV symptoms on health-related quality of life. We
elicited preferences from 100 uninfected subjects and 100 subjects chronically infected
with HBV in Hong Kong using: 1) a visual analogue scale (VAS) based on a `feeling’ thermometer anchored between 0 (death) and 1 (perfect health), and 2) standard gamble (SG)
utility weights using probability wheels with 2-color pie charts for the relative probabilities
of perfect health and death. RESULTS: For infected subjects, the mean age was 45 years
(range: 18 to 80) and 79% were male. Mean utility weights elicited from infected subjects
using SG were: 0.69 (95% confidence interval: 0.63-0.74) for chronic hepatitis B; 0.71
(0.66-0.77) for compensated cirrhosis; 0.27 (0.22-0.32) for decompensated cirrhosis; 0.64
(0.58-0.69) for first year after liver transplant; 0.71 (0.65-0.76) for subsequent years after
liver transplant and 0.36 (0.30-0.42) for hepatocellular carcinoma. Mean utility weights
elicited from uninfected subjects had the same relative rankings and similar numerical
values. VAS ratings were generally lower than SG utilities and ranked in the same order for
infected and uninfected subjects. CONCLUSIONS: In this, the first study of its kind in Hong
Kong, we observed that the health states were associated with substantial loss in healthrelated quality of life. The lowest utility estimates were associated with decompensated
cirrhosis and hepatocellular carcinoma. This information can be used in estimating QALYs
for incremental cost-utility analyses.
PGI8: TREATMENT PREFERENCE AND IMPROVEMENTS IN HEALTH RELATED
QUALITY OF LIFE (HRQOL) IN RENAL TRANSPLANT RECIPIENTS WITH GASTROINTESTINAL (GI) COMPLAINTS CONVERTED FROM MYCOPHENOLATE
MOFETIL (MMF) TO ENTERIC-COATED MYCOPHENOLATE SODIUM (EC-MPS)
Bonney MA1, Fassett R2, Kark A3, Faull R4, Hutchison B5, Walker R6, Mahony J7,
Goodman D8, Pussell B9, Ierino F10, Kurstjens N1, 1Novartis Pharmaceuticals
Australia, Sydney, NSW, Australia, 2Launceston General Hospital, Launceston, TAS,
Australia, 3Royal Brisbane Hospital, Brisbane, QLD, Australia, 4Royal Adelaide
Hospital, Adelaide, SA, Australia, 5Sir Charles Gairdner Hospital, Perth, WA, Australia,
6Royal Melbourne Hospital, Melbourne, VIC, Australia, 7Royal North Shore Hospital,
Sydney, NSW, Australia, 8St Vincents Hospital, Melbourne, VIC, Australia, 9Prince of
Wales Hospital, Sydney, NSW, Australia, 10Austin Hospital, Melbourne, VIC, Australia
OBJECTIVE: GI complaints are common side-effects of immunosuppressive agents, but
dose reductions to ameliorate symptoms may compromise efficacy. This study evaluated
changes in GI symptoms and HRQoL after renal transplant patients were converted from
MMF to EC-MPS. A substudy gained additional information on patients’ utility and preference for treatment. METHODS: An open-label, multi-centre study; patients with GI complaints on MMF were switched to EC-MPS (Gp1); asymptomatic patients remained on
MMF (Gp2). Patients completed the Gastrointestinal Symptom Rating Scale (GSRS),
Gastrointestinal Quality of Life Index (GIQLI), and Psychological General Well-Being Index
(PGWB) at baseline and four-six weeks. Of the 328 patients, 90 were Australian – they also
completed the EQ-5D and SF-6D utility instruments and treatment preference questions.
Non-parametric tests were used. RESULTS: In the Australian ITT population there was no
significant difference between Gp1(n=56)and Gp2(n=34) with respect to age (45.8 vs 49.6
yrs), male gender (55% vs 62%) or time post-transplant (4.6 vs 3.5 yrs). At baseline, Gp1
had significantly more symptoms and HRQoL impairment compared to Gp2 (p<0.01, all
scores). At follow-up, patients converted to EC-MPS demonstrated significant improvement
(p<0.01) in four of five GI symptoms. HRQoL also improved, as measured by the GIQLI
(p<0.001) and PGWB (p=0.003); (EQ-5D/SF-6D, ns). Scores for Gp2 remained generally
stable. Of the 56 patients converted, 28 (50%) stated a preference for EC-MPS; 20
(35.7%) had no preference; 6(10.7%) preferred MMF (p=0.001). Patients preferring ECMPS had greater improvement in HRQoL compared to those with no preference or a preference for MMF (GIQLI p<0.001, PGWB p=0.002, EQ-5D p=0.017, SF-6D p=0.035). CONCLUSIONS: Converting patients with GI complaints to EC-MPS resulted in significant
improvement in GI symptoms and HRQoL.Generic utility instruments were less sensitive to
changes in GI complaints. Overall, HRQoL improvements were consistent with reduced GI
symptom severity, and this was ultimately reflected in patients’ preference for treatment.
PGI9: SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS IN DRUG DECISION-MAKING: AN EXAMPLE FROM ANTIVIRAL THERAPY FOR CHRONIC
HEPATITIS B
Sun X1, Li Y2, Zhou R3, Hu S4, 1The Chinese Cochrane Centre, West China Hospital,
Sichuan University, Chengdu, China, 2Chinese Evidence-Based Medicine Center,
West China Hospital, Chengdu, Sichuan, China, 3West China Hospital, Sichuan
University, Chengdu, China, 4Fudan University (former Shanghai Medical University),
Shanghai, China
OBJECTIVE: To investigate the applicability of systematic review of economic evaluations
in drug decision-making, by systematic reviewing lamivudine for chronic hepatitis B (CHB)
as an example. METHODS: Medline, Cochrane Database, CBMDisc and SCI-E were
searched, with complementary searching of references of eligible studies. Full economic
evaluations on single and combined therapy of lamivudine for patients with CHB were eligible. Quality was appraised by Drummond’s 36-item checklist and transferability
assessed by 12-item checklist developed by the research group. The eligibility of studies
for informing drug decision-making was weighted by the overall quality and transferability,
as assessed by independent investigators, with consensus reached by panel agreement. A
matrix-based summary of outcomes were conducted. RESULTS: Fifteen studies were
included. Ten trial-based studies were conducted in China, and five modelling studies from
Australia, USA and Poland. Eight studies compared lamivudine with interferon, four with
interferon and no treatment, one with thomycin, one with four alternative strategies, and
one with placebo. Thirteen studies adapted health care-sector perspective, and two US
studies from third-payer perspective. Quality of Chinese studies was poor to moderate
(4/10 moderate) with concerns in costing methods, while foreign studies were at least
moderate in quality. Transferability of foreign studies was low due to variations of clinical
practice pattern and costing sources. The short-term analyses from 13 studies consistently
indicated that lamivudine was more effective in seroconversion and cost-effective compared with interferon or thymosin, and 11 studies further indicated that lamiuvdine was
cost-saving. The long-term analyses were not available in Chinese studies. Three studies
indicated that lamiuvudine was cost-saving and life-extending in Australia, but was less
cost-effective in US. CONCLUSIONS: Lamiuvdine was cost-effective in short-term analysis
in the Chinese setting, but remained unclear for long-term results. It suggested that systematic review was helpful for drug decision-making, though difficult to address all questions of interest.
HEMATOLOGICAL DISORDERS
PHM1: HEALTH-RELATED QUALITY OF LIFE OF ANEMIA PATIENTS IN THE US
Cremieux PY1, Xie J2, Wu EQ3, Castor AR1, 1Analysis Group Inc, Boston, MA, USA,
2The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3Analysis
Group, Boston, MA, USA
OBJECTIVE: To assess the health-related quality of life (HRQL) of anemia patients in the
U.S. METHODS: SF-12 and EQ-5D results from adults (age >= 18) in the 2000 and 2002
Medical Expenditure Panel Survey (MEPS) were used in this study. The anemia sample (i.e.
patients with anemia, ICD9CM 280-285) was compared to a non-anemia sample (i.e. people without anemia) using SF-12 physical and mental scores and EQ-5d index scores.
Differences in HRQL scores between the anemia and non-anemia samples were reported
using absolute difference and effect size (ES). Certain demographics (e.g. age, sex, race,
and geographic region) were controlled for using stratification matching methods. All
analyses were adjusted to be nationally representative. RESULTS: A total of 39,735 adults
were included in the study, of which 643 were reported to have anemia, corresponding to
1.42% of the adult U.S. population. The SF-12 physical scores, SF-12 mental scores, and
EQ-5D index scores of anemia patients were 1.87, 5.63, and 0.10 lower than non-anemia
people (1.87%, 5.63% and 10%; ES = 0.17, 0.45, and 0.32, respectively). The differences
in all three HRQL scores are statistically significant (p<0.01) after adjusting for age, sex,
race, and geographic location. CONCLUSIONS: Anemia is a serious condition that significantly reduces patients’ physical and mental HRQL and overall health utility in the U.S.
INDIVIDUAL’S HEALTH
PIH1: COST-BENEFIT ANALYSIS OF THE SCHOOL-BASED HEALTH CENTER
PROGRAM IN GREATER CINCINNATI
Guo JJ1, Jang R1, Keller KN2, 1University of Cincinnati, Cincinnati, OH, USA, 2Health
Foundation of Greater Cincinnati, Cincinnati, OH, USA
OBJECTIVE: This study was designed to measure the cost benefit of the School-Based
Health Centers (SBHC). METHODS: Four SBHCs (3 urban and one rural) plus four comparison school districts were studied from 1997 to 2003. A total of 5,056 students who
enrolled in six schools and the Ohio Medicaid program were evaluated to assess the value
of health status change. Parent’s survey was conducted to assess the potential benefit for
families. SBHC coordinator’s survey was conducted to document the operational costs and
benefits. Cost-benefit analysis (CBA) was conducted to estimate the value of resources
used by the SBHCs compared to the value of resources the program might save or create.
RESULTS: During the first three years of operation, the total cost for four SBHCs was $1.5
million. The savings from health improvement included $228,144 from students with asthma, $594,228 from prescription drug use, $42,956 form travel expense, and $542,761
from parent’s productivity. The value of health status changes involved $771,840 for mental health care, and $51,672 for dental care. The benefits of four SBHCs ranged from
$2.72 to $5.99 million. CONCLUSIONS: From a societal perspective, the four SBHCs were
cost beneficial with a net social benefit from $0.71 to $3.98 million over the first three
year of operation. The SBHCs were cost beneficial in a societal perspective.
PIH2: A GERIATRIC SCREENING PROGRAM CONDUCTED AT THE OBSERVATION ROOM OF AN EMERGENCY DEPARTMENT (GSPOR)
Ho WWS, Dai D, The Chinese University of Hong Kong, Hong Kong
OBJECTIVE: Elderly people who have chronic diseases frequently requires Emergency
Department attendances and hospital admissions. Patients staying in Observation room
are more prone at risk. We believe many of the geriatric medical and psychosocial problems could be settled in the Observation Room obviating the need of hospitalization.
Extended community supportive services, such as community nursing, community geriatric
out-reach assessment team; geriatric day hospital can be organized to provide close monitoring of the medical and social problems of AED attendees. METHODS: Geriatric screening program is provided to all elders aged 65 and above who are admitted to Observation
Room. Geriatric input includes making diagnosis and management, assessment of common geriatric syndromes, detection of social problems and evaluation of the home care
support. In cases of necessity, direct transferal to convalescence hospital, referral to
appropriate social services and medical follow up for continuity of care are made.
RESULTS: A total of 615 elderly patients were admitted to Observation room during June
to August 2004. The Geriatric screening program was evaluated with 234 cases received.
One hundred and thirty-five (57.7 %) cases were female. The mean age was 78.2 (SD
7.49).The average length of stay was 1.68 days. Most common complaints were dizziness
and vertigo (21.1%), chest pain (14.6%), gastroenteritis (5.7%) and hypoglycemia (4.8%).
The program was welcomed by AED colleagues and was helpful in making the diagnosis
in 31.3% of patients. Medication was adjusted in 58.1%, and underlying social problems
were identified in 13.7%. Majority of patients (81.2%) were discharged back to their original accommodations. CONCLUSIONS: A geriatric screening program in the Observation
Room is effective in resolving common geriatric problems and may possibly reduce
unnecessary hospital admissions.
PIH3: FEASIBILITY OF A COMPUTER-MEDIATED TAI CHI EXERCISE
Li J, Finkelstein J, University of Maryland School of Medicine, Baltimore, MD, USA
OBJECTIVE: To assess the feasibility and patient acceptance of a Tai Chi Home Automated
Telemanagement (HAT) system in patients with chronic diseases. We will explore the magnitude of effect of the Tai Chi HAT system on over all quality of life, psycho-cognitive factors related to exercise and physical performance. METHODS: We used the existing HAT
system as a prototype for development of multi-component support for patients to practice
Tai Chi at home. It consists of a Home Unit (HU), HAT server, and clinician unit (CU). The
HU, a laptop supporting a patient-tailored Tai Chi exercise plan, will be used by the patient
at home. The HU sends patient data to the HAT server. Any web-enabled device can serve
as a CU to review patient results. Patients report exercise information using an HU. The
HAT system is able to automatically monitor patient compliance and analyzes self-testing
results according to the practice guidelines in real-time. Therefore, the system assists
patients in carrying out their individual exercise plans. In instances of patient non-compli51
ance or failure to follow their exercise plans, the system gives feedback to the patient to
motivate better compliance, and notifies a case manager who contacts the patients when
necessary. RESULTS: The Tai Chi HAT system may be able to help patients engage in a
regular exercise and manage their symptoms of chronic disease, therefore, improve their
quality of life. CONCLUSIONS: The advantages of the Tai Chi HAT system are: 1) the system has the potential to assess compliance to the exercise program and support adjustments in the individualized exercise program that may be needed; 2) patients will be able
to observe the progress being achieved with the exercise 3) the system is able to provide
patient education, verbal encouragement, and social support.
PIH4: TAI CHI FOR IMPROVING BALANCE AND PREVENTING FALLS - A
REVIEW OF EXISTING OBSERVATIONAL STUDIES
Li J, Lawpoolsri S, Finkelstein J, University of Maryland School of Medicine,
Baltimore, MD, USA
OBJECTIVE: To review the epidemiologic literature on evaluating the effectiveness of Tai
Chi, an aged Chinese exercise regime, for improving balance and preventing falls and to
provide recommendations for future research design. METHODS: Literature on Tai Chi,
published after 1966, as identified by Medline, was reviewed. Studies were selected if they
met the following criteria: 1) the research was related to balance and fall prevention; and
2) observational study designs, including: case series, ecologic, cross-sectional, cohort,
case-control and quasi-experiment. RESULTS: Thirteen studies were identified, based on
the two criteria above, from a total of 187 articles. Findings from these studies are inconsistent because of a number of inherent limitations and potential biases in the study
design. These limitations include: selection bias due to non-randomization of study subjects in quasi-experimental study; no convincing causal relationship established using
cross-sectional study; selection bias due to poor baseline demographic data collection and
assessment; failure to identify the difference between people who are compliant to the
study and those who drop off; lack of external validity due to including only one gender or
one age group in the study; failure to define intervention assessment in the study (e.g., the
style, intensity, frequency of the Tai Chi intervention) and no standard measurement for
improving balance across different studies. CONCLUSIONS: The evidence of the effectiveness of Tai Chi on improving balance and preventing falls based on existing observational
studies is inconclusive. In the future, randomized clinical trial should be used in order to
control confounding and eliminate bias. More systematic studies are needed to understand
the therapeutic nature of Tai Chi. Based on this, the consensus about the terms of use and
core measures that help describe and compare participants, characterize Tai Chi interventions, and describe relevant outcomes has to be achieved.
PIH5: MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) OF THE ERECTION QUALITY SCALE
Huang X1, Harris K1, Song J1, Wincze J2, Rosen R3, 1Bayer Pharmaceuticals
Corporation, West Haven, CT, USA, 2Brown University, Providence, RI, USA, 3UMDNJRobert Wood Johnson Medical School, Piscataway, NJ, USA
OBJECTIVE: The recently developed Erection Quality Scale (EQS) is a self-reported measure for assessing the quality of penile erections. To clinicians, it is important not only to
ascertain validity of the EQS, but also to comprehend the smallest change in EQS score
that patients consider important. The objectives are to report the MCID of EQS and the scientific process within which the MCID was estimated. METHODS: A randomized, doubleblind, placebo-controlled study was conducted to investigate the responsiveness of the
EQS. Men age >= 18 years with ED for at least 6 months were eligible. Following a 4week run-in period, eligible subjects were randomized to receive 10 mg vardenafil or
matching placebo for 4-weeks.In a subsequent 4-week period, subjects remained on the
assigned treatment with an option to titrate the dose to 5 mg or 20 mg. The International
Index of Erectile Function (IIEF), the Global Assessment Question (GAQ), Sexual Encounter
Profile (SEP), Keep it Simple (KIS) scale, EQS, and anchor question were administered to
study subjects. Safety was assessed throughout the study period. Anchor-based methods
and distribution based methods were used to estimate the MCID. RESULTS: A total of 219
men were enrolled in this study, of whom 113 received placebo and 106 received vardenafil. The MCID generated by two distribution based methods, namely the 1/2 SD and
SEM, were comparable and was 5 points. The estimate generated by cross-sectional
anchor-based analyses ranged from 4.82 to 16.33 (with ES ranging from 0.66 to 1.16).
With longitudinal method, the mean EQS change scores for subjects with one point of
anchor score change were 8.08 and 8.03 with ES of 1.12 and 1.18, respectively. Applying
52
Cohen’s ES criteria ranging from 0.2 and 0.8, the estimated EQS MCID was five points
with corresponding ES of 0.5. CONCLUSIONS: The MCID of EQS is five points.
PIH6: A COST-EFFECTIVENESS ANALYSIS OF CONTRACEPTIVES IN UKRAINE
Zaliska O, Pushak K, Lviv National Medical University named Danylo Galitsky, Lviv,
Ukraine
OBJECTIVE: In the Ukraine the authorized National program «Reproductive health» which
provides rational contraception of women. To carry out the pharmacoeconomical analysis
of hormonal contraceptives and to validate economical advantages New-Ring compared to
oral contraceptives in Ukraine. METHODS: A marketing analysis, a “cost-effectiveness”
analysis. The marketing analysis of hormonal contraceptives has shown, that in Ukraine
the import preparations submitted only. It is carried out the pharmacoeconomic analysis of
hormonal combined contraceptives in different medical forms: vaginal rings (New–ring),
scin plaster (Evra) and tablets for oral reception (Jaryna). Mean cost of contraceptives was
calculated based on the minimal wholesale price and the limiting state margin - 35 % the
April 2005. The costs for contraception within one year preparation Åvra have made
33396,12 Hryven (1 Euro - 6,35 Hryven.), the New-ring - 1014,96 Hrn., Jaryna - 784,08
Hrn. By results of an expert estimation of women compliance preparations following: Åvra
– 88,7 %, New-ring – 81,0 %, Jaryna – 79,2 %. The maximum compliance of a plaster
and vaginal rings caused by transdermal receipt of contraceptives provides, as against
tablets, stable concentration of hormones during a month. RESULTS: The marketing analysis having shown necessity of creation of a domestic production contraceptives in Ukraine.
Taking into account similar level of compliance to the Åvra and to the New-ring, it is possible to recommend the New-ring as an optimum contraceptive behind a CER. The analysis
“cost-effectiveness” has shown, that contraception within one year Evra will cost to the
woman in 4,3 times more expensive, and a ring the New-ring - in 1,3 times more expensive, than tablets Jaryna. CONCLUSIONS: The New-ring represents a less expensive alternative to long-term oral contraceptives.
PIH7: THE SITUATION OF HEALTH TECHNOLOGY ASSESSMENT IN HUNGARY
Kincses G, National Institute of Strategic Health Research, Budapest, Hungary
The situation of health technology assessment in Hungary Ministry of Health, Budapest,
Hungary; After Hungary’s accession to the European Union (1 May 2004) technology
assessment plays a mandatory role in granting social insurance subsidies. In every case
the process starts with licensing/registration, then continues with decisions on social
insurance inclusion, and if judged so after a period of time, it ends with exclusion from circulation/subsidy. In all this cost-efficiency, health policy, social-political and insurance policy considerations also play a role. This is the process in which the National Institute for
Strategic Health Research (ESKI) takes part as it supports decision-making by preparing
background materials, analyses and studies. Within this the Technology Assessment Office
(TEI) supports decision-makers of the committee of the National Health Insurance Fund
(OEP) that awards social insurance subsidies with its work of evaluating pharmaceutical
subsidy applications. The basic criteria of this work among others are cost-efficiency and
ranking/qualifying of the technology to be replaced or the problem to be solved. The inclusion of pharmaceutical products operates in accordance with the principle of transparency:
Within the framework laid down by law the appropriate data sheet with its supplements
are passed to the Pharmaceutical Division of the National Health Insurance Fund (OEP),
where in a simplified case the inclusion of generic drugs, as well as new potencies and
packaging, etc. takes place directly on the premises. The documentation of drugs containing new agents are transferred to ESKI TEI, where evaluation of applications are prepared
for the OEP committee that makes recommendation for inclusions. After the committee
decisions all final recommendations are made in OEP’s Pharmaceutical Division that are
then disseminated as law by the minister of health in agreement with the minister of
finance. There is a possibility for appeal. In that case the director of OEP makes decisions.
PIH8: PRIVATE PRACTICE AMONG PUBLIC MEDICAL DOCTOR IN THAILAND
Prakongsai P1, Tantivess S2, Tangcharoensathien V2, 1International Health Policy
Program, Amphoe Muang, Thailand, 2International Health Policy Program,
Nonthaburi, Thailand
OBJECTIVE: To investigate patterns, behavior, motivation, and impacts of private practice
among public medical doctors in Thailand and search for appropriate policies to regulate
and mitigate consequences of private practice toward public health services. METHODS:
Comprehensive literature review, an anonymous self-administered questionnaire for 1,808
public medical doctors in five selected provinces, and in-depth interviews with key informants at local and national levels. RESULTS: Sixty-nine percent of public doctors had undertaken private practice. The main reason for having private practice was “income from public services is not adequate”. A logistic regression analysis indicated that factors influencing private practice engagement were being male medical doctors and being a medical
specialist (e.g. surgeons, obstetricians). The ratio of total monthly income between fully
public and dual job-holding doctors was 2.2. In-depth interviews illustrated that implications of private practice were ranging from public-time corruption, neglecting public
patients, poor performance in the public sector due to exhaustion from private work, and
differences in the quality of care providing for public and private patients. Existing regulations towards private practice in Thailand tend to be weak with poor enforcement.
Responsible organizations such as Ministry of Public Health and Thai Medical Council have
neither any policies in this area nor intention to regulate such practice. CONCLUSIONS:
Even though private practice provides two useful functions: compensating for the low
salary scale of public medical services and increasing access to health care for those who
are affordable, its negative impact requires regulations and measures to minimize those
consequences. Strengthening of regulatory measures and administrative capabilities with
an introduction of new payment methods reflecting performance and quality of care are
urgently needed. Indirect measures including changing payment methods for public health
care providers, quality assurance (QA), and hospital accreditation (HA) are widely accepted
as an effective measure by Thai health care providers.
INFECTION
PIN1: COST-EFFECTIVENESS OF NEVIRAPINE VERSUS EFAVIRENZ BASED
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN HIV-INFECTED PATIENTS IN
THAILAND
Phumipan S1, Kaewnoi C1, Pongchareonsuk P1, Chaikledkaew U2, 1Mahidol
University, Payathai, Bangkok, Thailand, 2Mahidol University, Bangkok, Thailand
OBJECTIVE: To compare the cost-effectiveness of nevirapine (NVP) versus efavirenz (EFV)
based highly active antiretroviral therapy in HIV-infected patients in Thailand. METHODS: A
cost-effectiveness model was developed based on efficacy and cost data in Thailand. The
cost-effectiveness analysis was conducted using a decision tree analysis. Costs of physician visit, medication, lab test, physician, and hospitalization were obtained from Siriraj
Hospital Thailand. Sensitivity analysis was also performed to test the model robustness.
RESULTS: After receiving nevirapine base regimen for six months, the probability of virological success was 47%. The probability of virological success was 63% for efavirenz
base regimen. Total costs were 43,320 baht(US$ 1057.88)and 44,773 baht (US$ 1093.36)
for NVP and EFV base groups, respectively. The EFV base regimen was more cost-effective
and its incremental cost-effectiveness ratio was 9,023 baht (US$ 220.34) when compared
to NVP base regimen. In Thailand, there was the treatment regimen (i.e., the fixed-dose
combination of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP). Total cost of this
regimen was 41,694 baht (US$ 1018.17). When compared to EFV, the incremental costeffectiveness ratio was 19,121 baht (US$ 466.94). CONCLUSIONS: The results were sensitive to a number of assumptions including the cost and fixed-dose combination of starvudine, lamivudine and nevirapine. In developing countries, using fixed-dose combination
regimen will present more accessibility for HIV patients.
PIN2: COMPARING COST-EFFECTIVENESS OF INTERVENTIONS TO REDUCE
MOTHER-TO-CHILD TRANSMISSION OF HIV IN SOUTH AND SOUTH-EAST
ASIA
Chang CW, Taipei Medical University, Taipei, Taiwan
OBJECTIVE: To compare the cost-effectiveness of different treatments to prevent motherto-child transmission (MTCT) of HIV/AIDS in south and southeast Asia countries. METHODS: Estimated data from literature reviews and clinical trials for a hypothetical cohort
study of 20,000 pregnant women in south and south-east Asia in 2004 is applied within
this study. Comparing cost-effectiveness of five different treatments of Nevirapine regimen
Universal Treatment (universal HIVNET012), Nevirapine regimen Targeted Treatment (targeted HIVNET 012), Petra-B regimen Targeted Treatment (Petra B), Zidovudine Cote d’
Ivoire Trial regimen Targeted Treatment (Cote d’ Ivoire), and no intervention. Main outcome
data are measured in cost per disability adjusted life years saved, and cost per MTCT case
averted. RESULTS: Universal HIVNET012AED treatment is the most cost-effective treatment ($4.37 per DALY; $117.39 per case averted) among all optional interventions, followed by targeted HIVNET 012 ($6.97 per DALY; $187.03 per case averted). Petra B costs
$9.26 per DALY and $239.94 per case averted. Cote d’Ivoire costs Petra B costs $12.03
per DALY and $306.05 per case averted. The incremental cost-effectiveness ratio of
$1.3750 per DALY saved moves from no intervention to Universal HIVNET012AED treatment. CONCLUSIONS: This study is in favor of the use of Universal HIVNET012AED treatment for preventing mother-to-child transmission in south and south-east Asia. Due to the
limited information of the cost and effectiveness of pre-treatment screenings, the study
can not compare the accurate cost-effectiveness of different stages of each different intervention. Therefore, comparing the cost differences between universal and targeted treatment may lead to the result of favoring of intervention without screening (universal treatment). KEY WORDS: HIV, mother-to-child transmission (MTCT), cost-effectiveness.
PIN3: COST-EFFECTIVENESS OF SINGLE-DOSE PERINATAL NEVIRAPINE
PLUS STANDARD ZIDOVUDINE TO PREVENT MOTHER-TO-CHILD TRANSMISSION OF HIV IN THAILAND
Yuwaree V1, Ponsoongnern K1, Pongcharoensuk P2, Chaikledkaew U2, 1mahidol
university, Bangkok, Thailand, 2Mahidol University, Rajathevi, Bangkok, Thailand
OBJECTIVE: Recently published clinical trails in Thailand have demonstrated that perinatal
nevirapine added to zidovudine could further reduce mother-to-child transmission of HIV in
Thailand. Cost of providing antiretroviral drugs and other services to mother and children
has never been considered. The objective of this study is to compare the cost-effectiveness of standard zidovudine alone with single-dose perinatal nevirapine plus standard
zidovudine regimen to prevent mother-to-child transmission of HIV in Thailand. METHODS:
Decision tree model who used to conduct cost-effectiveness analysis. Cost data were
obtained from the government hospital and effectiveness data were derived from published study. The main outcome measure is cost of perinatal HIV infection avert in children
follow up six months. RESULTS: Single-dose perinatal nevirapine plus standard zidovidine
to prevent mother-to-child transmission ( PMTCT ) of HIV-1 cost 5421.23 baht ( $135.53 )
per HIV infection avert in children whereas the cost per HIV infection avert in children of
standard zidovudine is 5770.22 baht ( $ 144.26 ). This is much less than the standard
zidovudine cost per HIV infection avert in children. CONCLUSIONS: Based on the results, it
is cost-effective to add single-dose nevirapine in standard zidovudine regimen to PMTCT
HIV-1 in Thailand.
PIN4: CAN REDUCTION OF OPPORTUNISTIC INFECTION TREATMENT COST
OUTWEIGH COST OF TRIPLE ANTIRETROVIRAL THERAPY?
Loongbarn S, Kulsomboon V, Chulalongkorn University, Bangkok, Thailand
OBJECTIVE: To determine whether the reduction of opportunistic infection treatment cost
among HIV patients offsets their increased cost after providing the triple ARV combination
drug, GPO-VIR® , which costs only US $ 1 (40 baht) per day. METHODS: Only the HIV
patients who had CD4 cell count less than 200 cell/mm3 at the initiation of receiving GPOVIR were recruited in the study. Clinical and cost data of the HIV patients, one year before
and at least 6 months after receiving GPO-VIR, were collected. Cost-consequences analysis was employed based upon provider perspective. RESULTS: Of the 78 HIV patients,
52.6% were females and 80.8% had the CD4 cell count level less than 100 cell/mm3 at
the initial treatment. The mean of the CD4 cell count level (179.2 ± 94.00) after receiving
GPO-VIR significantly increased from baseline (56.5 ± 52.9) at the initial treatment
(P=0.000). The incidence rate of specific OI at OPD visit substantially decreased including
Pneumocystis Carinii Pneumonia (PCP), Cytomegolovirus (CMV), Tuberculosis (TB), and
Cryptococcal Meningitis. Four HIV patients (5.1%) were admitted with severe ADR including two cases of acidosis, one case of renal failure, and one case of hepatic failure. The
treatment costs before receiving GPO-VIR were 108.7 US $ per patient per year (PPPY).
After receiving GPO-VIR, the total costs were 567.1 $ PPPY including 459.2 $ PPPY for the
GPO-VIR cost. The hospitalization cost reduced from 49.5 $ PPPY to 20.4 $ PPPY after
receiving GPO-VIR. Cost of ADR treatment was 48.4% of overall hospitalization cost. CONCLUSION: After receiving GPO-VIR, although the overall cost did not outweigh the cost
prior to the ARV treatment, it substantially decreased severe OI and hospitalization cost.
The positive impact of GPO-VIR enhances provider to increase universal coverage of GPOVIR for all eligible HIV patients in Thailand.
53
PIN5: QUALITY OF LIFE INSTRUMENTS IN HIV/AIDS PATIENTS: AN APPROPRIATE INSTRUMENT FOR THAI PATIENTS
Inngam P, Pratheepawanit N, Tripop S, Johns J, Khon Kaen University, Khon Kaen,
Thailand
OBJECTIVE: In the year 2005, there are approximately 670,000 people in Thailand living
with HIV/AIDS. New pharmaceutical interventions may extend the survival of these patients.
Health related quality of life (HRQOL) is increasingly of interest for a comprehensive outcome of care in these patients. To select an appropriate instrument for Thai patients, this
article comprehensively reviews the psychometric properties of HRQOL instruments used in
HIV/AIDS patients that were published from 1990 to 2005 in the Medline database. METHODS: These were found using the search terms ‘quality of life’, ‘HIV’, and ‘instrument’. Of 19
instruments reviewed, 8 are generic and 11 are disease-specific instruments. To evaluate
these instruments, we considered the content, administration, depth of HRQOL measured
and psychometric properties. Overall, generic instruments do not adequately cover the
important issues for HIV/AIDS patients and are not responsive. The disease specific instruments consist of aspects not assessed by generic instruments, such as medication, sexual
and financial aspects. RESULTS: The MOS-HIV, FAHI, and AIDS-HAQ exhibit high reliability in
all domains, and have evidence of responsiveness. However, they still lack evidence of testretest reliability, which is important for assessing the stability of the instrument over time.
The MOS-HIV is claimed to have higher responsiveness than the other tools, making it the
most appropriate among these instruments. However, the weakness lies in its high ceiling
effects that weaken its ability to capture change, particularly with asymptomatic patients.
The MOS-HIV is the only instrument that has been translated into Thai language to date.
CONCLUSIONS: The single study published reported that this version had even higher ceiling effects. Revision of this instrument to enhance this shortcoming and adding content
about medication and symptoms to increase its content coverage are necessary for the
development of a Thai HRQOL instrument for HIV patients.
PIN6: ECONOMIC EVALUATION OF INFLUENZA VACCINATION AMONG THE
ELDERLY IN BANGKOK
Plasai V1, Viputsiri OA2, Pongpanich S3, Lertmaharit S4, Panichpathompong U5,
Tarnmaneewongse V5, Cheunkitmongkol S5, Baron-Papillon F6, 1College of Public
health Chulalongkorn University, Bangkok, TN, Thailand, 2Dept. Preventive & Social
Medicine Chulalongkorn University, Bangkok, Thailand, bangkok, Thailand, 3college
of public Health Chulalongkorn University, Bangkok, Thailand, 4Dept. Preventive &
Social Medicine Faculty of Medicine, Bangkok, Thailand, 5sanofi pasteur, Bangkok,
Thailand, 6sanofi pasteur, Lyon cedex 07, France
Influenza causes substantial morbidity and mortality in elderly people. Despite recommendations for annual vaccination against influenza and the availability of effective vaccines to
deal with this disease, most elderly Thais are not vaccinated. Evaluation of the economic
impact of influenza vaccination among elderly in Bangkok can support public health policy
decisions concerning vaccination and also help influence medical practices. OBJECTIVE:
To determine (i) the effectiveness of influenza vaccination among the elderly in Bangkok in
reducing influenza like illness (ILI) and influenza-related complications and (ii) the costeffectiveness from the societal perspective. METHODS: Using nonrandomized, non-controlled, prospective study, we studied active living people aged 60 or over who enrolled in
two Elderly Co-ordination Centers (ECC). The two study arms were vaccinated and a nonvaccinated group with sample size of 520 each. The occurrence of influenza and its complications in each group was examined and cost-effectiveness evaluation of influenza vaccination performed. RESULTS: During the 12-month study, vaccination was associated
with a reduction in the rate of visiting doctors and reported ILI (7.7% of vaccinated vs
13.3% of non-vaccinated). Under Thailand’s 30 Baht health insurance program (governmental co-payment scheme), the out-of-pocket expenditures were lower in the vaccinated
group (B9,896: B23,562) and mean value per person of vaccinated elderly was lower than
non-vaccinated elderly (B206:B277) even though they were not significantly different.
Annual direct saving in cost of illness if vaccination averaged B71 per elderly vaccinated,
with cumulative saving of B36,920. Vaccination was associated with a reduction in ILI
episodes during the influenza season. CONCLUSIONS: Although the results indicated the
benefit and effectiveness of influenza vaccination for the elderly in Bangkok, the vaccine
availability and affordability is still a discussion issue. It is clear that strategies targeting
elderly and/or other groups are needed to improve vaccination policy and ensure better
health of Thai population.
54
PIN7: EFFECT OF INTEGRATED TRADITIONAL CHINESE MEDICINE AND
WESTERN MEDICINE ON SARS TREATMENTS: SYSTEMATIC REVIEW AND
META ANALYSIS
Chen Y1, Guo JJ1, Daniel PH1, Zhan SY2, 1University of Cincinnati, Cincinnati, OH,
USA, 2Peking University, Beijing, China
OBJECTIVE: To assess the effect of integrated TCM (Traditional Chinese Medicine)/WM
(Western Medicine) on severe acute respiratory syndrome (SARS) treatments compared
with those patients treated with WM alone. METHODS: A systematic review and metaanalysis of controlled clinical studies. Data were collected from published and unpublished
controlled clinical studies, and systematic clinical reviews indexed in either Medline,
Chinese National Knowledge Infrastructure (CNKI), or other important official reports from
2003 to 2005. A total of 4122 patients from 30 controlled clinical studies fulfilling the
inclusion criteria were identified for this study. Outcome measurements: mortality rate,
resolution of lung infiltrate, the use of corticosteroid, time to defervesence, immune functions tests, duration of hospitalization,the Adverse Drug Reactions. RESULTS: Of 30 selected studies, there were 2110 patients from 20 randomized controlled studies and 2012
patients from ten non-randomized controlled studies. The pooled estimated mortality rates
in the integrated TCM /WM and WM groups were 40.1 per 1,000 and 136.4 per 1,000,
respectively (Relative Risk= 0.31, 95%CI =0.20- 0.48, p<0.0001). Analysis of the clinical
cure rate showed a significant treatment effect for integrative treatments (p=0.004).
Patients with integrated TCM/WM used less corticosteroid in terms of daily dosage
(p<0.00001). Last, patients with TCM/WM had better resolution rate of lung infiltrate
(p=0.0002), more rapid resolution of fever (p=0.001), higher counts of CD4+ lymphocyte
(p=0.0008), and less duration of hospitalization (p=0.04). In addition, through the literatures review, we found that integrated TCM/WM also could lower the abnormal level of ALT
and AST resulted from the medications and reduce the possibility of the occurrence of ADR
or other complications. CONCLUSIONS: The integrated TCM/WM for SARS treatments was
superior to the treatment with WM alone in terms of lower mortality rate, high curative
rate, and other clinical outcomes. It is clinically important to consider the integrated
TCM/WM treatment for SARS treatment.
PIN8: ECONOMIC EVALUATION COMPARING VORICONAZOLE WITH CONVENTIONAL AMPHOTERICIN B AS THE PRIMARY TREATMENT REGIMENS OF
INVASIVE ASPERGILLOSIS IN TAIWAN
Lin SSF1, Chu CHY1, Li MPY1, Chen YJ2, Roberts C3, Chen NCC1, 1Pfizer Limited
Taiwan, Pfizer Global Pharmaceutical, Tamsui, Taipei County, Taiwan, Taiwan,
2National Taiwan University Hospital, Taipei, Taiwan, 3Pfizer Inc, New York, NY, USA
Voriconazole (VOR) is a broad-spectrum triazole that has been shown to be superior to
amphotericin B deoxylate (AMB) as initial therapy for invasive aspergillosis (IA) in terms of
response, survival, and safety in the largest comparative trial of IA to date (Herbrecht et al.
NEJM 2002, 347:408-15). No economic evaluation has been conducted to assess the
cost-effectiveness of VOR in Taiwan. OBJECTIVE: To assess treatment costs and costeffectiveness of VOR compared with AMB as initial therapy of invasive aspergillosis.
METHODS: Cost-effectiveness of VOR compared with AMB for treatment of invasive
aspergillosis in Taiwan was evaluated with a decision-analytic model developed from clinical trial data supplemented with local data. Clinical success, survival, hospital stay by
treatment pathway, and need for second line therapies were obtained from the clinical
trial. Unit costs of medications and resources of medical care were obtained from Taiwan’s
national reimbursement system database. Data were collected from local experts on use
of concomitant therapy, monitoring, and second line therapies. Cost-effectiveness was
expressed as incremental cost per successful case and incremental cost per life saved.
RESULTS: The average cost of treating invasive aspergillosis primarily with VOR was
547,002 New Taiwan Dollars compared with 493,060 NTD with AMB. Hospitalization costs
and the cost of antifungal therapies were the largest contributors to cost in both the treatments. The incremental costs per life saved for VOR vs. AMB was 254,444 NTD (7,951
USD) and the incremental cost per successfully treated patient was 418,155 NTD (13,067
USD), respectively. CONCLUSIONS: Although treating patients with invasive aspergillosis
with voriconazole costs more than AMB, the incremental costs per successful case and life
saved for VOR is reasonable. VOR is likely to be a cost-effective treatment for invasive
aspergillosis in Taiwan.
PIN9: HBE-ANTIGEN NEGATIVE CHRONIC HEPATITIS B: COST-EFFECTIVENESS OF PEGINTERFERON ALFA-2A COMPARED TO LAMIVUDINE TREATMENT IN TAIWAN
Veenstra DL1, Sullivan SD1, Lai MY2, Lee CM3, Tsai CM4, Patel KK5, 1University of
Washington, Seattle, WA, USA, 2National Taiwan University Hospital, Taipei, Taiwan,
3Chang Gung Memorial Hospital, Kaohsiung, Taiwan, 4Roche Products Ltd, Taipei,
Taiwan, 5Hoffmann-La Roche, Nutley, NJ, USA
In Taiwan, the carrier rate of HBsAg is 15-20%, one of the highest in the world. Among
chronic hepatitis B (CHB) patients, HBeAg-negative disease accounts for roughly 40-50%
of patients. A recent trial showed that peginterferon alfa-2a (40KD) (PEG) was more effective than lamivudine (LAM) in treating HBeAg-negative CHB. The cost-effectiveness of PEG
compared to LAM has not been evaluated. OBJECTIVE: To evaluate the incremental costeffectiveness of 48 weeks of PEG compared to 48 weeks of LAM, from the perspective of
the Taiwan Bureau of National Health Insurance. METHODS: A Markov model was developed to simulate the natural history of HBeAg-negative CHB in a cohort of 40-year old
patients. Efficacy, disease progression, economic, and quality of life data were extracted
from the published literature and validated by clinical experts in Taiwan. Life expectancy,
quality-adjusted life expectancy, lifetime costs (NTD$), and incremental cost-effectiveness
ratios (ICERs) were computed. Sensitivity analyses were undertaken. RESULTS: The gain in
quality adjusted life years (QALYs) for 48 weeks of PEG compared to 48 weeks of LAM was
0.45 at an additional cost of NTD$157,000 (US$5,000), resulting in an ICER of
NTD$347,000 (US$11,000) per QALY gained. Despite plausible variation in each parameter
used in the analysis, the ICER did not exceed NTD$448,000 (US$14,000) per QALY gained.
CONCLUSIONS: In HBeAg-negative CHB, 48 weeks of treatment with PEG compared to 48
weeks of LAM appears to offer life expectancy and quality of life improvements at a favorable cost-effectiveness ratio.
PIN10: COST-EFFECTIVENESS OF PEGINTERFERON ALFA-2A COMPARED TO
LAMIVUDINE TREATMENT IN PATIENTS WITH HBE-ANTIGEN POSITIVE
CHRONIC HEPATITIS B IN TAIWAN.
Sullivan SD1, Veenstra DL1, Chen PJ2, Chang TT3, Chuang WL4, Tsai CM5, Patel
KK6, 1University of Washington, Seattle, WA, USA, 2National Taiwan University,
Taipei, Taiwan, 3National Cheng Kung University Hospital, Tainan, Taiwan,
4Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 5Roche Products Ltd,
Taipei, Taiwan, 6Hoffmann-La Roche, Nutley, NJ, USA
Peginterferon alfa-2a (40KD) (PEG), a new treatment option for patients with chronic hepatitis B (CHB), offers improved efficacy with a defined treatment duration compared with
lamivudine (LAM), but at a higher cost. OBJECTIVE: We undertook a cost-effectiveness
analysis from the perspective of the Taiwan Bureau of National Health Insurance to assess
the clinical outcomes and costs of PEG for the treatment of patients with HBeAg-positive
CHB, compared to LAM treatment for 48 weeks. METHODS: An economic evaluation using
a state-transition Markov model simulating the natural history of HBeAg-positive CHB was
used. Efficacy data were obtained from a randomized clinical trial of 820 patients (87%
were Oriental) comparing PEG to LAM. We modeled a hypothetical cohort of 32-year old
patients with HBeAg-positive CHB. Life expectancy, quality-adjusted life expectancy, lifetime costs (NTD$), and incremental cost-effectiveness ratios (ICERs) were estimated.
RESULTS: 48 week treatment with PEG compared to LAM resulted in higher total costs,
but greater quality-adjusted life expectancy, yielding an ICER of NTD$381,000 (US$12,000)
per quality-adjusted life year (QALY) gained. Although there is uncertainty associated with
the prognosis of HBeAg-positive CHB, the ICER did not exceed NTD$485,000 (US$15,000)
per QALY gained despite variation in each parameter used in the analysis. CONCLUSIONS:
48 week treatment with PEG compared to 48 week of LAM treatment in CHB patients who
are HBeAg-positive appears to offer life expectancy benefits at a favorable cost-effectiveness ratio for the Taiwan Bureau of National Health Insurance.
PIN11: COST-MINIMIZATION ANALYSIS OF DURAPREP AND AQUEOUS
IODOPHOR SCRUB FOR SKIN PREPARATION IN CABG SURGERY IN SOUTH
KOREA: A RANDOMIZED CONTROLLED TRIAL
Jo MW1, Kim YS2, Lee SI1, 1University of Ulsan College of Medicine, Seoul, South
Korea, 2University of Ulsan, College of Medicine, Asan Medical Center, Seoul, South
Korea
OBJECTIVE: To conduct the economic evaluation of iodophor-in-alcohol, film-forming,
water-insoluble skin prep (Duraprep Surgical Solution, 3M company St. Paul, MN) and
aqueous iodophor scrub for skin preparation in coronary artery bypass graft(CABG) in
South Korea. METHODS: A prospective randomization controlled trial was conducted after
approval of Institutional Review Board in Asan Medical Center, Seoul, South Korea. A total
of 189 patients were assigned by block randomization to apply Duraprep or aqueous
iodophor for measurement of 30 days-postoperative infection rate as a outcome. For costanalysis, 64 patients among them were recruited and time-dependent cost variables such
as cost for anesthesia, healthcare professionals, and drugs and cost of consumables variables such as surgical glove, gauze, bowl, iodophor etc were collected. Sensitivity analyses for each assumption also were done. RESULTS: We conducted cost-minimization
analysis because postoperative infection rate was equivalent(3.2% in Duraprep group vs
5.3% in aqueous iodophor scrub group, p=0.497). In social and patient perspectives, each
cost in Duraprep group was $37.2 & $6 and in aqueous iodophor scrub group was $49.1
& $11.6. In insurer perspectives, cost in Duraprep group was $ 23.2 and in aqueous
iodophor scrub group was $14.8. In sensitivity analysis, most results were similar to basic
analysis. CONCLUSIONS: In conclusion, using Duraprep for skin preparation in CABG surgery in South Korea might save cost in social and patient perspectives.
PIN12: ESTIMATION OF CLINICAL AND ECONOMIC CONSEQUENCES OF
COUNTERFEIT ANTIMALARIAL MEDICINES IN LAO PDR: USING AN EPIDEMIOLOGIC MODEL
Suyavong P1, Chaiyakunapruk N2, Patmasiriwat D2, 1National University of Laos,
Vientiane, Vientiane, Laos, 2Naresuan University, Muang, Phitsanulok, Thailand
OBJECTIVE: Counterfeit antimalarial medicines have worsened the malaria situation in
Laos because its use placed patients at risk of developing complications and death. This
study aims to estimate its clinical and economic consequences in Lao PDR. METHODS: An
epidemiologic model was structured and analyzed from the societal perspective. The population of Lao PDR was simulated through the model under 1) current situation (existence
of counterfeit drugs) and 2) idealistic situation (no counterfeit drugs). The prevalence of
counterfeit artesunate (41.18%) was used in the model. Several probability data were
derived from literature, while others were based on interviews of providers in the settings.
The cost of medications was taken from the wholesale price of a pharmaceutical company, while medical visit and hospitalization costs were converted from the hospital charges
using a cost-to-charge ratio. The indirect cost was estimated using human-capital
approach. The model was used to compute the differences of the number of hospitalizations, deaths, and total costs between both situations. A series of sensitivity analysis were
performed. Since the time horizon of this study was one year, discounting was not needed.
RESULTS: In the base-case analysis, 65 deaths, 4,741 hospital days, and $US 50,633
were incurred due to counterfeit antimalarial medicines. It was found that the probability
of becoming severe malaria when using counterfeit medicines was very influential to clinical consequences, while the cure rate of counterfeit antimalarial medicines was influential
to economic consequences. Scenario analyses demonstrated that counterfeit antimalarial
medicines resulted in 539 of deaths in worst-case sensitivity analysis, and 9 deaths in
best-case sensitivity analysis. CONCLUSIONS: In Lao PDR, an existence of counterfeit antimalarial medicines results in substantial increases in morbidity, mortality, and costs. Our
research findings could be used as part of information to help policy makers prioritize
problems and properly allocate budget to eliminate them.
PIN14: PREDICTING TREATMENT COST OF BACTERIAL DIARRHEA
Riewpaiboon A, Mahidol University, Bangkok, Thailand, Intraprakan K, Phobpra
Hospital, Amphur Phobpra, Tak, Thailand, Phoungkatesunthorn S, Saraburi Hospital,
Amphur Muang, Saraburi, Thailand
OBJECTIVE: This study was aimed to formulate the treatment cost function of bacterial
diarrhea from provider perspective at Saraburi regional hospital in Thailand. METHODS:
This study was a retrospective study using the incidence-based approach. The study covered both out and in-patients (ICD code A00-A05, DRG group 182-184) received treatment
during October 1, 2000 to July 31, 2003. There were 878 out-patients and 233 inpatients. Sample size of out-patients were calculated based on a preliminary cost analysis
and selected by convenience sampling. All in-patients were included. Stepwise multiple
regressions were employed to create the cost function. RESULTS: The study covered 393
episodes. All costs were calculated at 2002 prices. The average costs were 451 THB,
3,903 THB, and 2,250 THB per outpatient episode, inpatient episode, and average episode,
respectively (approximately Thai baht; THB 40 = US$ 1). It was found that the cost of out55
patients was associated with number of visits, out-patient clinics, and antibiotic prescribing. Costs of inpatients were associated with length of stay, type of pathogens (ICD),
antibiotic prescribing, fever, age, and payment scheme. In case of forecasting at the beginning of treatment, type of patient (out or inpatient), type of pathogen (ICD), antibiotic prescribing, fever, age, and payment scheme were significant variables. The three models had
high determination coefficients of 0.845-0.880. CONCLUSIONS: Treatment cost of nearly
90% of bacterial diarrhea episodes could be explained by number of visits, hospitalized
days, type of patients, clinics, pathogens, antibiotics use, fever, age, payment scheme.
PIN15: INITIAL CONTENT VALIDATION OF A DISEASE-TARGETED HEALTHRELATED QUALITY OF LIFE (HRQOL) INSTRUMENT IN CHRONIC HEPATITIS B
VIRUS (HBV) INFECTION
Spiegel B1, Bolus R1, Han S2, Talley J1, Ong SH3, Chang J4, Kanwal F1, 1UCLA/VA
Center for Outcomes Research and Education (CORE), Los Angeles, CA, USA, 2UCLA
Medical Center, Los Angeles, CA, USA, 3Novartis Pharmaceuticals, Basel,
Switzerland, 4Novartis Pharmaceuticals, East Hanover, NJ, USA
OBJECTIVE: The burden of illness of HBV is significant in Asia-Pacific, not only because of
its high prevalence, but also because of its HRQOL decrement. Despite the importance of
HRQOL in HBV, there are no disease-targeted instruments currently available. We are
therefore developing a new, disease-targeted HRQOL instrument in HBV. This presentation
describes the candidate items and scales resulting from our initial content validation
process. METHODS: “Content validity” is the degree to which an instrument contains a
representative range of items and scales relevant to the disease under study. In order to
establish content validity for our evolving instrument, we initially conducted a systematic
review to identify published HRQOL instruments in chronic liver disease and related conditions. We then convened a panel of five hepatologists experienced in HBV. Using a semistructured protocol, we elicited the domains perceived as most relevant in HBV, and asked
the panel to comment on the relevance of the items from systematic review. Finally, in
concert with three psychometricians, we developed a conceptual model of the scales in
HBV. RESULTS: We selected five scales on the basis of their content validity and potential
responsiveness (i.e. ability to detect HRQOL change after successful treatment); 1)
Anticipation Anxiety/Psychological Well Being (e.g. fear of cancer/cirrhosis);2) Disease
Stigma/Social Well Being (e.g. embarrassment, concern for job); 3) Sexual Well
Being/Intimacy (e.g. transmission concern, impact on sexuality); 4) Daily Functioning (e.g.
impact on diet or medication use); and 5) Vitality/Physical Well Being (e.g. feeling worn out,
low energy). CONCLUSIONS: Five scales may capture HRQOL in HBV across a range of
psychological, social, and physical factors. The breadth and depth of symptoms in HBV
highlights the significant HRQOL burden of this condition. Future research will test these
scales with patient focus groups, and will prospectively measure the psychometrics of our
evolving instrument.
PIN16: QUALITY OF LIFE AND COST OF DIFFERENT TREATMENT STRATEGIES FOR HEPATITIS C PATIENTS IN TAIWAN
Yang MC, Wen CY, National Taiwan University, Taipei, Taiwan
OBJECTIVE: The Bureau of National Health Insurance in Taiwan implemented an experimental plan for strengthening the chronic hepatitis C patient treatment on October 1,
2003. The purpose of this study was to analyze the medical cost (including direct cost and
indirect cost) and Health-Related Quality of Life (HRQoL) during the period of treatment
with different treatment strategies (peginterferon versus interferon), from the societal perspective. METHODS: We used a cross-sectional survey method to interview 45 patients
with chronic hepatitis C and were receiving treatment in an academic medical center. The
medical expenditures were provided by the hospital and the personal expenses reported
by patients. The HRQoL questionnaire contained the Short Form-12 (SF-12), the Fatigue
symptom inventory (FSI), and the Hospital Anxiety and Depression Scale (HADS). RESULTS:
The total medical costs per month for insurance claims was NT$23,666 for peginterferon
group and NT$14,125 for interferon. Indirect cost of Peginterferon group is NT$1618, and
NT$77 for interferon. Mean scores for PCS was 40.26 and 39.58 in the MCS of the SF-12.
Patients’ quality of life was lower than that of general people during the treatment. In addition, patients during treatment were worse in fatigue intensity, duration, and interference
with quality of life. The same results were observed in the anxiety and depression status.
Patients with peginterferon were significantly worse than those on interferon in MCS of
56
SF-12, duration of FSI, and depression of HADS. CONCLUSIONS: We suggest that the
genetic type of virus should be identified before the treatment is given. This may let
patients receive more appropriate care and also let the health insurance allocate the
resource better.
PMC1: USING DRUG PRICE DISCREPANCY INDEX TO IMPROVE EFFICIENT
USE OF PHARMACY BUDGET
Kulsomboon V, Sriwiriyanuparb W, Chulalongkorn University, Bangkok, Thailand
OBJECTIVE: Since 1999, the Ministry of Public Health (MOPH), Thailand, has developed
website to inform reference drug price to public health service institutions. The objectives
of this study were to analyze the available reference drug price data and compare the
price based on Weighted Average Price (WAP) and Drug Price Discrepancy Index (DPDI).
METHODS: Drug price data in 2001 were used for the analyses. The 62 drugs from a
provincial collective drug purchasing database were selected based on the their high
expenditure and the same 62 drugs were also selected from an individual purchasing
database for studying their purchasing prices. The WAP and DPDI of individual drugs were
calculated. The WAP was calculated from every unit price and volume purchased divided
by total amount of drug purchased. Drug Price Discrepancy Index (DPDI) was the ratio of
the individual unit price of each collective purchasing group and the WAP. To determine
high unit price of purchased drug for individual collective purchasing group, the acceptable
DPDI was set up to be no greater than 1.2. The WAP and DPDI of each drug were compared within the collective or individual purchasing group. RESULTS: Of the drug purchased by collective purchasing at provincial level, 15 (24%) drugs had a high purchasing
price and of the drug purchased by individual purchasing, 20 (32%) drugs had high a purchasing price. The WAP and DPDI parameter provided the group of target drugs to be
monitored to prevent highly purchased drug prices. CONCLUSIONS: The WAP might be
used to assist hospital in drug procurement to improve the efficient use of the pharmacy
budget. Other affiliating factors including quality of drug should also be considered in actual purchasing. It is anticipated that the DPDI will enable the collective purchasing network
and MOPH to be aware of high unit prices of drugs purchased around the country.
PMC2: PHARMACOECONOMIC ASPECTS OF THE ADMINISTRATIVE REFORMS
IN PHARMACEUTICAL SECTORS OF REPUBLIC HEALTH DEPARTMENTS IN
MONTENEGRO
Tomic Z1, Sabo A1, Bralic R2, Glomazic Z2, Mikov M1, Lazovic V3, 1Faculty of
Medicine, Novi Sad, Serbia and Montenegro, 2Republic Health Department,
Podgorica, -, Serbia and Montenegro, 3Faculty of Economy, Podgorica, Serbia and
Montenegro
OBJECTIVE: In 2002 in Montenegro, there was no efficient system to follow up the prescribing practice in outpatient clinics. The total expenses for drugs were so high that they
threatened to diminish the whole system of drug supply. Therefore in 2003 at the whole
Montenegro republic a system to follow up the drug prescribing in outpatient practice was
implemented. METHODS: The system consisted of the central unit in the Republic health
system in the Republic central health service, and the all pharmacies which give drugs on
the prescriptions were covered financially by the Republic health centre. System started on
January 1,2004; System contains bases with all drugs on market in Montenegro, all doctors, pharmacists, drug users and enables to follow the drugs way from each doctor to the
patient. At the same time the Republic health centre introduced the new list of drugs
refunded by the Republic health centre. The list of drugs refunded by the Republic health
centre so called positive list covered all important drugs, and was prepared in accordance
to new pharmacotherapeutic guidelines. ATC/DDD classification of drugs was used.
RESULTS: Analysis performed one year after implementation showed that the use of drugs
significantly decreased(15,68%) when compared with 2002. Expenses were 1,5 mil E
lower than in 2002/2003. From the all drugs, the most often issued drugs were for arterial
hypertension and for tonsilopharingitis, more than 25% of all prescriptions. The structure
of drugs prescribed was improved when compared with the pre-implementation period.
CONCLUSIONS: Permanent monitoring and periodic analyses of informations obtained
from an information system in the future will improve rationalization of the drug prescribing. Monitoring and analyses will show if some other administrative measurements are
needed to keep this positive trend on.
PMC3: USE OF OBSERVATIONAL HEALTH DATABASES FOR RESEARCH IN
PHARMACOECONOMICS AND PHARMACOEPIDEMIOLOGY
Guo JJ, University of Cincinnati, Cincinnati, OH, USA
OBJECIVE: Observational data often contain retrospective patient-specific and populationbased information, and have been widely used for health services and outcomes research.
The objective of this study is to review and compare characteristics of public and proprietary health care databases available for research in Pharmacoeconomics, epidemiology,
and outcomes research. METHODS: Published information and literature on health care
databases other than clinical trials were searched using Medline, International
Pharmaceutical Abstracts, Internet, as well as other commercially available sources.
RESULTS: Over 51 public health data sources or proprietary health care databases were
selected for review. This paper discussed major characteristics of these selected healthcare databases by categories, including: 1) electronic claims databases, like US Medicare
and Medicaid, Canadian Saskatchewan health database, US Veterans Affairs clinic databases, regional Blue Cross/Blue Shield database; 2) medical record databases, like
Harvard Pilgrim health care, United Health Group, UK General Practice Research Database,
Kaiser Permantente; 3) spontaneous adverse drug reaction reporting systems, like Food
Drug Administration Adverse Event Reporting Systems, Canadian Adverse Drug Reaction
Monitoring Program, World Health Organization Adverse Reaction database, and UK Yellow
Card; 4) health care survey data, like US Medical Expenditure Panel Survey (MEPS), and
National Ambulatory Medical Care Survey; and 5)disease registries and other health data,
like Surveillance Epidemiology and End Results, Metropolitan Atlanta Congenital Defect
Program, and National Death Index. In addition, the linkage capability of health data files,
data validity, and health privacy issues were also discussed. CONCLUSIONS: Many public
and proprietary healthcare databases are available for research in Pharmacoeconomics
and Pharmacoepidemiology. This review article on healthcare databases provides useful
information to compare and identify potential appropriate databases for specific research
objectives.
PMC4: SELECTING A PROPER EQ-5D VALUE SET MODEL FOR TAIWAN POPULATION
Tarn YH1, Chang TJ2, 1Taipei City Hospital, Taipei, Taiwan, 2Tri-Service General
OBJECTIVE: The objective of this study is to select a suitable EQ-5D value set model for
Taiwan population. METHODS: Data for valuation of EQ-5D health states were obtained via
three methods: a) through postal survey value analog scale (VAS); using the standard EQ5D format; A random sampling 12,924 adults was surveyed. b) VAS and c) Time Trade-Off
(TTO) interview methods were used to interview patients and care givers in a medical center. There were 228 adults interviewed. Four methods were used to exclude responses
from individuals to better fit the model. A: According to EuroQol exclusion criteria. B: when
A+(7). C: when A+(5)+(6). D: C+(7). The study used four criteria to select the proper EQ-5D
model: the higher adjust R2, smaller actual and estimated value difference, higher correlation with EuroQol model, larger sample size, the preference value (PV) graph had the similar pattern as EuroQol value set chart. RESULTS: In VAS method either by postal survey or
interview, the study indicate that D method was proper and the PV adjusted R2 achieving
0.53~0.57. In TTO interview method indicate that all A~D exclusion criteria results in the
preference value adjusted R2 of 0.48. In N2N3/VAS/D and N2N3/TTO/A models the actual
and estimated value difference was smaller and higher correlation with EuroQol model
than N3/VAS/D and N3/TTO/A. The N2N3/VAS/D and N2N3/TTO/A model had the similar
pattern as EuroQol value set chart. CONCLUSIONS: The N2N3/VAS/D/Postal and
N2N3/TTO/A models adjusted R2 achieve 0.53~0.48 and the correlation with EuroQol
model achieve 0.907~0.966. The two models can be used to interpolate values of the
states for which there is no direct observation.
PMC5: FEASIBILITY AND ACCEPTABILITY OF TTO AND SG AND FACTORS
INFLUENCING THEIR ACCEPTANCE FOR HEALTH VALUATION AMONG SINGAPOREANS
Wee HL1, Li SC2, Xie F2, Zhang XH2, Luo N3, Cheung YB4, Machin D5, Fong KY1,
Thumboo J1, 1Singapore General Hospital, Singapore, 2National University of
Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of
Hygiene & Tropical Medicine, London, United Kingdom, 5National Cancer Centre,
Singapore
OBJECTIVE: As time trade-off (TTO) and standard gamble (SG) are well-established health
valuation techniques (with advantages and disadvantages), their feasibility and acceptability are important in selecting either technique for population-based health valuation studies. We therefore evaluated the feasibility, acceptability and factors influencing acceptance
of TTO and SG among Chinese and Indian Singaporeans. METHODS: In in-depth interviews
with adult Chinese and Indian Singaporeans (selected to represent various ages/ educational levels) conducted in English, Chinese or Tamil, respondents sorted and ranked 3
hypothetical health states using a 0-100 visual analogue scale (VAS), then generated utilities for these health states using both TTO and SG (order randomized). Respondents and
interviewers evaluated (using 0-10 VAS) various aspects of these exercises. We explored
associations between ethnic and sociodemographic variables and health preferences
using Mann-Whitney, chi-squared tests or logistic regression analysis. RESULTS: Among
45 respondents (53% Chinese, 53% female, median age: 41 years), reported preference
for TTO (n=23) or SG (n=21) was similar. Clarity and comprehension of instructions, ease
of completion and amount of concentration needed were similar for both TTO and SG, with
the exception of Chinese respondents’ giving lower ratings for clarity of SG instructions
compared to Indians (median (IQR): 8.5 (7.0, 9.0) versus 10.0 (8.5, 10.0), p=0.011).
Interviewers judged that respondents had little difficulty completing, were able to understand, and required the same amount of concentration for TTO and SG, and reported that
respondents easily understood and completed sorting and ranking exercises. In exploratory subgroup analysis using logistic regression, only less education was associated with
preference for TTO over SG (odds ratio 5.8 (95% CI 1.05 to 32.2, p=0.044). CONCLUSIONS: Feasibility and acceptability of TTO and SG among Chinese and Indian
Singaporeans are high. Although there was no preference for TTO or SG in general, TTO
was preferred by subjects with less education.
PMC6: A SURVEY OF PATIENT REPORTED OUTCOME(PRO) CLAIMS IN PHARMACEUTICAL ADVERTISING
Yuwaree V, Rojsutee S, Thavorncharoensap M, Mahidol University, Bangkok, Thailand
OBJECTIVE: To investigate the quantity and quality of Patient-Reported Outcome (PRO)
claims in pharmaceutical advertisements in two Thai medical journals. METHODS: A retrospective review of all pharmaceutical advertisements in the 2004 issues of 2 Thai medical
journals(Clinic and Pharmatime) was performed by 3 trained pharmacists.Two reviewers
independently reviewed the advertisements. If the reviewers disagreed the final decision
was made by the third reviewer. All distinctive pharmaceutical advertisements were classified into claim advertisement or reminder advertisement. PRO claims and economic claims
were also identified. Then, the advertisements were categorized according to their reference statuses. Finally, the reviewers evaluated whether the cited references provided substantial evidence to support the claims. RESULTS: From 183 advertisements reviewed,
there were 48 distinctive advertisements. Forty-five (0.94%) and three (0.06%) of the
advertisements were classified as claim advertisement and reminder advertisement,
respectively. Nineteen (0.42%) of the claim advertisements contained PRO claims while
two(0.04%) of the claim advertisements contained economic claims. The result indicated
that only 16 (0.36 %) of the claim advertisements cited at least one published article
retrievable from Medline as a reference, while the remaining 24 (0.49%) contained no reference or cited package insert or non-published data on file as references. When looking
closely at PRO claims, it was found that 12 (0.63%) of the PRO claims were misleading
because the outcomes stated in the claims were not supported by the given references. In
addition, there was not sufficient evidence to support all 2 economic claims. CONCLUSIONS: More than half of the PRO claims were misleading. Practitioners should be cautions in assessment of PRO claim advertisements in medical journals. There is also a substantial need for more rigorous regulation of PRO claims.
PMC7: RELATIVE WEIGHTS ASSIGNED TO PHARMACY PROCEDURES: OPPS
METHODS AND CONCEPTS
Baker JJ1, Panarites CJ2, Pierce C1, 1The Resource Group, Dallas, TX, USA, 2Scios,
Inc, Fremont, CA, USA
OBJECTIVE: The Centers for Medicare and Medicaid Services (CMS) assigns a relative
weight to procedures in the hospital outpatient setting and may do so for pharmacy handling costs in 2006. This study examines the current approach to assignment of relative
weights for drug and biological administration codes under the CMS Hospital Outpatient
Prospective Payment System (OPPS) and compares this approach to the resource-based
level of effort concept initially created for payment to physicians. METHODS: Resourcebased methods originally proposed for the hospital OPPS and equivalent measurement
methods in the original Harvard RBRVS work were deconstructed and evaluated. The
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MedPAC rationale for recommendation of relative weights for payment of pharmacy handling costs and the proposed weights were also examined and evaluated. RESULTS: The
evaluation sought indications of resource-based level of effort applications in the OPPS
and their comparability to the original resource-based studies, in the area of intensity
measures. The underlying intent of the resource-based relative value scale (RBRVS) was to
create a hierarchy of resource-based level-of-effort in physician service delivery. The concept of hospital OPPS was also intended to reflect resource-based service delivery.
Procedures are assigned a relative weight, implying that the payment includes level of
effort resources. Recommended 2006 handling costs for drugs are assigned five relative
weights, each compared to drawing up an injected drug for administration. We postulate
these relative weights contain insufficient recognition of the level of effort and resource
consumption required, thus distorting the concept’s initial intent. CONCLUSIONS: Many
researchers and policy makers assume that relative weights equate to level of effort
resource consumption in all instances. We cannot find this is so regarding the five levels of
relative weights recommended for OPPS pharmacy handling costs. Because resource consumption is disproportionately greater than relative weights assigned in many cases, the
resulting payment will be understated.
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PMC8: AFFORDABLE BOOTSTRAPS? EVALUATING FREEWARE OPTIONS FOR
ANALYZING INCREMENTAL COST-EFFECTIVENESS DATA
McGhan W, Gandhi P, Ruparel P, Peterson A, University of the Sciences, Philadelphia,
PA, USA
OBJECTIVE: To compare and evaluate freeware options for bootstrap analyses for incremental cost effectiveness data. METHODS: Obenchain’s ICEplane software can be downloaded and installed from www.math.iupui.edu/~indyasa/bobodown.htm. This software
was compared against the web-based analyses available through HDS at www.healthstrategy.com. Three datasets, from the Obenchain site, were used in the comparisons. The
datasets are from published studies dealing with abciximab (ABX), tricyclic antidepressants
(TCA), and pindolol (PIN). RESULTS: ICEplane must be installed on MS Windows operating
systems and the HDS program runs online through any operating system with browsers
such as Internet Explorer, Netscape or Firefox. Both software options provide output graphs
such as scatter plots, confidence intervals and acceptability curves. ICEplane and HDS calculators both generated statistics on the initial raw data such as mean, median, standard
deviation and standard error. Bootstrapped statistics include incremental cost- effectiveness ratio (ICER), and 95% Confidence Intervals. Respective mean ICERs and confidence
intervals between ICEplane and HDS bootstraps are as follows: ABX: 3771 (-665, 20797)
vs 3692 (-1054, 13303); PIN: -1880 (2665, -421) vs -1259 (16939,-260) and TCA: -16.48
(-169, 136) vs -19.96 (-221, 147). CONCLUSIONS: The Obenchain software has additional
statistical and charting features that are not available in the HDS program. The analyses
from the HDS site runs slowly on more than 1000 bootstrap replications, but the results
obtained compare well to ICEplane. The analyses from the Obenchain site can perform up
to 25,000 replications. ICEplane and HDS calculate Fieller’s statistic on both raw and boostrapped data. ICEplane allows calculations with missing data, while HDS requires manual
recoding. Both of these programs should make it easier for individuals to perform basic
bootstrap analysis of their data, but certainly more powerful and user-friendly statistical
software packages would be preferred.
MENTAL HEALTH
PMH1: MENTAL HEALTH SERVICES AND DRUG UTILIZATION PATTERNS FOR
STUDENTS WITH MENTAL ILLNESSES IN SCHOOL-BASED HEALTH CENTERS
Guo JJ1, Keller KN2, Jang R1, Cluxton RJ1, 1University of Cincinnati, Cincinnati, OH,
USA, 2Health Foundation of Greater Cincinnati, Cincinnati, OH, USA
OBJECTIVE: Mental health problems among children and adolescents do not have sufficient attention in the US. The purpose of this study was to assess direct health care costs
and drug utilization for students with mental health illnesses in School-Based Health
Centers (SBHC) and comparable schools. METHODS: Four SBHC intervention schools and
two comparable non-SBHC schools in Greater Cincinnati, Ohio were selected for this study.
A total of 1200 students who were enrolled in Medicaid program and had at least one
mental illness diagnosis and received mental health medications were identified for this
cohort. There were 850 students in those schools with SBHCs, and 350 students in nonSBHCs. The study period was from August 1997 to August 2002. Repeated measures
analysis of covariates was conducted to assess the cost and mental health services before
and after the SBHC program. RESULTS: The cohort involved 64.8% male, 40.7% African58
American, and average 9.8 (SD 2.65) years-old in September 2001. During the study period, average monthly total costs were $221 (SD 692) before SBHC and $295 (SD 742) after
SBHC. The most frequently diagnosed mental illnesses for all students were hyperkinetic
syndrome of childhood, adjustment reaction, disturbance of emotion/conduct, affective
psychoses, neurotic disorders, and specific delays in development. Frequently prescribed
medications were antihyperkinesis agents (4.3 Rx per student), anticonvulsants (2.8
Rx/student), adrenergics/ amphetamine (2.4 Rx/student), antidepressants (2.3 Rx), and
antipsychotics (1.9 Rx/student). After controlling for demographics and Medicaid enrollment status, ANCOVA indicated a significant SBHC intervention effect (Time*SBHC) for both
monthly total cost (F=8.82, p=0.003) and monthly mental health service cost (F=5.06,
p=0.025). CONCLUSIONS: The SBHC program that provides mental health services for
students did not decrease the total Medicaid costs, instead, might increase the health
quality and health care accessibility for those students.
PMH2: COST-EFFECTIVENESS OF OLANZAPINE VERSUS LITHIUM FOR THE
PREVENTION OF RELAPSE IN BIPOLAR I DISORDER IN AUSTRALIA
Price N1, Davey P1, Mudge M1, Fitzgerald B2, Rajan N2, Montgomery B2, 1M-TAG
Pty Ltd, A Unit of IMS, Chatswood, NSW, Australia, 2Eli Lilly Australia Pty Ltd, West
Ryde, NSW, Australia
OBJECTIVE: To assess the cost-effectiveness of olanzapine compared with lithium in
relapse prevention of bipolar I disorder. METHODS: Resource use data from a 52-week
double-blind randomised controlled trial of olanzapine versus lithium (n = 431) were used
to determine costs of both treatments. Resources considered were study drug, concomitant medication, hospitalisations and laboratory tests. This trial also reported relative safety
and efficacy. Australian cost data were applied to the resource utilisation from the trial to
estimate the overall treatment costs associated with each therapy. Study drug and concomitant medication prices were sourced from the Schedule of Pharmaceutical Benefits
and E-MIMS, while national casemix costs were applied to hospitalisations. Rather than
episodic costing, a mixture of fixed and marginal costs were used. Laboratory test prices
were from the Medicare Benefits Schedule. RESULTS: The overall cost of therapy for olanzapine patients was A$9340 (US$6452), compared with A$9589 (US$6624) for lithium
patients. Although the acquisition cost of olanzapine is greater than for lithium, the fewer
(82 vs. 88) and shorter hospitalisations (15 vs. 19.7 days) associated with olanzapine relative to lithium therapy lead to this overall cost saving of A$249 (US$172). Olanzapine
patients do not require laboratory tests to monitor serum lithium levels, which also contributes to the cost saving. In terms of efficacy, 8.8% (p=0.055) fewer olanzapine patients
relapsed compared with lithium patients. Additionally, 13.7% (p<0.001) fewer olanzapine
patients suffered manic relapse. Time to relapse analysis confirmed that benefits from
olanzapine are maintained over a longer period than those of lithium. Hence, the probability of relapse diverges over time. When costs were varied in sensitivity analyses, olanzapine continued to be cost-effective. CONCLUSIONS: Olanzapine displays greater efficacy
and is cost-saving compared to lithium. Hence, olanzapine represents a dominant therapeutic option. Sensitivity analysis indicated that even in extreme circumstances, olanzapine remains cost-effective.
PMH3: A SYSTEM APPROACH TO RESOLVE DISPUTES IN ADOPTING NEW
TECHNOLOGY-USING ALZHEIMER MEDICATION AS AN EXAMPLE
Kao Yang YH1, Kuo SC2, Lin SJ3, 1Cheng-Kung University, Taiwan, Taiwan,
2Pittsburgh University, Pittsburgh, PA, USA, 3Illinois University, Chicago, IL, USA
OBJECTIVE: In order to reduce the disputed cases, the study was carried out to give a
detailed account of the cases submitted to the National Health Insurance Dispute
Mediation Committee, Taiwan, on the use of Alzheimer medications. METHODS: The
Bureau of National Health Insurance in Taiwan established the criteria for the pharmaceutical reimbursement in 1999. Cases denied by the Bureau can be further submitted to the
DMC for arbitration based on considerations about evidence-based medicine, ethics, regulations and economy. The disputed cases further submitted to the DMC for arbitration were
examined comprehensively. RESULTS: The authorization was granted to 61% of the new
cases, and 87% of the continuing cases. Among the health-care settings, the most cases
(12,480 cases) submitted for PA came from medical centers, and the approval rate was
71%. Among six branches of the BNHI, the highest approval rate (76%) was in the Taipei
and Central Branches, while the lowest one (40%) was in the Northern Branch. Among the
thousands of denied cases by BNHI, 124 were submitted to the DMC between June 2000
and September 2002. The majority (111 or 90%) of these cases was in favor of the denial
decisions made by the BNHI, while the rest 13 cases were authorized to use the medica-
tions. The causes of disputes centered on the discrepancy in diagnosing AD, evaluating
treatment results, and excluding other sources of AD-like symptoms. A consistent theme
underlying these causes is a lack of consensus between physicians and referees on interpreting the criteria, especially the criteria concerning co-morbidities and existing conditions such as vascular origin or drug-induced dementia, among others. CONCLUSIONS:
The major reason for denying PA and disputed cases is because physicians or referees
misunderstand and/or misinterpret the criteria.
PMH4: ECONOMIC BURDEN OF DEPRESSED PATIENTS IN SHANGHAI
Chen XB1, Ji JL2, Tan-Mulligan A3, Sheng F3, 1Fudan University, Shanghai, China,
2Zhongshan Hospital, Fudan University, Shanghai, China, 3GlaxoSmithKline
OBJECTIVE: The aim of this study was to evaluate the annual economic burden of the
patients suffering from depression in Shanghai. METHODS: A bottom-up, prevalencebased design was used, this study evaluated 652 outpatients with depression in seven
hospitals in Shanghai and all patients were diagnosed by a senior psychiatrist or psychologist based on CCMD-3 diagnostic criteria. The data were collected from treatment records
and follow-up interview of the clients. The annual economic burden attributed to the major
depression was calculated, including annual direct medical expenditures, direct non-medical expenditures & indirect expenditures. The indirect expenditure was calculated based
on human capital approach. RESULTS: 1) The total annual economic burden of depressed
patients in Shanghai was estimated at RMB 354 million a year(2003 values), the estimated
average yearly direct medical cost in Shanghai was around RMB 177 million. 2) The annual economic burden of pure depressed patients was higher than that of co-morbidity with
anxiety symptoms patients, RMB 7342 and 6167 respectively, the average RMB 6809. 3)
Pure depressed patients has a higher indirect expenditures (RMB 2932.61, i.e 39.94% in
total annual economic burden) compared to patients with anxiety co-morbidity (RMB
757.95, only 12.29%); but these patients have a higher direct expenditures (RMB 5409.54)
compared to pure depression patients (RMB 4409.50). 4) Drug Cost for managing
depressed patients were relatively very high, accounting for 86% of the total healthcare
costs in a visit. 5) 49.4% of their per capita disposable income was spent due to the pure
depression and 41.5%, co-morbidity with anxiety symptoms. CONCLUSIONS: Both pure
depressed & co-morbidity with anxiety symptoms patients create a huge burden on the
patients, their families, and the society.
PMH5: PRICE AND UTILIZATION OF ANTIDEPRESSANTS IN U.S. MEDICAID
PROGRAMS
Guo JJ, Jing Y, Chen Y, Kelton CM, Patel N, University of Cincinnati, Cincinnati, OH,
USA
OBJECTIVE: Antidepressants are frequently used for the treatment of depressive and anxiety disorders. Three major classes of antidepressants are selective serotonin reuptake
inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressants. The objectives of this study are to describe drug price and utilization trends in each subcategory of
antidepresants. METHODS: The First DataBank national drug file was used to calculate the
monthly average wholesale price (AWP) per daily dose from 1986 to 2002. Using the
Centers for Medicare & Medicaid Services prescription drug database, we constructed
quarterly per-prescription reimbursement figures for each drug from 1991 to 2004.
Descriptive interrupted time-series analyses were conducted to quantify drug utilization
and price trends. RESULTS: The average AWP per daily dose for all branded drugs
increased over time regardless of new agent entry or patent expiration. The reimbursement costs per prescription for Prozac and Luvox dropped when their generics entered.
The average cost per SSRI prescription increased from $60 in 1991 to $110 in 2001, then
decreased to $90 in 2004 due to generic entry. The proportion of total expenditure for
SSRIs increased from 13% in 1991 to 57% in 2004, while spending on TCAs decreased
from 74% in 1991 to 12% in 2004. CONCLUSIONS: Large increases in antidepressant
drug expenditures have accompanied increased SSRI utilization. With growing concerns
over high drug expenditure, we need to explore more the factors affecting drug-pricing
strategy.
PMH6: DIFFERENCES IN THE COST OF ANTIDEPRESSANTS ACROSS STATE
MEDICAID PROGRAMS
Kelton CM1, Guo JJ1, Rebelein RP2, Ferrand Y1, 1University of Cincinnati,
Cincinnati, OH, USA, 2Vassar College, Poughkeepsie, NY, USA
OBJECTIVE: Depression is the most prevalent major mental health disorder, affecting
between four and eight percent of the population in the U.S. Expenditure on antidepressants is very high and rising rapidly due to both rising utilization and rising prices. The U.S.
Medicaid programs spent in total over $2.3 billion on antidepressant drugs in 2003. Our
objectives are: 1) to describe in detail state Medicaid spending on antidepressants, and 2)
to determine the magnitude and significance of the effects of state Medicaid cost-containment drug policies on reimbursement cost. METHODS: Pharmacy data from the Centers
for Medicare & Medicaid Services were used to calculate state expenditures on antidepressants and number of prescriptions for antidepressants. Policy variables were taken
from a 2003 Kaiser Commission report, while demographic data (income per capita, percentage rural, percentage elderly, and so forth) were taken from the Census of Population.
Regression analysis is used to explain reimbursement per prescription and percent of prescriptions filled by generic, instead of branded, medications. RESULTS: Total spending on
antidepressants in 2003 ranged from $2.8 million for Washington, D.C., to $218.1 million
for New York state, with approximately two-thirds of the spending for SSRI antidepressants. Average reimbursement per prescription was $62.69, with the minimum in
Michigan ($49.86) and the maximum in California ($78.54). The average portion of generic
prescriptions was 37.6%, with a minimum of 26.0% in Delaware (implying 74.0% of prescriptions were for branded pharmaceuticals) and a maximum of 47.3% percent in
Wisconsin. Regression results suggest that more populated states have higher reimbursements per prescription and lower generic percentages. CONCLUSIONS: There is considerable variation across states in reimbursement costs for antidepressant prescriptions. While
states have adopted a number of different cost-containment policies, there is no indication
that any of the policies improves the state’s per-prescription cost position relative to other
states.
PMH7: STATE-BASED DIFFERENCES IN THE USE OF ANTIPSYCHOTIC MEDICATIONS BY HOSPITALS IN AUSTRALIA - 2004
Montgomery WS1, Kulkarni J2, Bradley MN1, 1Eli Lilly Australia, West Ryde, NSW,
Australia, 2Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
OBJECTIVE: To analyse by geography, in this case by state, the usage patterns of the different antipsychotic medications purchased by public and private hospitals in Australia.
METHODS: National hospital sales data for all antipsychotic medications purchased by
565 hospitals were obtained from IMS Health Australia for the period January 2004 to
December 2004. This was segregated into the major states and territories of Australia
(New South Wales, Northern Territory, Queensland, South Australia, Tasmania, Victoria &
Western Australia). This was then converted into defined daily doses (DDDs) for each
agent. The level of antipsychotic use in each state was expressed as the estimated DDDs
per 1000 population/day. RESULTS: Significant variation by state was seen in the usage of
antipsychotics across Australia. Nationally the atypical antipsychotics were the most frequently used class of agents, accounting for 69% of total use. The use of individual atypical agents varied significantly across geographies. Clozapine use varied from a high of
42% in Victoria to 13% in SA and WA. Depot typical antipsychotics were the most commonly used class of agents (39%) in NT, whereas they only accounted for 15% of use in
Victorian hospitals. Oral typical agents were most frequently used in SA (17%) and least
used in WA (6%) and Vic (7%). CONCLUSIONS: Significant variation in antipsychotic usage
patterns by hospitals is seen between the different states in Australia. Community usage
patterns, by comparison, show much less variation. Such information has the potential to
be used as an indicator of quality of care in mental health services.
PMH8: PRICE AND UTILIZATION TRENDS OF ANTIPSYCHOTICS IN U.S. MEDICAID PROGRAMS
Guo JJ1, Kelton CM1, Jing Y1, Chen Y1, Louder A2, Patel N1, 1University of
Cincinnati, Cincinnati, OH, USA, 2Anthem Health Care, Mason, OH, USA
OBJECTIVE: Antipsychotics are classified as either typical or atypical. Despite being
expensive, atypical antipsychotics have increasingly been used in the past decade due to
improved tolerability, replacing the use of typical antipsychotics. Our objective is to examine typical and atypical antipsychotic price and utilization trends. METHODS: The First
DataBank national drug file was used to calculate the monthly average wholesale price
(AWP) per daily dose from 1986 to 2002. Using the Centers for Medicare & Medicaid
Services Medicaid Pharmacy databases, we constructed quarterly per-prescription reimbursement figures for each brand-name and generic drug from 1991 to 2004. Descriptive
interrupted time-series analyses were conducted to quantify drug utilization and price
trends. RESULTS: The average AWP shows that atypical antipsychotics are relatively
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expensive compared to typical antipsychotics. Generic clozapine was introduced at a price
90% of the branded drug’s price, then dropped gradually over time. The average AWPs for
all branded drugs, including Hadol, Thorazine, Loxitane, Risperdal, Zyprexa, and Geodon,
increased over time. The average reimbursement cost per atypical prescription incrased
from $80 in 1991 to $240 in 2004, while the average cost per typical prescription was relatively stable with the exceptions of Haldol and Loxitane. The total Medicaid expenditure
on antipsychotics increased sharply from $135 million per quarter in 1991 to $1.25 billion
per quarter in 2004, due to the increased use of atypical antipsychotics. CONCLUSIONS:
Dramatic increases in antipsychotic drug expenditures paralleled increases in the use of
atypical antipsychotics. As additional safety data for atypical antipsychotics become available, it will be important to determine whether they affect drug utilization of specific
agents.
PMH9: ANTIPSYCHOTIC UTILIZATION TRENDS AMONG TEXAS VETERANS
Yang M, Barner JC, University of Texas at Austin, Austin, TX, USA
OBJECTIVE: To understand antipsychotic utilization trends and factors associated with
index medication selection (second generation antipsychotics – SGAs vs. first generation
antipsychotics – FGAs) among Texas veterans newly initiated on antipsychotics.
METHODS: Data were extracted from the computerized patient record system of Veterans
Administration North Texas Health Care System (VANTHCS) and South Texas Veteran Health
Care System (STVHCS). Prescriptions were available from January 1, 1996 to December
31, 2003. For all of the patients newly started on antipsychotics, prescriptions were followed for up to 12 months. Descriptive analyses were used to examine utilization trends;
logistic regression was used to examine the factors associated with antipsychotic index
medication selection. RESULTS: A total of 4,809 patients were included (n=3,079 in VANTHCS; n=1,730 in STVHCS) with the majority being male (93.6%), ≥55 years old (44.1%)
and white (62.6%). Descriptive analyses revealed that antipsychotic prescriptions had
changed from primarily FGAs (71.7% in 1997, 25.2% in 1999, and 5.7% in 2002) to SGAs.
Olanzapine (30.7%) and risperidone (31.0%) were most commonly prescribed and the preferred SGA was different between VANTHCS – olanzapine and STVHCS – risperidone. Use
of antipsychotic switching (17.8%) and combination therapy (6.0%) increased over the last
few years, but monotherapy was still dominant (76.2%). In addition to schizophrenic
patients, antipsychotics were also commonly prescribed for patients with other mental illness disorders. Logistic regression found that when compared to white patients, Hispanic
and black patients were less likely to start on SGAs. Older patients, with a hypertension
diagnosis, patients in STVHCS were less likely to start on SGAs. Patients with dyslipidemia,
and patients started treatment in recent years were more likely to have SGAs as the index
medications. CONCLUSIONS: This study found that SGAs replaced FGAs as the primary
medications for patients with mental illness disorders. Race, age, comorbidity and treatment exposure time are important factors in index medication selection.
PMH10: TIME TO ALL-CAUSE DISCONTINUATION OF ATYPICAL VERSUS TYPICAL ANTIPSYCHOTICS IN THE NATURALISTIC TREATMENT OF SCHIZOPHRENIA
Zhu B1, Swartz M2, Ascher-Svanum H1, Faries DE1, Tunis SL1, Swanson J3,
Landbloom R1, 1Eli Lilly and Company, Indianapolis, IN, USA, 2Duke University
Medical Center, Durham, NC, USA, 3Duke University School of Medicine, Durham,
NC, USA
OBJECTIVE: To prospectively compare atypical and typical antipsychotics on time to allcause medication discontinuation, an important effectiveness measure in the usual care of
patients with schizophrenia. METHODS: Participants (N=1704) were initiators on oral atypical or typical antipsychotics (low, medium, or high-potency) in a three-year naturalistic
study of schizophrenia. Medication groups were compared on time to all-cause medication
discontinuation during the one-year following medication initiation. Statistical analysis
used Kaplan-Meier and Cox proportional hazard models. RESULTS: Patients treated with
atypical antipsychotics had longer time to medication discontinuation compared to patients
receiving low, medium, or high-potency typical antipsychotics (odds ratio= 1.4, 1.5, 1.9;
p= 0.044, 0.004, <0.001, respectively). Among atypical antipsychotics, clozapine and
olanzapine-treated patients had a significantly longer time to medication discontinuation
than patients receiving low, medium, or high-potency typical agents. Risperidone and quetiapine-treated patients had a longer time to medication discontinuation compared to only
high-potency typicals. Ziprasidone did not significantly differ from low, medium, or highpotency typical agents. Further, only clozapine- and olanzapine-treated patients had a sig60
nificantly longer time to medication discontinuation compared to perphenazine, a mediumpotency typical antipsychotic. CONCLUSIONS: In usual care of schizophrenia patients,
atypical antipsychotics appear to be superior to typical antipsychotics (regardless of potency level), and to significantly differ in treatment effectiveness.
PMH11: EFFECTIVENESS AND TOLERABILITY COMPARISON OF RISPERIDONE LONG-ACTING INJECTION AND CONVENTIONAL DEPOT ANTIPSYCHOTICS IN A LARGE CANADIAN PSYCHIATRIC HOSPITAL
Welch RP, Snaterse MH, Alberta Hospital Edmonton, Edmonton, AB, Canada
OBJECTIVE: To evaluate the effectiveness and tolerability of risperidone long-acting injection (RLAI) as compared to the usual treatment alternative of conventional depot antipsychotics. METHODS: Patients initiated on RLAI during the four-month period of March 2004
through June 2004 were compared to patients initiated on a conventional depot antipsychotic during the same time period. Patient demographics including age, gender, diagnosis, number of previous psychiatric admissions and in-patient program were evaluated.
The effectiveness outcomes of antipsychotic polypharmacy, discharge and readmission
rates were compared. Neurological tolerability was assessed as measured by the prescribing of anticholinergic side-effect medications. RESULTS: Forty patients initiated on RLAI
were compared to 49 patients initiated on a conventional depot antipsychotic. The two
patient groups were demographically similar. The RLAI group was 75% male, with an
average age of 41 years and 6.0 previous psychiatric admissions. The conventional depot
group was 67% male, with an average age of 47.5 years and 5.9 previous psychiatric
admissions. All patients in each group were diagnosed with schizophrenia. Antipsychotic
polypharmacy was reduced from 63% to 31% in the RLAI group but increased from 29%
to 73% in the conventional depot group. The use of anticholinergic side-effect medications
decreased from 47% to 12% in the risperidone RLAI group but increased from 31% to
73% in the conventional depot group. After ten-months, 83% of the risperidone RLAI
patients had been discharged and none had been readmitted, whereas only 58% of the
conventional depot group had been discharged with 26% having been readmitted. CONCLUSIONS: In this difficult-to-treat population of patients, risperidone RLAI conferred significant advantages over conventional depot antipsychotics in terms of effectiveness and
tolerability. As well, the substantial differences in discharge and readmission rates create
considerable pharmacoeconomic advantages in favor of RLAI.
PMH12: COST OF ANTIPSYCHOTIC POLY PHARMACY IN THE TREATMENT OF
SCHIZOPHRENIA
Zhu B1, Ascher-Svanum H1, Faries DE1, Correll CU2, Kane JM2, 1Eli Lilly and
Company, Indianapolis, IN, USA, 2The Zucker Hillside Hospital, Glen Oaks, NY, USA
OBJECTIVE: To compare the cost of antipsychotic polypharmacy during the treatment of
schizophrenia patients with risperidone, olanzapine, or quetiapine. METHODS: Data were
drawn from a large prospective naturalistic study of treatment for schizophrenia in the
United States, conducted between 7/1997 and 9/2003. Participants who initiated on
risperidone (N=276), olanzapine (N=405), or quetiapine (N=115) were followed for 1-year
post initiation and compared on annual cost of all antipsychotic medications, and on daily
cost of concomitant antipsychotic medication. Statistical analysis used propensity score
adjusted bootstrap re-sampling methods. RESULTS: Quetiapine-treated patients accrued
significantly higher annual cost of all antipsychotic medications compared to olanzapine or
risperidone (p<.01). The daily cost of concomitant antipsychotic medications was significantly higher for quetiapine ($8.70) compared to olanzapine ($3.82, p<.01) or risperidonetreated patients ($4.30, p<.01). The total daily cost of antipsychotics, including index
antipsychotic cost, was $15.33, $13.90, and $11.04 for quetiapine, olanzapine and risperidone, respectively. Each dollar spent on quetiapine-treated patient was accompanied by
additional $1.31 on concomitant antipsychotic medication, compared with $0.64 for
risperidone, and $0.38 for olanzapine-treated patients. CONCLUSIONS: Prevalent antipsychotic polypharmacy adds substantial cost to the treatment of schizophrenia. A clearer
understanding of the concomitant antipsychotic costs provides a more accurate portrayal
of medication cost.
PMH13: VALUATION OF SCHIZOPHRENIA-RELATED HEALTH STATES BY THE
GENERAL POPULATION USING THE ASSESSMENT OF QUALITY OF LIFE
QUESTIONNAIRE, TIME TRADE-OFF AND VISUAL ANALOGUE SCALES
Adams J1, Le Reun C2, Crowley S3, Nand V4, Eggleston A4, Schrover R5, 1Medical
Technology Assessment Group, Chatswood, NSW, Australia, 2M-TAG Pty Ltd,
Chatswood, Australia, 3University of Melbourne, North Ryde, NSW, Australia,
4Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 5Janssen-Cilag Pty
Cilag Pty Ltd, North Ryde, NSW, Australia, 3University of Melbourne, North Ryde,
NSW, Australia, 4Janssen-Cilag Pty Ltd/University of Melbourne, North Ryde, NSW,
Australia
OBJECTIVE: To assess differences in the valuation of eight schizophrenia-related health
states using a multi-attribute utility instrument, the Assessment of Quality of Life
Questionnaire (AQoL), and two scaling techniques, the time trade-off (TTO) and a visual
analogue scale (VAS). METHODS: Eight schizophrenia-related health state scenarios based
on severity of symptoms and medication side effects were presented to 87 participants
from the general population. Scenarios were: A) ‘good’ function with no movement disorders (extrapyramidal symptoms); B) ‘good’ function with movement disorders; C) ‘poor’
function with no movement disorders; D) ‘poor’ function with movement disorders; E) hospitalised relapse with no movement disorders; F) hospitalised relapse with movement disorders; G) post-hospitalisation with no movement disorders; and H) post-hospitalisation
with movement disorders. Participants, once educated about schizophrenia, were asked to
value each health state using the AQoL, TTO, and a VAS. RESULTS: Mean utility values for
all health states ranged from 0.62 to 0.05, 0.72 to 0.54 and 0.74 to 0.19 for the AQoL,
TTO and VAS, respectively. For each instrument or scale the rank order of utility values
was consistent with the severity of symptoms, with more severe symptoms producing
lower scores. Patients experiencing EPS had lower utility scores and hospitalisation also
producing utility decrements. There were differences between the global results for AQoL,
TTO and VAS (p<0.001, Kruskal-Wallis test) and differences between the utility measures
for each health state, except between the TTO and VAS results for health state A
(p=0.655), and the AQoL and VAS results for health state G (p=0.094). CONCLUSIONS:
Utility values varied with severity of health state (symptoms) and in most cases differed
significantly between instrument and/or scale. For schizophrenia, the AQoL was most sensitive to differing symptom severity, as assessed by the general population. However, further research comparing the different utility instruments is required in this disease area.
OBJECTIVE: To determine carer preference and willingness to pay (WTP) for a long-acting
injection administered fortnightly versus short-acting oral-based treatment for schizophrenia. METHODS: Carers of people with schizophrenia were recruited through the
Schizophrenia Fellowship of New South Wales and participants completed a mail out questionnaire (n=73). All data were de-identified and privacy regulations were adhered to.
Treatment preference and WTP for a fortnightly long-acting injection versus oral-based
treatment were evaluated using discrete choice conjoint analysis (CA). WTP was also valued with contingent valuation (CV). Attributes in the WTP valuation included route of
administration, frequency of relapse, frequency of extrapyramidal symptoms, weight
change and injection site reactions. Responses deemed irrational were excluded from the
primary analyses. RESULTS: The mean age of carers was 61 years and the majority were
females caring for a son or daughter. Approximately 90% of respondents returned rational
responses. WTP with CA was consistently higher than the WTP with CV. The results from
the WTP analyses showed that a long-acting fortnightly injection-based treatment was
preferred over a short-acting tablet-based treatment. The unadjusted incremental WTP
from the CA and CV for the long-acting injection-based treatment over a short-acting oral
medication were AUD$322 per month and $155 per month, respectively. The individual
attributes driving the overall WTP were explored. CONCLUSIONS: Overall, carers of people
with schizophrenia prefer and are willing to pay for an injection-based treatment over a
tablet-based treatment. Reasons for the treatment preference and willingness to pay for
an injection-based treatment include the perception that the long-acting injection would
improve patient adherence with medication and the fact that the treatment is administered
by a nurse within the public hospital or community setting.
PMH14: ASSESSING THE HEALTH AND ECONOMIC IMPACT OF SCHIZOPHRENIA ON CARERS: A PILOT STUDY
Adams J1, Nand V2, Le Reun C3, Mudge M1, Crowley S4, Eggleston A2, Schrover
R5, Brown A1, 1Medical Technology Assessment Group, Chatswood, NSW, Australia,
2Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 3M-TAG Pty Ltd, Chatswood,
Australia, 4University of Melbourne, North Ryde, NSW, Australia, 5Janssen-Cilag Pty
OBJECTIVE: To determine the direct and indirect economic burden associated with caring
for someone with schizophrenia; carer quality of life using Assessment of Quality of Life
(AQoL) and carer willingness-to-pay (WTP) and overall preference for two schizophrenia
treatments. METHODS: Eight schizophrenia-related health state scenarios were presented
to eight carers of patients with schizophrenia. Scenarios were A) ‘good’ function without
extrapyramidal symptoms (EPS); B) ‘good’ function with EPS; C) ‘poor’ function without
EPS; D) ‘poor’ function with EPS; E) hospitalised due to relapse without EPS; F) hospitalised due to relapse with EPS; G) post hospitalisation without EPS; and H) post hospitalisation with EPS. The carers valued each health state using the AQoL and the visual analogue scale (VAS) from the carer and patient perspectives. Treatment preference and WTP
for two schizophrenia medicines (one long-acting injection and one tablet) were evaluated
using contingent valuation (CV) and conjoint analysis (CA). RESULTS: On average, participants reported caring for a person with schizophrenia for 15.3 hours/week. Mean costs
incurred by carers included non-prescription medication (AUD$21.67/week), food
($51.67/week), and travel expenses ($15.00/week). The AQoL utility values from the carer
and patient perspectives ranged from 0.08–0.03, for health state F, to 0.65 and 0.34, for
health state A, respectively. The VAS ratings from the patient perspective for the same
health states ranged from 0.44 to 0.10. The CA and the CV suggested a preference for the
injection-based treatment for schizophrenia (WTP $242/month). CONCLUSIONS: The
results from this pilot study suggest that schizophrenia is a costly illness. Furthermore, the
AQoL is sensitive to changes within schizophrenia-related health states including movement disorders. The results suggest that carers prefer and are willing to pay for an injection-based treatment. The results of the pilot study were used to implement a larger-scale
survey of a more representative sample of carers.
PMH15: PREFERENCE AND WILLINGNESS TO PAY FOR THE TREATMENT OF
SCHIZOPHRENIA FROM A CARER’S PERSPECTIVE
Adams J1, Nand V2, LeReun C1, Crowley S3, Eggleston A2, Schrover R4, Brown A1,
1Medical Technology Assessment Group, Chatswood, NSW, Australia, 2Janssen-
PMH16: PREVALENCE AND RECOGNITION OF MENTAL DISORDERS IN PRIMARY CARE
Magruder K1, Frueh B1, Knapp R2, Yeager D2, 1Veterans Administration Medical
Center, Charleston, SC, USA, 2Medical University of South Carolina, Charleston, SC,
USA
OBJECTIVE: Among military veterans seeking primary care, we sought to determine 1) the
prevalence of common mental disorders; 2) rates of mental disorder recognition by medical providers; 3) health services use patterns. METHODS: In this prevalence study with
retrospective chart review, we randomly selected patients from among those who had
used health services in FY 1999 at one of four Veterans Administration hospitals. We
obtained informed consent from 888 patients (74.1% of 1198 contacted) and reached 746
for a telephone diagnostic interview. Diagnostic interviews included the Mini International
Neuropsychiatric Interview (MINI) (which assesses major depression, dysthymia, suicidality, hypomanic and manic episode, panic disorder, agoraphobia, social phobia, obsessivecompulsive disorder, substance use disorders, and generalized anxiety disorder) and the
Clinician Administered PTSD Scale (CAPS) (for post-traumatic stress disorder). Additionally,
we reviewed patients’ charts for the year prior to the interview to assess provider recognition of mental disorders and health services use. RESULTS: Prevalence of current disorders is: major depression 16.3%; PTSD 11.5%; other anxiety disorders 17.9%; substance
use disorders 3.5%. Less than half of those who met criteria for a mental disorder were so
recognized in their medical charts, despite the fact that patients averaged nearly 3.5 primary care visits in the prior year. Similarly, less than half of those who met criteria for a
mental disorder were seen in specialty mental health care in the prior year. CONCLUSIONS: Despite considerable improvements in treatments for mental disorders and
advances in screening and diagnostic capabilities, approximately half of primary care
patients who have a disorder are neither recognized nor treated by their providers. More
attention should be given to overcoming both patient and provider barriers that inhibit
patients from seeking care for psychiatric conditions.
PMH17: AGGREGATION OF RANKED RESPONSES TO QUESTIONNAIRES
EXPLORING QUALITY OF LIFE
Lamure M, Auray JP, Duru G, Rico A, University Lyons 1, Villeurbanne, France
OBJECTIVE: To determine an aggregating process based upon ordinal properties of scores
computed from QOL questionnaires. METHODS: The method is based on the Sugeno integral properties we recall hereafter: “Let E be a compact subset of the set of real numbers
and N = {1, 2, 3,…,n-1, n}; 2N denote the set of subsets of N. A capacity on N is a map61
ping v(.) from 2N onto E which satisfies the two following conditions: C1 : v(φ) and v(N) are
respectively lower and upper elements of E, C2 : for all subsets S and T of N, S included
into T implies v(S) ≤ v(T). Lastly, let f(.) be a mapping from N onto E. Denoting by π(.) the
permutation of N such that f(π(1)) & πουνδ;f(π(2)) & πουνδ; …≤ f(π(n)), the Sugeno
integral of f(.) with respect to v(.) is the real number defined as :∫fdv = Max{min{f(font
face=”Symbol”>p(j)),v({font face=”Symbol” >p(j), font face=”Symbol” >p(j+1), … , font
face=”Symbol”>p(n)})} ; j=1, … ,n}”. We focus on solving two problems: the one consisting of aggregate the set of responses given to the questions concerning a domain, the
other consisting of comparing two populations, for instance patients before and after a
treatment for which one wants to evaluate effects on quality of life. We also propose an
analysis of the meaning of v(.) in these two problems and a comparison of the results
obtained by our “Sugeno integral based procedure” and those obtained by usual process.
RESULTS: Our process is applied on data issued from a questionnaire about QOL of
French teenagers. The obtained results are compared to those obtained by classical procedures, in particular to results obtained from multidimensional methods. CONCLUSIONS: In
this paper, we demonstrate that it’s possible to define operational processes for analyzing
qualitative data while respecting the qualitative nature of these data.
NEUROLOGICAL DISORDERS
PNL2: EVALUATING HEALTH-RELATED QUALITY OF LIFE OUTCOMES IN
STUTTERING: A CRITIQUE OF CONDITION-SPECIFIC INSTRUMENTS
Franic DM, Bothe AK, University of Georgia, Athens, GA, USA
OBJECTIVE: To evaluate the psychometric properties of disease-specific quality of life
(QOL) instruments in stuttering. METHODS: A comprehensive search for stuttering instruments was conducted using: a literature review, web search engines, references, and personal files. Instruments were included in the study for evaluation if there was at least one
publication using the instrument including psychometric data, in addition to instrument
availability. Instruments were, evaluated based on criteria developed by McHorney and
Tarlov (1995). The eight domains considered in the evaluation were: item information, versatility, practicality, breadth (social, role, physical and mental functioning), depth, reliability,
validity and responsiveness. RESULTS: Of the 18 instruments identified, adequate data
was available to evaluate eight based on study criteria. The eight stuttering-specific metrics were Stutterer’s Self Ratings of Reactions to Speech Situations (ARSF), Erickson’s
scale of communication attitudes (S-scale), shortened S-scale (S-24), Communication
Attitude Test – English and revised (CAT and CAT-R), Perceptions of Stuttering Inventory
(PSI) Speech Situations Checklist (SSC) and its shortened version (Shortened-SSC). Item
information was only available for S-scale and S-24. Only S-24 and the S scale satisfied
breadth criteria. Depth information was lacking for all instruments evaluated. Of the eight
instruments S-24 fared the best being the most widely used and satisfying six of eight criteria (omitting depth and reliability), however due to inadequate reliability (coefficients <
0.9) authors do not recommend S-24 for individual decision-making. CONCLUSIONS: None
of the eight metrics satisfied all the study criteria and as a result none can be recommended for use in individual decision making. However, if used for group level decision
making the authors recommend the use of S-24 which would then meet most of the study
criteria reporting adequate or better performance on seven of the eight criteria assessed
(omitting instrument depth), in conjunction with a generic QOL instrument.
PNL3: A COST-EFFECTIVENESS COMPARISON OF RASAGILINE WITH
DOPAMINE AGONISTS FOR DELAYING LEVODOPA USE IN EARLY PARKINSONIAN PATIENTS IN THE UNITED KINGDOM
Roch B, Eckert L, Guelfucci F, Cochran J, François C, H. Lundbeck A/S, Paris, France
OBJECTIVE: Assess the cost-effectiveness of rasagiline, a potent, selective, and irreversible monoamine oxidase-B inhibitor and second-generation dopamine agonists ropinirole and pramipexole (DAs) for delaying levodopa-related motor complications (delaying
levodopa start) in patients with early Parkinson’s disease (PD) in the UK. Development of
motor complications is related to duration under levodopa, and clinical consensus in PD
management advises postponing levodopa treatment. METHODS: We compared costeffectiveness in starting treatment with rasagiline versus second-generation DAs in early
PD patients. A 5-year probabilistic Markov model with 3 states: ‘under rasagiline’, ‘under
DA’ and ‘levodopa start’ was used. Model inputs included transition probabilities from randomised clinical trials in early PD for rasagiline and DAs, and costs and resources from an
English cost-of-illness study. Effectiveness measure was number of years before levodopa
request. Primary analysis was performed from the NHS perspective. Sensitivity analysis
62
was performed varying ropinirole dose. Prices for rasagiline, pramipexole and ropinirole
were obtained from the NHS based on WHO-DDD. RESULTS: Over five years, time without
levodopa was greater when early PD patients’ treatment was initiated with rasagiline compared with DAs (3.93 vs. 2.65 years). There was a small increase in costs of £1807 compared with DAs. Incremental cost effectiveness was £1411.7 per patient per year before
levodopa compared with DAs. Cost-effectiveness acceptability curve shows that with a
willingness to pay of £1704 per year without levodopa, rasagiline has a 95% probability of
being cost-effective. Sensitivity analysis on ropinirole dose confirmed that rasagiline was
cost-saving for a differential gain of 1.28 years and dominates ropinirole. CONCLUSIONS:
This economic model demonstrates initiating treatment with rasagiline is a cost-effective
alternative compared with initiating DAs in delaying time to levodopa. Further studies are
necessary to evaluate if delaying motor complications in advanced PD will offset the slight
increases in costs observed.
OBESITY
POB1: PREVALENCE TRENDS OF OVERWEIGHT AND OBESITY AND TREATMENT PATTERNS FOR WEIGHT CONTROL IN THE U.S. POPULATION
Suh DC1, Barone JA1, Choi IS1, Shin HC1, Park J2, Lee C1, 1Rutgers University,
Piscataway, NJ, USA, 2Inha University, Incheon, South Korea
OBJECTIVE: To assess epidemiologic trends of overweight and obesity and to examine
treatment patterns to control weight in children/adolescents aged 2-19 years and for
adults ≥20 years old. METHODS: The Third National Health and Nutrition Examination
Survey (NHANES III) conducted in 1988-1994 and NHANES 2001-2002 were used.
Children/adolescents were classified as at risk for overweight if body mass index (BMI)
was ≥85th-<95th percentile and as overweight if BMI was at ≥95th percentile of the sexspecific BMI for age growth charts. Adults were categorized as overweight (BMI 25.0-29.9)
or obese (BMI≥30.0). Duration of physical activity was calculated using leisure-time physical activity to assess compliance of CDC/ASCM recommendations. SAS and SUDAAN software were employed to account for the complex survey design. RESULTS: The proportions
of children/adolescents at risk for overweight or overweight increased from 13.1% to
14.5% and from 11.1% to 15.5%, respectively, between 1988-1994 and 2001-2002. The
prevalence of overweight and obesity for adults also increased from 32.8% to 35.2% and
from 22.3% to 30.2%. Prevalence of diabetes in overweight and obese adults slightly
increased between 1988-1994 (5.5%,10.0% respectively) and 2001-2002(6.1%,10.6%).
However, LDL„d130mg/dL was less prevalent in 2001-2002 (53.4% to 41.8% for overweight and 54.0% to 41.0% for obesity). Overall, 10.3% of overweight and 14.9% of
obese adults used liquid diet formula, prescription drugs, non-prescription drugs, laxatives
or vomiting to control weight in 2001-2002. Only 1% of overweight and 3% of obese
adults took prescribed diet pills. About 47% of overweight and 43% of obese adults either
took medications or complied with physical activity recommended by CDC/ASCM to control
weight. CONCLUSIONS: Overweight and obesity have become more prevalent in the U.S.
population during the past decade. However, very few patients took medications prescribed by their physicians to lose or control their weight.
POB2: FEASIBILITY AND VALIDITY OF A GERMAN CHILD-FRIENDLY VERSION
OF THE EQ-5D
Greiner W, Bielefeld University, Bielefeld, Germany
OBJECTIVE: Validating a German child-friendly version of the EuroQol (EQ-5D) in different
patient samples. METHODS: After the translation from the original English version and pretesting in cognitive interviews with native speakers of the target language, the questionnaire was tested in two patient groups (obesity and CF) and a sample of healthy children
between the ages of 8 and 16. For the validation three validated instruments which measure hrQol in children and adolescents were utilized (KINDL, KIDSCREEN and ChildDynHA).
T-Tests were conducted to audit potential differences in the EQ-5D scores depending on
age and sex of the children. Descriptive statistics were used to summarize EQ-5D scores
as wella s scores of the additional instruments. RESULTS: The correlation between the
EQ-5D and the other instruments was quite high (0.46 - 0.61). The highest correlation was
found in the mobility dimension. The CF groups shows the highest rates of reported problems (42%), the rates of children who report no poblems are quite similar for the obese
and the healthy children (25 versus 27). CONCLUSIONS: This pilot study of the questionaire showed that the German child-friendly version of the EQ-5D is a valid and feasible
instrument to measure hrQol.
OSTEOPOROSIS
POS1: A PREVALENCE-BASED COST EVALUATION OF FRAGILITY FRACTURES
IN THE PHILIPPINES
Bonifacio LR1, Dela Rosa M2, Cañete A, 1Philippine Orhopaedic Association, Quezon,
Metro Manila, Philippines, 2Philippine Orthopaedic Association, Quezon City, Manila,
Philippines
OBJECTIVE: Describes fragility fractures in the country taking into account the prevalence
of the disease and appraisal of health care costs. METHODS: Epidemiological and costs
data were obtained from secondary sources. Female patients °Y50 years with fractures of
the hip, spine and distal radius was considered as the surrogate variable for fragility fractures. The Philippine Health Insurance Corporation database, where a total of 4670 records
of patients with reported spine fractures (11.7%, 545), distal radius (48.8%, 2280) and hip
(39.5%, 1845) were considered in the estimation of the prevalence of osteoporosis in
2004. Costs inputs were obtained from randomly selected patients accounting records
from health facilities nationwide. Direct costs include in-patient services and material
costs. The National Pension Fund (NPF) database provided data on indirect costs covering
present and future production losses resulting from premature death, morbidity or disability caused by the disease provided figures on sickness reimbursements, disability claims
and death benefits. RESULTS: Prevalence estimates relative to the total female population
according to age and fragility fracture involving the spine, lower end of radius and hip,
showed 41%, with lower limit of 39.6 and upper limit of 42.5 (SE=0.7). The prevalence
proportion for all age group is 67.9 for hip, 43.5 for spine and 18.7 for distal radius. Cost
valuation was done for hip fractures, as it is most severe and best documented. The NPF
paid a minimum of 120 days and maximum of 240 days for sickness reimbursements, an
average of 35 months for disability claims and lifetime pension for primary beneficiary for
premature deaths. CONCLUSIONS: Osteoporosis-related fractures are significant public
health problems that require a more elaborate cost valuation assessment. Costs are significantly affected by government subsidy, monopoly of services and cross subsidization. A
sensitivity analysis is needed for extrapolating costs estimates to the entire population.
POS2: PRICE AND UTILIZATION OF OSTEOPOROSIS MEDICATIONS IN U.S.
MEDICAID PROGRAMS
Knight D, Guo JJ, Shiyanbade H, Kelton CM, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: Approximately eight million women and two million men in the U.S. suffer
from osteoporosis, a disease that causes over 1.5 million fractures each year. The cost to
Medicaid for anti-osteoporosis medications topped $85 million in the first quarter of 2004.
The objective of this study is to analyze price, cost, utilization, and market shares of oral
anti-osteoporosis medications in U.S. Medicaid programs, with the specific purpose of
assessing interbrand competition in a tightly oligopolistic market. METHODS: There are
five oral medications for osteoporosis, including Didrone (etidronate), Skelid (tiludronate),
Actonel (risedronate), Fosamax (alendronate), and Evista (raloxifene). Data from the First
DataBank were used to calculate the monthly Average Wholesale Price (AWP) per daily
dose for each drug over the period 1990-2004. Data from the National Medicaid Pharmacy
claims were used to calculate quarterly drug prescriptions, market shares, and reimbursements over essentially the same time period. RESULTS: The three most frequently prescribed drugs are alendronate (utilization reached 600,000 scripts in the 1st quarter
2004); risedronate whose use increased from 90 scripts in the 2nd quarter 1999 to
400,000 in the 1st quarter 2004; and raloxifene with utilization of 190,000 scripts in the
1st quarter 2004. Each of these drugs has an AWP per daily dose in the $2.00-to-$4.00
range. Interestingly, the Medicaid cost per prescription for risedronate decreased from
$300 in 1999 to $80 in 2004. Though not widely prescribed, the AWP for tiludronate is
much higher than for its competitors at $15.00 per daily dose. CONCLUSIONS: There is no
indication that market shares or prices of branded medications are responding to new
entry in the anti-osteoporosis drug market. Movement in prices and utilization are driven
much more by dosage and compliance issues.
RESPIRATORY DISORDERS
PRS1: ECONOMIC EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY
DISEASE IN LOCAL HONG KONG HOSPITALS: A COMPARISON BETWEEN
TIOTROPIUM AND IPRATROPIUM
Lee VWY1, Hui DS2, Cheng HM1, Ho JY1, Li LM1, Wong WW1, Yung GK1, Lee KK1
1The Chinese University of Hong Kong, Shatin, Hong Kong, China, 2Department of
Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong,
China
OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a disabling disease that
has put significant burden to the society and its management has not evolved a lot until
the launch of tiotropium in 2001. COPD is currently the fourth leading cause of death and
is projected to rank the fifth as burden of diseases in 2020 worldwide. Local economic
studies were limited and cost effectiveness analysis on local population between tiotropium and ipratropium was also unavailable. METHODS: The study consisted of a cost of illness analysis and a cost-effectiveness analysis between tiotropium and ipratropium. Cost
of illness was conducted on a cohort of 173 COPD patients and only direct medical costs
were included in our study. Modeling method was used to evaluate the cost-effectiveness
of tiotropium with local cost data. RESULTS: The annual cost of illness was $69,985 per
patient with hospitalization cost being major cost driver. Medications accounted for less
than three percents of the total direct costs. The use of tiotropium can reduce the total
direct cost by 12%; however, statistical significance cannot be demonstrated. CONCLUSIONS: COPD imposed significant financial burden to the public healthcare system with
most of the costs spent in hospitalization and tiotropium has the potential to reduce the
economic burden of COPD.
PRS2: COST-EFFECTIVENESS OF DOMICILIARY OXYGEN THERAPY FOR
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Shimbo T1, Fukuhara S2, Sato S2, Chin K2, Fukuoka A3, Kimura H3, Akashiba T4,
1International Medical Center of Japan, Shinjyuku-ku, Tokyo, Japan, 2Kyoto
University, Sakyo-ku, Kyoto, Japan, 3Nara Medical University, Kashihara, Nara,
Japan, 4Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan
OBJECTIVE: To determine cost-effectiveness of domiciliary oxygen therapy (DOT) for
patients with severe chronic obstructive pulmonary disease (COPD). DOT improves survival
of patients with severe COPD, and has been rapidly utilized over Japan for the last decade.
It is prescribed even for patients with milder COPD who do not fulfill the application criteria
of DOT. METHODS: With a Markov model, the incremental cost-effectiveness ratio between
DOT and the conventional therapy without DOT was evaluated from the societal perspective. Effectiveness of DOT was derived from randomized controlled trials reported in the literature. Utility of patients was investigated with EQ-5D for 25 patients with COPD,
although DOT was assumed not to improve quality of life of the patients. Costs of DOT,
outpatient clinic, admission around fatal events were estimated based on the national
medical insurance reimbursement table and national statistics. The cost of care giving by
family members was also counted based on the opportunity cost of the time for caring.
One-way and probabilistic sensitivity analysis using second-order Monte-Carlo simulation
was done. RESULTS: We estimated the hazard ratio of DOT on mortality is 0.49. Utility of
COPD was 0.54 (95%CI, 0.40-0.68). The incremental cost-effectiveness ratio (ICER) of DOT
was $54,100/QALYs (assuming one dollar is 110 yen), which is considered to be comparable with other common medical practices in Japan. This estimate was sensitive to effectiveness of DOT. If the hazard ratio of DOT was 0.86, ICER would change to
$157,900/QALYs. Probabilistic sensitivity analysis revealed ICER of DOT was under
$50,000/QALYs in 36.3% of sampling simulations, and under $80,000/QALYs in 78.9% of
them. CONCLUSIONS: DOT for severe COPD patients is a cost-effective intervention.
However, if it is used for milder cases in which effectiveness of DOT is not clear, ICER
could be sharply increased according to the results of sensitivity analysis.
PRS3: INCORPORATING JAPANESE CULTURAL DIFFERENCES IN DEVELOPING A PATIENT REPORTED IMPACT OF COUGH AND SPUTUM IN CHRONIC
(OBSTRUCTIVE) BRONCHITIS – SIMULTANEOUS DEVELOPMENT OF THE
CASA-Q
Crawford B1, Buie W1, Tetzlaff K2, Monz BU3, Breugelmans R4, 1Mapi Values,
Boston, MA, USA, 2Boehringer Ingelheim, Biberach/Riss, Germany, 3Boehringer
Ingelheim International, Ingelheim, Germany, 4Tokyo Medical University, Tokyo, Japan
It is suspected that questionnaires developed in Western languages and translated into
Asian languages fail to capture relevant cultural differences. In the development of a new
questionnaire (Cough and Sputum Assessment Questionnaire(CASA-Q), Japanese patients
were included in the process to account for cultural differences. Cough and sputum are
leading symptoms of chronic (obstructive) bronchitis, yet the impact of these symptoms
63
has never been measured adequately or in a way comparable across diverse cultures.
Existing instruments capture the impact of the condition on quality of life, rather than
focusing on symptoms and targeting aspects important to patients. OBJECTIVE: To develop in five countries, a self-administered instrument that captures concepts relevant to
chronic (obstructive) bronchitis patients who suffer from cough and sputum. METHODS: A
simultaneous development process was used to develop the CASA-Q. Face-to-face interviews were conducted with patients in five countries (France, Germany, Japan, Spain, US).
After transcription and domain-mapping, an international item generation meeting was
conducted and a draft questionnaire simultaneously created in five languages. Expressions
of concepts in each culture were identified to develop the draft questionnaire. This draft
was reviewed by clinical respiratory experts and cognitively debriefed with patients in
each language. RESULTS: The conceptual model addressed two complementary aspects:
symptoms (cough/sputum) and their respective impact. Core symptoms were described
similarly in each language. Expressions of the impact of these symptoms were generally
consistent across cultures. Social impact was expressed differently by Japanese and
Western respondents (concern regarding one’s symptoms before manifestation versus
self-embarrassment after the fact). The final questionnaire is comprised of 6 items for
symptoms and 19 items for impact. The ease of understanding and relevance of each
question was found acceptable across languages. CONCLUSIONS: The simultaneous
development process allowed us to incorporate potential cultural differences into a
patient-based questionnaire relevant to the international assessment of chronic bronchitis.
spasticity was evaluated using a pooled analysis of individual patient data from five randomised controlled trials (RCTs). The objective of the analysis was to determine an overall
estimate of patient response rate across spasticity of different muscles. METHODS:
Individual patient data from five double-blind RCTs of BoNTA versus placebo for the treatment of focal spasticity were included in the pooled analysis. The trials were 12-24 weeks
in duration and enrolled patients with post-stroke focal spasticity in upper or lower limbs.
The primary outcomes in the RCTs were assessed using the Ashworth scale, a five-point
grading of muscle tonicity. As muscle hypertonia interferes with movement, a reduction in
muscle tone is beneficial. For the pooled analysis, a responder was defined as a patient
who obtained a decrease of at least two points in the Ashworth scale measurement of any
upper or lower limb muscle, indicating a clinically significant improvement. RESULTS: The
results of the responder analysis indicated that 140/271 (51.7%) of patients treated with
BoNTA were responders compared to 30/136 (22.1%) of patients treated with placebo, a
statistically superior result in favour of BoNTA (risk difference 28%; 95% confidence intervals 18-37%; p < 0.001). In addition there were no significant differences between treatment groups in the proportions of patients that discontinued treatment or experienced an
adverse event, indicating equivalent tolerability. CONCLUSIONS: The results of this analysis
indicate that significantly more patients treated with BoNTA obtained a clinically significant
reduction of muscle tone, compared with those receiving placebo. Improvement in tonicity
reduces muscle resistance and facilitates the use of physical rehabilitation methods to
improve a patient’s ability to perform various activities of daily living.
SMOKING
PST2: RESOURCES USE AND OUTCOMES OF ACUTE CARE FOR FIRST-EVER
ISCHEMIC STROKE IN TAIWAN: SHORT VS. PROLONGED STAY PATIENTS
PSM1: COST-EFFECTIVENESS ANALYSIS FOR SMOKING CESSATION THERAPY IN JAPAN
Tseng MC1, Chang KC2, 1National Sun Yat-Sen University, Kaohsiung, Taiwan,
2Chang Gung Memorial Hospital, Kaohsiung County, Taiwan
Igarashi A1, Takuma H1, Fukuda T1, Oshima A2, Nakamura M3, Tsutani K, 1Tokyo
University, Bunkyo, Tokyo, Japan, 2Osaka Medical Center for Cancer and
Cardiovascular Diseases, Osaka, Japan, 3Osaka Medical Center for Health Science
and Promotion, Osaka, Japan
OBJECTIVE: To evaluate cost-effectiveness of nicotine-replacement therapy (NRT). METHODS: We developed Markov-model to analyze lifetime costs and effectiveness expressed
in life-year gained. With expert interview, we developed a Markov-model. We only included
direct medical cost from the perspective of health care payer. We identified 19 tobaccoassociated diseases, including ten cancers based on “Health Risk Appraisal for Japanese
People” developed by Nakamura-Oshima in 2000. One cycle of Markov model was set to
five years. We assumed hypothetical cohort who started smoking at the age of 20. They
participate in NRT at the age of 30-70. We terminated analysis at the age of 90. We discounted both cost and outcome at 3% annually. In addition to cost-effectiveness of NRT,
we calculated annual excess loss in medical cost caused by tobacco. RESULTS: Annual
excess loss in medical cost caused by tobacco was estimated as JPY500 bil. Focusing on
one person, tobacco reduced their life-expectancy for 1.9 years for male and 1.0 year for
female, increased their lifetime medical costs for JPY 2.4 mil. for male and JPY 1.2 mil. for
female. We found that NRT was more effective and cost-effective for those who intended
to stop smoking than for others. For male, NRT saves life time medical costs for JPY
270,000 and expand life-expectancy for 0.19 years. For female, NRT saves life time medical costs (direct medical cost only) for JPY 136,000 (768,000 vs 631,000) and expand
life-expectancy for 0.12 years (23.7y vs 23.5y). Various sensitivity analyses showed
robustness of our results. CONCLUSIONS: NRT is dominant to control for smoking cessation therapy. In the future, we will undertake cost-utility analysis to evaluate smoking cessation therapy using this model.
STROKE
PST1: EFFICACY OF BOTULINUM TOXIN TYPE A (BONTA) IN THE TREATMENT OF ADULT FOCAL SPASTICITY: A META-ANALYSIS OF RESPONSE
RATE USING INDIVIDUAL PATIENT DATA
Aldridge G1, Frost M2, LeReun C3, Lynch M4, Davey P4, Napier-Flood F5, 1M-TAG
Pty Ltd, A Unit of IMS Health, Chatswood, Australia, 2M-TAG, A Unit of IMS Health,
Chatswood, Australia, 3M-TAG Pty Ltd (A Unit of IMS Health), Chatswood, NSW,
Australia, 4M-TAG, A Unit of IMS Health, Chatswood, NSW, Australia, 5Allergan
Australia Pty Ltd, Gordon, NSW, Australia
OBJECTIVE: The efficacy of Botulinum toxin type A (BoNTA) for the treatment of adult focal
64
OBJECTIVE: To analyze the distribution of resources use and outcomes at discharge
between patients who had prolonged acute hospitalization for first-ever ischemic stroke
and those staying for a shorter period of time. METHODS: Data were prospectively collected from 360 first-ever ischemic stroke patients consecutively admitted to a medical center
within 48 hours after symptom onset. Prolonged stay was defined as length of stay (LOS)
>7 days after admission in department of neurology for acute care. Demographic and clinical data at admission, resource use, in-hospital mortality and outcomes at discharge were
collected. RESULTS: Patients (58% male) had mean age 64.9±12.7 (range, 18 to 93)
years. Mean National Institutes of Health Stroke Scale (NIHSS) score at admission was 9.4
(median, 6); mean modified Barthel Index (MBI; on a scale of 0 to 20) at admission was
10.7 (median, 12). Laboratory work-up were ordered in all patients, 93% of patients
underwent emergent brain CT, 21% brain MRI, 75% duplex ultrasound, and 76% initiated
rehabilitation in the acute care phase. The LOS was >7 days in 169 (47%) patients.
Overall, patients with prolonged stay had more severe stroke at admission by HINSS score
(median, 10 versus 4). Mean (median) inpatient cost per patient was US$748 ($610) for
patients with shorter stay, $2,984 ($1,316) for those with prolonged stay. Mean (median)
cost per day was US$189 ($129) for patients with shorter stay, $139 ($112) for those with
prolonged stay. In-hospital mortality was similar, 8% in group of prolonged hospitalization
and 7% in the other. Mean improvement in NIHSS for those who survived acute care and
stayed longer were 1.3±6.8, MBI 2.4±5.0, and similar for those stayed shorter, 1.3±3.2
and 2.5±4.4, respectively. CONCLUSIONS: The impact of stroke severity need to be understood to manage LOS. Early supported discharge planning would probably reduce the prolonged acute hospitalization.
PST3: HEALTH-RELATED QUALITY OF LIFE OF STROKE SURVIVORS IN THE
US
Xie J1, Wu EQ2, Zheng ZJ3, Croft JB3, Mensah GA3, Labarthe DR3, 1Center for
Disease Control and Prevention, Northrop Grumman, Atlanta, GA, USA, 2Analysis
Group, Boston, MA, USA, 3Center for Disease Control and Prevention, Atlanta, GA,
USA
OBJECTIVE: To assess health-related quality of life (HRQL) of stroke survivors in the U.S.
population. METHODS: SF-12 and EQ-5D of the adults (age >=18) in the 2000 and 2002
Medical Expenditure Panel Survey (MEPS) were examined in this study. Stroke was defined
based on the ICD-9 codes from 430 to 438. SF-12 physical and mental scores and EQ-5D
index scores of patients with stroke were compared with those of individuals without
stroke. The differences in HRQL scores between individuals with and without stroke were
reported using both absolute difference and effect size (ES). Age, sex, race, and geograph-
ic region were adjusted using a stratification matching method. In addition, subgroup
analyses were conducted to compare HRQL of stroke patients between younger (18-64
years) and older (>=65 year) groups, males and females, and whites and non-whites. All
analyses were done using individual weights to achieve nationally representative estimates. RESULTS: Among 39,735 adults included in the study, 515 were reported to have
stroke, corresponding to 1.3% of the U.S. adult population. SF-12 physical score, mental
score and EQ-5D index score were 7.04, 4.33 and 0.15 point(s) lower, respectively, among
stroke patients, compared with non-stroke population. The effect sizes were 0.57, 0.39
and 0.48, respectively (all p-values <0.01). Subgroup analyses revealed that stroke
patients in the younger group, female patients and nonwhite patients scored 0.16, 0.08
and 0.10 lower in EQ-5D, compared with their respective older age, male, and white counterparts (all p-values <0.05). In addition, stroke was further associated with 7.50 points
lower SF-12 physical score in the younger group (p<0.01). CONCLUSIONS: Stroke is significantly associated with lower physical and mental HRQL and overall health utility in the
U.S. The decrease in the quality of life seems to be greater in the younger age, female,
and nonwhite groups.
domains (0.95 to 0.98), moderate for emotion (0.69) and participation (0.77). Intraclass
correlation coefficients ranged from 0.63 to 0.89, except for memory (0.13), hand function
(0.47), and ADL/IADL (0.53). Based on first assessment, memory and communication may
have potential for ceiling effects in mild stroke group, strength and hand function may
have potential for floor effects in moderate stroke group, and all domains may have potential for floor/ceiling effects in severe stroke group. The correlations between each of the
physical domains (strength, ADL/IADL, mobility, hand function) and Barthel Index were
good (0.72 to 0.92). Memory domain showed a high correlation with MMSE (0.81). CONCLUSIONS: The Mandarin version of the SIS is an acceptable stroke-specific outcome
measure in most domains. Further studies in determining the content should enhance
confidence in its validity.
PST4: HIGH INCIDENCE AND VARIATION IN INTRACRANIAL ATHEROSCLEROTIC DISEASE (ICAD) IN CHINA - EPIDEMIOLOGY AND TREATMENT
OPTIONS
Dong H, Buxton M, Brunel University, Uxbridge, London, UK
Ho G, Lacey M, Valentin M, Boston Scientific Corporation, Natick, MA, USA
OBJECTIVE: To study the incidence and geographical variance of ischemic stroke resulting
from ICAD, an important risk factor for stroke, in the various regions within China. To survey current treatment options and describe new solutions. METHODS: A literature review
was conducted and incidence rates of stroke in the 29 provinces of China were used to
derive estimates for the specific incidence of intracranial ischemic stroke. Publications on
the proportion of different stroke subtypes in China were used to determine the rates for
ischemic stroke and intracranial disease in China, and then estimate how extensively the
population is afflicted by ICAD. RESULTS: The geographic distribution of stroke incidence
and mortality in China varies by region, ranging from 80.9/100,000 in Shanghai city to
486.4/100,000 in Harbin city. In the urban areas of Guangdong, Shanghai and Beijing,
there are an estimated 13,087, 12,855, and 3,534 persons affected in the respective
provinces. The nearby provinces of Hebei and Hunan have respectively 43,792 and 49,362
affected. With improved diagnostic capabilities, collection of this specific data will give further clarification on the variability in incidences of ICAD in China. CONCLUSIONS: As incidence and mortality rates have not been previously tracked for ICAD, values for ICAD in
regions of China are estimates based on current literature. The results of the analysis
show a high incidence of ICAD. The burden of ICAD is especially high in China compared
to other countries and suggests the need for a solution to relieve the health care system
and society of long term care costs associated with ICAD sufferers. It will be important to
develop strategies to enhance public awareness of risk factors and prevent the disease.
For those affected by ICAD seeking an alternative to drug therapy and surgical bypass,
there is an unmet medical need for a minimally invasive treatment.
PST5: MANDARIN VERSION OF STROKE IMPACT SCALE: ADAPTATION AND
VALIDATION
Chang KC1, Tseng MC2, Hung JW1, Lin TK1, Tan TY1, Chen CH1, 1Chang Gung
Memorial Hospital, Kaohsiung County, Taiwan, 2National Sun Yat-Sen University,
Kaohsiung, Taiwan
OBJECTIVE: To assess the properties of the Mandarin version of the Stoke Impact Scale
(SIS) versions 3.0, developed by Pamela W. Duncan et al. METHODS: The SIS, a strokespecific outcome measure, assesses 8 domains: strength (4 items), memory (7 items),
emotion (9 items), communication (7 items), activities of daily living/instrumental activities
of daily living (ADL/IADL) (10 items), mobility (9 items), hand function (5 items), and participation (8 items). SIS was translated and back-translated according to the standardized
guidelines for cross-cultural adaptation. Patients consecutively admitted with ischemic
stroke were recruited, until 30 patients in each of three groups of stroke severity were
reached. Stroke severity was evaluated with NIH stroke scale and categorized as mild (06), moderate (7-15), or severe (16-38). Patients were assessed 3 times, within 7 days of
admission, 3 months and 6 months afterwards. Ten randomly selected patients were readministered 2 weeks after first administration for test-retest study. RESULTS: We studied
50 mild, 36 moderate, and 33 severe stroke patients. Cronbach’s alpha was high for 6
SURGERY
PSU1: EARLY ASSESSMENT OF THE LIKELY COST-EFFECTIVENESS OF A
NEW TECHNOLOGY: A MARKOV MODEL WITH PROBABILISTIC SENSITIVITY
ANALYSIS OF COMPUTER-ASSISTED TOTAL KNEE REPLACEMENT
OBJECTIVE: To apply a Markov model to compare cost-effectiveness of total knee
replacement (TKR) using computer-assisted systems (CAS) with that of TKR using conventional method. METHODS: Nine Markov states were identified based on the process of the
disease following TKR. Effectiveness was expressed by QALYs. The length of a cycle was
set at one month, a discount rate of 3.5% was used for both cost and effectiveness. The
simulation was carried out initially for 120 cycles, starting with 1,000 TKRs. After this, a
probabilistic sensitivity analysis was carried out using Monte Carlo approach of 10,000
iterations. RESULTS: For the patients who had TKR using conventional technique the
cumulative serious complication rate was 87.3%, the minor complication rate 135.9%, the
complex revision rate 5.1%, the simple revision rate 2.6% and the all-cause mortality
37.1%. For the patients after TKR using CAS, the cumulative rates were 58.1%, 136.5%,
3.6%, 1.9% and 37.1%, respectively. The incremental cost-effectiveness analysis shows
that TKR using CAS was a long-term cost-effective technology, but the QALYs gained were
small. After the first two years, the incremental cost per QALY of TKR using CAS was dominant because TKR using CAS was cheaper and produced more QALYs. The ICER was sensitive to the 'effect of CAS', to the utility of the state 'normal healthy after primary TKR'
and to the additional cost of CAS. But it was not sensitive to utilities of other Markov
states. The average cumulative serious complication rate, minor complication rate, complex revision rate and simple revision rate from probabilistic analysis are similar as the
rates from deterministic analysis. Both analyses produced similar cost per QALY gained,
which is -d38,837 and -d39,543, respectively. CONCLUSIONS: Compared to conventional
TKR, modelling suggests that computer-assisted TKR is a cost-saving technology in the
long-term and may offer small additional QALY benefits.
PSU2: GROWTH OF FREE-STANDING AMBULATORY SURGERY CENTERS AND
HOSPITAL SURGERY VOLUME
Bian J, Morrisey MA, University of Alabama at Birmingham, Birmingham, AL, USA
OBJECTIVE: To examine the association of the growth in free-standing ambulatory surgery centers (ASCs) with hospital surgery volume. METHODS: Secondary data analyses of
the1992-2001 American Hospital Association annual survey files, the 2003 Medicare
Online Survey Certification and Reporting System, an HMO penetration file, and Area
Resource Files. We construct a balanced Metropolitan Statistical Area (MSA) panel dataset
including 317 MSAs from 1992-2001. Ordinary least squares regressions with MSA and
year fixed effects are used to control for MSA-level heterogeneity and time trends. Three
dependent variables are the log-transformed hospital outpatient, inpatient, and total surgery volumes. The key explanatory variable is the number of ASC's per 10,000 people.
Other covariates include HMO penetration, hospital concentration measured by the
Herfindahl-Hirschman Index, supplies of surgeons and physicians, and demographic and
economic characteristics. RESULTS: From 1992-2001, hospital outpatient surgery volume
at the MSA level increasing by 23% from 58,783 to 72,111 while inpatient surgery volume
decreased by 12% from 50,778 to 44,911. During the same period, the number of ASCs
per 10,000 people increased by 143% from 0.07 to 0.17, HMO penetration nearly doubled,
and hospital markets became less competitive. In regression analysis, the growth of ASCs
was inversely associated with outpatient and total surgery volumes (p<0.01) but was not
associated with inpatient surgery volume (p>0.10). Other thing equal, an increase in 1
65
ASCs per 100,000 people is associated with a decrease of 4.1% in outpatient surgery volume or an increase of 1.8% in total surgery volume. CONCLUSIONS: Our study suggests
that ASCs may lead to a decline in hospital total surgery volume, largely driven by
decreased hospital outpatient surgery volume. Additional research needs to focus on the
impact of ASCs on hospital provision of charitable care and quality of care.
HEALTH CARE USE & POLICY STUDIES
URINARY/KIDNEY
OBJECTIVE: Pharmaceutical markets are characterized by a high degree of product differentiation, where price, consumers’ income, perceived quality, and reputation interact. In
addition, induced demand affects not only the impact of prices on the decision of buying a
drug, but also the criteria used to prescribe it. In the Argentinean case, without patent protection, there is not a clear distinction between brand product and generics, which in turn
affects the nature of competition. Marketing efforts targeting physicians (detail advertisement) consume important shares of pharmaceutical producers’ budgets. On the other
hand, technical progress in chemical ingredients provides consumers and physicians with
new alternatives of choice. The goal of this paper is to understand the sources of differentiation among products in four Argentinean therapeutic classes, and their effects on price
elasticities. METHODS: A discrete choice model of product differentiation is used to measure demands for antidiabetics, gastroprocinetics, prostatics and quinolons, during 19881995. Such demand functions start with an individual utility function, which is explained
by observed prices, product characteristics, and consumers’ tastes. The econometric
implementation takes the form of a nested logit model, where the first source of substitution is by chemical ingredient, followed by variables related to marketing/reputation.
RESULTS: The confirmed hypothesis is that reputation builder variables are consistently
significant across therapeutic classes. CONCLUSIONS: In addition, the study shows a correspondence between the level of necessity of the drugs and the relative importance of
chemical ingredients in the decision of consumption.
PUK1: COST-EFFECTIVENESS ANALYSIS OF ORAL VS INTRAVENOUS IRON
GIVEN TREATMENT FOR RENAL ANEMIA PATIENTS
Bi K, Chen W, Fudan University (former Shanghai Medical University), Shanghai,
China
OBJECTIVE: To compare cost-effectiveness of oral iron given and intravenous iron given
treatment for anemia patients caused by renal failure. METHODS: One hundred and ninety
six hemodialysis patients are divided into two groups in the prospective randomized multicenter clinical trial. The oral group(n=97)patients are prescribed elementary iron(Ferrous
Succinate) 600 mg, tid. The other group in=99 use intravenous therapy during the
hemodialysis procedure according to the required dosage accounted in advance. And then
they are maintained 100 mg per month. RESULTS: The mean cost of the two group is
46714.62 yuan RMB and 46564.52 yuan RMB per year for each patient. The cost of oral
group is little higher but there is no significant statistic difference (p>0.050)between
groups. The effective rate is 56.7% for the oral group and 86.9% for the other with significant statistic difference (p<0.05). CONCLUSIONS: The intravenous iron given therapy is
more cost-effective than the oral iron given therapy in the treatment of hemodialysis
patients.
PUK2: POTENTIAL SAVINGS WITH EVEROLIMUS WITH REDUCED-DOSE
CYCLOSPORINE COMPARED TO MYCOPHENOLATE MOTEFIL WITH FULL
DOSE CYCLOSPORINE IN DE NOVO RENAL TRANSPLANT RECIPIENTS IN
CHINA
Yang X1, Ethgen O2, Wang W3, Lian R3, Ricci JF1, Spaepen E4, Annemans L5,
1Novartis Pharma AG, Basel, Switzerland, 2University of Liège, Liège, Belgium,
3Novartis Pharma China, Beijing, China, 4IMS Health, Brussels, Belgium, 5IMS
Health and Ghent University, Brussels, Belgium
OBJECTIVE: To explore potential savings with proliferation signal inhibitor everolimus
1.5mg with reduced-dose cyclosporine (CsA) vs. mycophenolate motefil (MMF2g) with full
dose CsA in de novo renal transplant recipients in China. METHODS: Data were obtained
from a trial that prospectively collected one-year kidney post-transplant resource utilization. The trial showed similar economic outcomes for everolimus 1.5mg, 3.0mg and
MMF2g with full-dose CsA. A subsequent trial of everolimus 1.5mg or 3.0mg with
reduced-dose CsA demonstrated similar efficacy but fewer complications. However, this
latter trial did not record resource utilization. A multivariate model was fitted using data
from the first trial to predict direct additional resource use and medical cost associated
with failures and complications. As no significant country-specific cost effect on length of
stay was found, individual country cost vectors was applied. The model was has been
developed for different European countries and presented earlier at ISPOR. In the current
analysis, resource utilization was valued using Chinese unit cost estimates to explore
whether the results are comparable to those of other countries. Regression coefficients
were then applied to the second trial data to predict the economic outcomes. RESULTS:
Valuing co-medications at brand prices, incremental costs were CNY:489 per hemodialysis
session (p<0.001), CNY:580 per day of hospitalization due to infection (p=0.004) and
CNY:11,948 per biopsy-proven acute rejection (p<0.001). After adjusting for recipient age,
living donors, and cytomegalovirus treatment between the two trials, everolimus with
reduced-dose CsA could decrease 1-year costs (excluding cost of CsA, MMF and
everolimus) by CNY:15,037 (US$:1,860) vs. MMF. Potential saving was lower when using
generic drug costs for all available co-medications: CNY:5,460 (US$:676). CONCLUSIONS:
As compared to MMF with full-dose CsA, everolimus 1.5mg with reduced-dose CsA has
the potential to reduce one-year post-transplant cost in de novo kidney recipient in China,
to the same extent as in European countries.
PHP1: ANALYZING PRODUCT DIFFERENTIATION IN FOUR ARGENTINEAN
PHARMACEUTICAL MARKETS
Maceira DA, Center for the Study of the State and Society (CEDES), Ciudad
Autonoma de Buenos Aires, Buenos Aires, Argentina
PHP2: COMPARATIVE ANALYSIS OF ADVERTISING EFFECTIVENESS
BETWEEN NEW AND EARLIER ENTRANTS IN THE PHARMACEUTICAL MARKET
Kwong WJ, University of Georgia, College of Pharmacy, Athens, GA, USA
OBJECTIVE: To evaluate the presence of first-mover advantage for pharmaceutical advertising that would support the entry deterrence theory in the pharmaceutical market.
METHODS: Advertising elasticities of demand for pharmaceutical products in the periods
following new product entries were estimated using time and disease fixed effects estimation. One-period and two-period lag models were estimated. Logarithm of a product’s
sales revenue was regressed on its own advertising expenditure, total advertising expenditure of competing products in the same market, number of competing products, number of
years the product has been on market, a dummy variable indicating whether the product
is a new entrant, and an interaction term between the dummy variable and the product’s
own advertising expenditure. Scott-Levin Market Research Audit advertising expenditure
and product sales data from Jan 1995 to Dec 2001 were used were analyzed on a quarterly basis. Products from eight therapy markets were examined: asthma, migraine, obesity, Parkinson’s disease, seizure, depression, lipid disorder, and gastric and duodenal ulcer.
RESULTS: In both lag models, product sales significantly increased with a product’s own
advertising expenditure, and significantly decreased with the total advertising expenditure
of competing products, and the number of competing products. For existing products,
advertising elasticity of demand was estimated to be 0.068% in the one-period lag model
and 0.062% in the two-period lag model. Elasticity estimates for new entrants was lower
at 0.046% and 0.044%, respectively. The elasticity estimates between new and existing
products were not significantly different. Comparing results of the two lag models, advertising elasticity of demand depreciated at 8.7% per quarter. CONCLUSIONS: Results did
not find any significant first-mover advantage in the effectiveness of advertising between
earlier and later entrants that would support the potential entry deterrence effect of advertising in the pharmaceutical market. These results did not support regulating pharmaceutical advertising based on anti-competitive grounds.
PHP3: STUDY ON PHARMACEUTICAL SETTING IN COMMUNITY HEALTH
SERVICE
Cheng X, Fudan University, Shanghai, Shanghai, China
According to the results of cluster analysis of pharmaceutical setting of community health
service, this study reveals whether it can meet the curative needs on the basis of the current condition of common diseases, frequently occurring diseases and chronic diseases.
The study also analyzes its effects on drug expenditure according to different scale of
pharmaceutical setting. Results of anova analysis demonstrate that the scale of pharma-
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ceutical setting of community health service has an impact on drug expenditure to some
extent. The drug expenditure per capita in the community health service group which has
200 kinds of drugs or above is higher than the group which has 100 to 200 kinds of drugs
.However ,the difference between the group which has 100 to 200 kinds of drugs and the
group which has less than 100 kinds of drugs is not significant.
PHP4: IDENTIFY GAPS OF EVALUATION OF ESSENTIAL MEDICINES IN CHINA
Sun X, Li Y, The Chinese Cochrane Centre, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
OBJECTIVE: In 2002, an evidence-based approach was initially applied to evaluate essential medicines (EM) in China. Although the performance of such an attempt was recognized, the evaluation system was considered incomplete. A study was, therefore, designed
to identify the gaps. METHODS: The decision-makers and reviewers who were involved in
the evaluation of EM in 2002 were convened. They were asked to answer a list of wellconstructed questions, and identify any additionally conceptualized problems throughout
the process. In addition, a literature review was carried out, based on electronic search of
Pubmed (1980-2004), WHO website, Australian Pharmaceutical Benefit Scheme website.
RESULTS: Several key weak points of the evaluation was identified and recognized. A)
Incomplete technical contents: medicines were assessed eligibility based on effectiveness
and safety, and marketing prices. The drug utilization and economic feasibility were not
estimated. B) Inadequate evaluation methods: the techniques to assess the effectiveness
and safety were either outdated (e.g. quality appraisal by Jadad scale), incomplete (e.g.
assessment of safety based on review of clinical trials) or inadequate (e.g. marketing
prices considered, instead of costs and cost-effectiveness). C) Lack of efforts from related
professionals: reviewers mostly consisted of medical specialists, pharmacologists and
pharmacists. No efforts from pharmacoeconomists, pharmacoepidemiologists, and consumer and industrial representatives were contributed. D) Lack of outcome predicting and
monitoring mechanism: no established outcome research methods were available, which
might lead to unawareness of results of drug utilization. E) Lack of unpublished data: all
the resources for evaluation came from published data, whereas unpublished data, as
understood by pharmaceutical industry, were not available. This resulted in bias of selection of EM. F) Quality of evidence: the evidence, especially of traditional Chinese medicine,
is too poor to be indicative for decision-making. CONCLUSIONS: The evidence-based evaluation of essential medicines in China is still at its early stage.
PHP5: THE EFFECT OF DRUG POLICY ON THE ADOPTION RATES OF NEW
DRUGS IN KOREAN OUTPATIENTS CARE
Choi SE, Kim JH, Health Insurance Review Agency, Seoul, South Korea
OBJECTIVE: Korea has implemented the new prescription drug policy in 2000, which separated the function of prescribing and dispensing drugs between doctors and pharmacists
and purposed to improve the quality of drug use and remove the economic incentive from
doctor’s prescribing behavior. The aim of this study was to understand the adoption rates
of new drugs in outpatient care after the new policy, and explore the effect of the policy on
the adoption rates. METHODS: Four new prescription drugs frequently prescribed in ambulatory care were selected. From 1999–2002, the National Health Insurance (NHI) claims
data for prescription drugs of selected clinics was used. The dependent variable was the
adoption rate defined by the period from the enlisted date of the new drug on the NHI
reimbursement list to the first prescribed date by each clinic. The explanatory variables
were collected from the adopter, technology, and environment characteristics including
policy change. The claims data was merged with telephone survey data. Cox’s proportional
hazard regression was performed to set and test the model in explaining the factors influencing on the adoption rate. RESULTS: The 1,792 observations were inputted into the
model. The model showed that the new prescribing system made the adoption rate faster
than before the change (HR=295.7, p<0.001) but the reimbursement restriction policy
restricted the adoption rate of new drugs (hazard ratio (HR) = 0.03, p<0.001). The behavioral characteristics also influenced on the rate of adoption. Doctors who prescribe more
number of drugs per claims and have higher proportion of drug costs per total medical
costs were early adopters (hazard ratio 1.02, p<0.05). In addition, the innovative drugs
and the drugs by multinational manufacturers were adopted earlier. CONCLUSIONS: The
prescribing system change accelerated the new drugs to be adopted earlier, but the reimbursement restriction policy trade off this tendency.
PHP7: ECONOMIC EVALUATION OF DISEASE MANAGEMENT PROGRAMS
Suh R, Uniformed Services University of the Health Sciences, Vienna, VA, USA
OBJECTIVE: To review existing methodologies for the economic evaluation of disease
management (DM) programs and to identify issues and challenges facing purchasers,
providers, vendors, and patients as this field continues to evolve. METHODS: A literature
review of current industry standards for the economic evaluation of DM programs, to
include those proposed by academicians, health plans, DM vendors, trade groups and
associations, and actuaries; identification of common themes and unresolved controversies; and suggestions for next steps and further research. RESULTS: A comparison of the
7 most recent and cited publications that provide methodological recommendations for the
economic evaluation of disease management programs reveal many common elements,
as well as disparate approaches to dealing with known challenges and biases. Central to
the differences is the need to balance practical feasibility and methodological rigor. This
review identifies the key issues and considerations that remain in formulating a true
industry standard for the economic evaluation of disease management programs. CONCLUSIONS: Medicare’s new disease management pilot program and the Congressional
Budget Office’s findings of “insufficient evidence” for the economic benefits of DM programs have both spurred on greater interest in finding valid methodologies that may be
used to substantiate claims of overall cost savings and in establishing some comparability
across economic evaluation studies. While some controversies remain, many organizations
and individuals have put forth several proposed methodologies that seem appropriate for
their target populations. Moving toward consensus in this field will need to accommodate
the interests and needs of a variety of stakeholders involved in the disease management
industry, and there may be a role for federal research or regulatory bodies in helping
establish an industry-wide standard. Further developments in this field may have wideranging impacts as disease management continues to grow in health systems outside the
United States.
PHP8: DISEASE PREVENTION AND PHARMACEUTICAL DRUG INNOVATION:
DEREGULATORY POLICY UNDER THE NHI
Yamada T1, Chen CC2, 1Rutgers University, The State University of New Jersey,
Camden, NJ, USA, 2Columbia University, New York, NY, USA
OBJECTIVE: Skyrocketed pharmaceutical spending and an increase in the share of pharmaceutical costs in the national health expenditures have caused the Japanese government to implement the price control of pharmaceutical drugs. This paper was designed to
identify the government price control policy, to investigate its effect on pharmaceutical
innovation, and to examine its influence on longevity. METHODS: The study is an application and extension of the PRECEDE-PROCEED model to analyze new drug introduction (i.e.
innovation) and employs aggregate time-series yearly data from 1970-2004 to examine
the effects of the Japanese government pharmaceutical pricing control policy on pharmaceutical innovation and illness. RESULTS: As the empirical evidence indicates, the overall
contribution of new chemical entities to longevity provides robust results. The findings of
the study show that:1) the aggregate effect of new chemical entities reduces the death
caused by illness by about 109,000 people per year; 2) a percentage decrease in the drug
price standard for pharmaceutical base reduces the death caused by illness by about
7,600 elderly population; and 3) the government pharmaceutical pricing policy would suggest that the price control tends to retrieve an incentive for the pharmaceutical drug innovation. CONCLUSIONS: The study offers a compelling argument about the government
pharmaceutical pricing policy on death caused by illness, i.e. longevity. The government
pricing policy with regulation may have been effective in giving the incentives for pharmaceutical companies to develop and introduce innovative pharmaceutical drugs with new
chemical entities.
PHP9: DELIVERY OF DAILY DOSES OF THE DRUGS TO HOSPITAL DEPARTMENTS AS A METHOD OF DRUG RATIONALIZATION AT THE CLINICS IN UNIVERSITY TEACHING CENTRE NOVI SAD
Sabo A, Tomic Z, Faculty of Medicine, Novi Sad, Serbia and Montenegro
OBJECTIVE: Introducing daily instead of weekly delivery of drugs and medicinal supply to
hospital departments has been widely supported by Ministry of Health and Crown agency
as a method for improvement of quality of drug supply and pharmacoekonomics in this
field. According to published data the pharmacoeconomic consequences of this measurements could lower the drug and medicinal supply expenses for as much as 90%. In Novi
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Sad Clinics, Serbia and Montenegro, weekly delivery of drugs and medicinal supply is stil
present. Therefore, we performed a study in order to see if a change to daily dosing,
together with everyday control of structure and dose of prescribed drugs by clinical pharmacologist can rationalize dug use. METHODS: Our study with daily dosing of drugs and
medicinal supply started at Urological clinic, University Teaching Hospital Novi Sad, Serbia
and Montenegro. At the beginning the monthly use of drugs was followed up. The drug use
was calculated using ATC/DDD classification. RESULTS: According to our expectation,
financial results did show substantial lowering of the drug expenses, of 36%, with antibacterilas being the most restricted drugs, followed by local anesthetics. CONCLUSIONS: The
new way of drug delivery, with every day follow up and corrections of the structure and
amount of drugs prescribed by urologist significantly improved the safety and quality of
the drugs. Constant monitoring in drug delivery enabled them to prevent potential clinically
harmful interactions, to improve patients compliance together with substantial financial
results, that support the new system of drug delivery.
PHP10: DEMAND NEEDS AND SUBSIDIES IN PHARMACEUTICALS: THE
EXPERIENCE OF THE REMEDIAR PROGRAM IN ARGENTINA
Maceira DA, Apella IR, Barbieri E, Center for the Study of the State and Society
(CEDES), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
OBJECTIVE: Between 2001 and 2002, as a consequence of the Argentinean economic crisis, the existent gap between potential and effective demand for pharmaceutical products
increased, especially in low income households. As a result, the Ministry of Health
launched the Remediar Program, consisting in the public provision of medicines among
houses under the poverty line and without formal health coverage. By implementing a subsidy for pharmaceutical products, families can substitute their own purchases by free
medicaments, shifting their incomes to alternative uses. Considering that Remediar acts as
an indirectly subsidy for the demand of medicines through primary health care posts
(CAPS), the main propose is to know the ability of the Program to reduce the gap between
potential and effective demands under the poverty line, as well as its effects over welfare
in terms of generated savings. METHODS: By using two Household Surveys on Expenses
and Utilization at the CAPS level during 2003 and 2004, designed for this research, the
paper develops a probit model, estimating the probability of accessing to free prescriptions, as a function of household incomes and socioeconomic characteristics, formal
health insurance coverage levels, and the participation of each CAP into the Program. The
results were compared to the data provided by the National Household Survey of Expenses
and Utilization in Health developed by the Ministry of Health in 2003. RESULTS:
Estimations suggest a potential redistributive effect due to the Program, by improving
equity on expenditures on pharmaceuticals, which may imply a reduction of the Gini coefficient from 0.11 to 0.08. In addition, population under the first and second income quintile
might reach saving of their expenses in drugs of 22.5 and 6.7 percent, respectively. CONCLUSIONS: The paper shows the effectiveness of the Remediar in increasing the access to
medicines of patients at the lowest income quintiles.
PHP11: DETERMINANTS OF CATASTROPHIC EXPENDITURE AND IMPOVERISHMENT OF HOUSEHOLDS IN THAILAND
Prakongsai P1, Tangcharoensathien V2, Limwattananon S3, 1International Health
Policy Program, Amphoe Muang, Thailand, 2International Health Policy Program,
Nonthaburi, Thailand, 3Khon Kaen University, Amphoe Muang, Khon Kaen, Thailand
OBJECTIVE: To explain variations in the magnitude of health care catastrophe and household impoverishment from out-of-pocket (OOP) payments in relation to differences in services and providers of health care during the pre- and post- universal health care coverage
(UC) periods in Thailand. METHODS: Analysis of the national socio-economic surveys of
household income and consumption in 2000 (N=24,747), 2002 (N=34,785) and 2004
(N=34,843). RESULTS: Households whose members being admitted to hospitals for inpatient (IP) experienced health care expenditure beyond a catastrophic level (defined as
OOP payments more than 10% of total consumption) most frequently (31.0% during preUC period in 2000 and 15.1-14.6% during post-UC period in 2002-2004). The catastrophic
incidence in households with OOP payments for out-patient (OP) without IP services was
less frequent (12.0% pre-UC and 7.9-8.3% post-UC). The households paying OOP only for
self medication faced the catastrophic expenditure by only 2.1% and 0.4-0.6% over the
same period. Among the households at risk to health care catastrophe from IP service during the post-UC period, the catastrophic incidence varied from 32.1-27.8% for services by
private hospitals, and 13.9-11.1% by provincial hospitals and 6.5-7.3% by district hospi68
tals respectively. The variations in household impoverishment due to OOP health payments
followed a similar catastrophic pattern. Paying for IP services accounted for the poverty
increase by 95.6% and 84.0-71.5% of the impoverished households during pre-UC and
post-UC periods, respectively. The relative increase in post-OOP impoverishment was
found in 98.8-100% of those became poor from the payments to private hospitals regardless of type of health care services. CONCLUSIONS: Households making OOP payments
for IP services and private hospitals were most likely to face the catastrophic health care
expenditure and impoverishment.
PHP12: EXPLORING THE AVAILABILITY & CHARACTERISTICS OF HEALTH
CARE COST DATA ACROSS SELECTED ASIAN COUNTRIES
Bindra S1, Duttagupta S2, Chan BS3, Hongxia C4, Cheah SK5, Wei Y4, Zhong J4,
Sze-Man Lai J6, Somasundaram S7, Suvarna V7, Nawawi S8, Lee HJ9, Park HJ9,
Nawaz A10, Tranquilino F11, Martin N11, Ramachandran S12, Kulasingham S13,
Lam KM14, Li M15, Lin S15, Chu C16, Ponprasit K17, Nganthavee W17, Pramanik
A18, 1Pfizer Asia Regional Office, Hong Kong, Hong Kong, 2Pfizer Inc, New York, NY,
USA, 3The Chinese University of Hong Kong, Hong Kong, China, 4Pfizer China,
Beijing, China, 5Pfizer Singapore, Singapore, Singapore, 6Pfizer Hong Kong, North
Point, Hong Kong, 7Pfizer India, Jogeshwari, Mumbai, India, 8Pfizer Indonesia,
Jakarta, Indonesia, 9Pfizer Korea, Seoul, South Korea, 10Pfizer Pakistan, West Wharf,
Karachi, Pakistan, 11Pfizer Phillipines, Makati City, Philippines, 12Pfizer, Selangor,
Malaysia, 13Pfizer Malaysia, Selangur Darul, Malaysia, 14Pfizer Singapore, Gateway
East, Singapore, 15Pfizer Taiwan, Tamsui, Taiwan, China, 16Pfizer Taiwan, Tamsui,
China, 17Pfizer Thailand, Bangkok, Thailand, 18Pfizer Asia, Admiralty, Hong Kong
OBJECTIVE: Increasingly local and regional health care payers are requesting economic
analyses for new drugs in order to effectively allocate resources in various Asia-Pacific
countries. However, the availability of uniform and reliable local or regional data sources
necessary to conduct such analyses is limited. In an effort to better understand the availability and characteristics of the health economic data sources from selected countries in
this region, the following exercise was conducted. We collaborated with various institutions
across selected Asian markets to gather relevant data to identify opportunities for economic analyses reflecting local and/or regional health care practices. METHODS: A list of commonly used health care services associated with hospitalized patients was developed from
published literature. Health care institutions were approached to provide corresponding
unit cost data, while keeping within respective country-specific privacy regulations. In
addition, wherever available, costs from published sources were also collected. RESULTS:
Indicative of the social, cultural and economic diversity of the region, health care service
costs varied considerably across the selected countries. Cost for a comparable hospital
bed/day in a private ward varied from as little as US$32 in Indonesia to US$72 in Pakistan.
Significant differences were also seen in the cost per bed/day in a comparable ICU setting,
ranging from as little US$271 in Singapore to US$1800 in Hong Kong Significant variances
were also observed for cost data collected on a number of comparable inpatient and outpatient services. CONCLUSIONS: While progress is being made to develop pharmacoeconomic analyses specific to health care demand in the Asia-Pacific region, the quantity and
quality of available data to meet these demands are still very limited.
PHP13: A NATIONAL SURVEY OF COST-ANALYSIS OF INPATIENT PHARMACEUTICAL SERVICES IN TAIWAN
Kao Yang YH1, Kuo SC2, 1Cheng-Kung University, Tainan, Taiwan, 2Pittsburgh
University, Pittsburgh, PA, USA
OBJECTIVE: This study has investigated costs of four IPS, unit dose drug distribution, total
parenteral nutrition, cytotoxic drug distribution, and patient-controlled analgesia preparation. METHODS: The investigation was conducted between February and March in 2002.
The surveyed organizations were drawn from National Health Insurance contracted medical institution database, including 23 medical centers and 75 regional hospitals. The pharmacy directors in these organizations were contacted by e-mail or fax. Descriptive statistics were computed for all variables. RESULTS: Nine MCs and 11 RHs surveys were
returned, for an overall response rate of 20.4%. The personnel costs in four IPS surveys
from MCs accounted for the largest proportion of the total costs each, and the similar findings were also evidenced in RH surveys. The medians of UDDD costs in MCs and RHs
were New Taiwan Dollar 115 and 82 per patient per day. They were 1.4 and 1.1 times the
amount of the reimbursement in MCs (NTD 84 PPPD) and RHs (NTD 73 PPPD) respectively.
The medians of TPN and CDD costs in MCs were 2.5 and 1.9 times the amount of the
reimbursement (NTD 147 PPPD), while they were 3.3 and 3.6 times the amount of the
reimbursement in RHs. The median of the PCA cost in MC surveys was NTD 397 PPPD, but
the service was not reimbursed by the NHI. We presented results and recommended to the
NHI Committee for the Arbitration of Medical Costs, successfully making IPS of TPN and
CDD achieve the 50% reimbursement increment respectively. CONCLUSIONS: As IPS keep
expanding, workforce shortage and workload increase in pharmacy continue to challenge
pharmacists to maintain safe and quality medication systems. Although the revised reimbursement for IPS falls short of our expectations, we are delighted to promote the reimbursement increase based on a national and rational cost survey.
PHP14: EFFECTS OF USING AN AUTOMATED PRESCRIPTION FILLING SYSTEM ON PHARMACY STAFF UTILIZATION AND PRESRIPTION FILLING LABOR
Lin AC1, Huang YC1, Punches G2, Chen Y1, Qian JJ1, 1University of Cincinnati,
Cincinnati, OH, USA, 2Punches Pharmacy Plus, Michigan, MI, USA
OBJECTIVE:To evaluate the effects of using an automated prescription filling system,
ScriptPro 2000, on pharmacy staff utilization and prescription filling labor in an independent US pharmacy. METHODS: Self-controlled before and after the installation of the
automation. Pharmacy Setting: The Punches Pharmacy Plus, an independent pharmacy
located in Clare, Michigan, USA and with a daily workload of 360 prescriptions was selected as the study site in this study. Intervention: The installation of an automated prescription filling system, ScriptPro 200. Data Collections: Videotaping and work measurement
techniques were used in collecting the data of before and after installation of the ScriptPro
200. Study Variables: The utilization of the pharmacy staff (pharmacists and technicians)
and the labor utilized in direct and indirect prescription-filling activities, e.g., receiving
order, order entry, filling, inspecting, packaging and dispensing, phone calls, inventory
management, were measured and compared before and after the installation. RESULTS:
With the installation of automation, the pharmacy staff was significantly reduced
(?2=25.54, P<0.001) by 0.4 FTEs (Full Time Equivalence) pharmacists’ efforts were shifted
to the technicians. Meanwhile, there was a statistically significant difference in term of the
percentages of labor spent on various activities between the pre-installation and postinstallation of automation (?2=137.65, P<0.001). Analyses of average labor used per prescription showed that the installation of automation could save 0.22 minutes per prescription. Especially, for the counting labor per prescription, it significantly decreased from 2.63
minutes to 2.07 minutes with an average of 0.56 minutes saved (Z=-1.984, P=0.045).
CONCLUSIONS: The automated system, ScriptPro 200, has shown the usefulness in terms
of reducing the prescription filling labor. Further research efforts should continue to assess
other effects in the workload, patient counseling and medication errors and conduct the
economic evaluation.
PHP15: IMPACT OF PHARMACIST’S INTERVENTIONS ON COST OF DRUG
THERAPY IN INTENSIVE CARE UNIT
Saokaew S1, Maphanta S2, Thangsomboon P3, 1Naresuan University, Muang,
Phayao, Thailand, 2Naresuan University, Muang, Phitsanulok, Thailand,
3Buddhachinaraj Hospital, Muang, Phitsanulok, Thailand
OBJECTIVE: To determine pharmacist’s interventions led to change in overall drug cost
and to describe the characteristics of pharmacist’s interventions in a Thai intensive care
unit. METHODS: A Prospective, standard care-controlled study design was used to compare overall drug costs of patients receiving care form patient care team including a clinical pharmacist with standard care (no pharmacist on team). All Patients admitted to the
medical intensive care unit (ICU) 1 and 2 during the same period were included in the
study. The outcome measures were overall drug cost and length of ICU stay. Interventions
made by the pharmacist in the study group were documented. The analyses of rate of
acceptance and cost saving and/or cost avoidance were also performed. RESULTS: A total
of 65 patients were admitted to either ICU 1 or 2 during the 5 week- study period. The
pharmacist participated in patient care and made total of 127 interventions for the ICU-1
team. Ninety-eight percent of the interventions were accepted by physicians. The difference of overall drug cost per patient between two groups was 6,982.05 THB (41,298.5
THB in study group and 48,271.55 THB in control group, p = 0.138). The average length of
ICU stay for the intervention group and the control group was not significantly different
(7.16 days VS 6.18 days, p=0.995). The 125 accepted interventions were evaluated for
cost saving and cost avoidance. Pharmacist’s interventions yielded a total of 75,624 THB
from drug cost saving and 11,301 THB from adverse drug event cost avoidance. The net
cost saved and avoided from pharmacist interventions was 86,925.81 THB. Interventions
involving antibiotic use accounted for the largest economic impact (75,132.18 THB).
CONCLUSIONS: Having a pharmacist participated in ICU patient care team can reduced
overall drug cost, cost saving, and cost avoidance. The largest economic impact involved
antibiotic use.
PHP16: BARRIERS TO PHARMACEUTICAL CARE IN THAILAND
Ngorsuraches S1, Li SC2, 1Prince of Songkla University, Hatyai, Songkla, Thailand,
2National University of Singapore,Singapore
OBJECTIVE: To examine barriers to pharmaceutical care in Thailand. METHODS: The study
had a cross-sectional and descriptive design. Data were obtained from a survey of a random sample of 600 hospital and community pharmacists across the country. The survey
was developed to measure barriers to the provision of pharmaceutical care from the hospital and community pharmacists’ perception using 5-point Likert scales (1 = ‘strongly
disagree’ to 5 = ‘strongly agree’). Descriptive statistics were used for data analyses.
RESULTS: The response rate was 53.2%; with hospital pharmacists comprised 78.4% of
all respondents. The majority of respondents had one to five years in patient care pharmacy practice. The Cronbach alpha of study measure for the pharmacists’ perception of barriers to pharmaceutical care was 0.83. The pharmacists agreed that lack of data on the
proven value of providing pharmaceutical care, lack of therapeutic knowledge and clinical
problem-solving skills, and lack of role model who provides pharmaceutical care deterred
them from providing pharmaceutical care. On the other hand, lack of opportunities for
face-to-face encounters with patients, lack of patient demand and acceptance of pharmaceutical care, and other health care providers’ resistance did not greatly prevent them
from providing pharmaceutical care. CONCLUSIONS: Even though pharmaceutical care
has been adopted to pharmacy practice and documented to prevent drug-related problems
in Thailand for a number of years, the pharmacists still perceived that insufficient evidence
supporting the value of providing pharmaceutical care existed. To remove the barriers,
besides an increase in therapeutic knowledge, and clinical skills, more evidence of the
proven value of providing pharmaceutical care and role models for pharmaceutical care
are also needed.
PHP18: SURVEY STUDY OF PHARMACOECONOMIC RESEARCH IN THE PACIFIC ASIA REGION
Luo MP, Cifaldi M, Abbott Laboratories, Abbott Park, IL, USA
OBJECTIVE: Given the rapid economic growth and increasing rate of health care spending
in the Pacific Asia (PA) area, pharmacoeconomic research (PE) has the potential to assist
decision-making on pharmaceutical coverage. This study evaluated the environment and
the future trend for PE in the PA region. METHODS: A comprehensive survey of pricing and
reimbursement personnel from pharmaceutical industry was conducted in 15 countries in
the PA area in 2004. The survey consisted of 22 structured questions and covered the following issues: health care system, PE guidelines, factors impacting pricing and reimbursement decision, importance of PE data in supporting reimbursement, submission channel
for PE data and future expectations. The questionnaire was pretested for content validity.
Respondents were expected to answer the survey relying on their own local knowledge
and experience. RESULTS: The response rate on the survey was 87% (13 out of 15 countries). In most countries reimbursement mechanisms were reported as combination of
government funding and private insurance. Over 60% of the countries had a reimbursement list for prescription drugs. Most countries indicated that drug price was determined
based on reference pricing, parity pricing and pharmaceutical profitability, while reimbursement decision was primarily based on drug price, but clinical data and pharmaceutical data also had a role. At the time of the survey, one-fifth of the countries indicated that
PE data were required for reimbursement and additional one-half of the countries indicated that PE data were helpful. Three-fourth of the surveyed countries expected that PE data
would be required for pricing and reimbursement within 5 years. CONCLUSIONS: Although
there were variations with regard to the practice and potential for PE data among the surveyed PA countries, this study suggested that PE is emerging in the PA region and more
countries are moving toward some formal requirement for PE evidence for pharmaceuticals.
PHP19: ANALYSIS OF PHARMACEUTICAL PRICE CHANGES IN A REGIONAL
HOSPITAL SYSTEM
Kelton CM1, Guo JJ1, Rebelein RP2, Ferrand Y1, Dusing ML3, 1University of
Cincinnati, Cincinnati, OH, USA, 2Vassar College, Poughkeepsie, NY, USA, 3Health
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Alliance, Cincinnati, OH, USA
OBJECTIVE: Drug expenditures have been rising rapidly in the United States over the past
decade, with annual double-digit increases, due partly to rising utilization and partly to rising prices. Hospital expenditures on pharmaceuticals rose 11 percent between 2000 and
2001, with considerable variation across individual drug purchases. Our objectives are (1)
to identify drugs with extreme transaction price changes and (2) to determine whether
large swings are associated with particular manufacturers and/or therapeutic classes.
METHODS: Monthly expenditure and utilization data are collected for the 2000 and 2001
calendar years for a large, six-hospital system for all regularly purchased drug products.
Monthly transaction prices are derived from these data, and annual price changes are calculated from average annual transaction prices for the two years, for approximately 3000
drug products. RESULTS: 185 drugs had price swings of at least 20 percent. The largest
price increases were for fentanyl citrate and albuterol with annual rises of 368 percent
and 273 percent, respectively. There were 13 drugs with price increases of 100+ percent.
The hospital buyer experienced the largest number of high price increases in the adrenal,
penicillin, and antiretroviral-agent therapeutic classes, while the companies responsible for
the highest number of price increases were Pharmacia & Upjohn, GlaxoSmithKline, Mead
Johnson & Company, and UDL Laboratories. A regression of price change on company and
class dummy variables reveals that only seven percent of the variation in price change can
be explained by company or class affiliation. CONCLUSIONS: Price changes for individual
drugs can be quite substantial even over a single year. Though there is significant variation
in individual drug price change (from -80 percent to over 300 percent), very little of this
variation can be explained by manufacturer or therapeutic class. Drug-specific factors
such as patent expiration or production issues must explain most of it.
PHP20: ANALYSIS OF THE PRESCRIPTIONS FILLING LABOR IN A MAJOR US
DRUGSTORE CHAIN
Lin AC, Qian JJ, Chen Y, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: This study was designed to quantify the staffing utilization, in terms of the
time spent by pharmacy staff on various activities, and the direct and indirect prescription
filling time, in an US chain drugstore. METHODS: Eight pharmacy sites of a major US drugstore chain. Data Collections: Videotaping and work measurement techniques were used to
collect the data from each selected pharmacy. Each pharmacy was observed by strategically installed cameras for seven days including five weekdays and two weekends. One
minute fixed interval work sampling approach was applied for reviewing the videotapes.
Study Variables: The utilization of the pharmacy staff and the time spent in direct and indirect prescription-filling activities, such as: receiving, order entry, filling, inspecting, packaging and dispensing phone calls, inventory management, were measured and compared
through the work sampling process. RESULTS: Totally, 166,703 minutes during 56-day
study period at eight sites were observed, among which 1,087.9 hours (65,276 minutes)
for the pharmacists and the other 1,609.5 hours (101,427 minutes) for technicians. The
results indicated an overall of 10.02 minutes (including 7.88 minutes for direct filling activities and 2.15 minutes for indirect filling activities) were spent by each prescription. The
ratio of pharmacist verse technician in direct filling time is 1:1.52, but 1:1.65 in indirect
filling time. CONCLUSIONS: This study illustrated the time spent on various activities related to prescription filling by the pharmacy staff in an US drugstores chain and provides the
micro-view of labor consumed for each prescription filling. This study enables the managers of pharmacy to utilize the pharmacy staff with optimal staffing arrangements.
Further efforts should be put into the study of potential factors affecting the efficiency of
pharmacy.
PHP21: THE EFFECTS OF AUTOMATED PRESCRIPTION FILLING SYSTEM ON
THE INVOLVEMENT OF PHARMACY STAFF IN PRESCRIPTION FILLING ACTIVITIES
Lin AC, Huang S, Qian JJ, Chen Y, Ma XQ, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: This study was to examine if the use of an automated prescription filling system would affect the pharmacy staff involvement in prescription filling activities in a major
US chain drugstore. METHODS: Eight pharmacy sites were selected from one major US
drugstore chain. Data Collections: Videotaping, work measurement, and telephone recording techniques were used for data collection. Cameras were strategically installed, collecting data for a continuous seven days in each sample site. One minute fixed interval work
sampling approach was applied in reviewing the videotapes. Study Variables: The time
spent in non-judgmental prescription filling activities by pharmacy staff, including drop off,
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order entry, filling packing, and storing by pharmacists and technicians were also
observed. Data Analysis: Mann-Whitney test was applied and all the statistical analyses
were performed using the software SPSS. RESULTS: Among the eight selected pharmacies, three pharmacies were equipped with Pharmacy 2000 and Baker Cell and five did
not have automation technologies. The time spent by pharmacists on non-judgmental
activities per prescription in pharmacies with and without automation was 1.33 ± 0.99
and 2.06 ± 0.50 minutes, respectively (Z=-1.043, P=0.297). The time spent by technicians was 4.14 ± 1.11 and 2.78 ± 0.33 minutes (Z=-1.64, P=0.101). The ratio of time
spent on non-judgmental activities by pharmacists and technicians in the pharmacies with
and without automation were 1:3.11 and 1:1.35, respectively. Moreover, there was an
average of 0.12 minutes spent by pharmacists on patient counseling per prescription in
pharmacies with automation, which was about twelve times more than pharmacies without automation. CONCLUSIONS: It indicates: 1) more non-judgmental prescription filling
activities were performed by technicians due to the working shift by the automation, and
2) pharmacy staffs increase direct contacts with customers at the pharmacies featuring an
automatic prescription filling system.
PHP22: THE EFFECTS OF TELEPHONE CALLS ON PRESCRIPTION FILLING
EFFICIENCY IN A DRUGSTORE CHAIN
Lin AC, Waston W, Chen Y, Qian JJ, University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE: This study was to quantify the occurrence of telephone calls, and to examine
the effects of those telephone calls on prescription filling efficiency in a major US drugstore chain. METHODS: Four pharmacies (A, B, C, and D) of one major US chain drugstore
were selected for this study. Data Collections: Videotaping, work measurement, and telephone recording and reviewing techniques were used. Telephone calls were automatically
captured and digitalized by the computer system. Study Variables: The study variables
include the number of prescriptions filled per hour, direct prescription filling time (DRxFT),
and daily frequency of phone call. Data Analysis: Each phone call was reviewed and categorized. One minute fixed interval work sampling approach was applied for reviewing the
videotapes. RESULTS: The daily frequency of phone calls in pharmacies, A, B, C, and D
were 230.14±77.81, 116.14±66.46, 160.86±136.26, and 309.43±157.48, respectively
(F=3.706, P=0.025). The corresponding estimated number of prescriptions filled per hour
and DRxFT were 5.94±1.21 and 7.01±1.73 for pharmacy A, 6.93±3.62 and 6.48±1.95 for
pharmacy B, 6.48±1.37 and 7.07±1.50 for pharmacy C, 5.25±1.29 and 8.52±1.79 for
pharmacy D, respectively. It was found the more daily phone calls the pharmacy had, the
less number of prescriptions were filled per hour, thus, taking longer to fill one prescription; however, the correlation between frequency of daily phone calls and number of prescriptions filled per hour were not found to be statistically significant (r=-0.052, P=0.793),
as well as the correlation between the daily frequency of phone calls and DRxFT (r=0.183,
P=0.352). CONCLUSIONS: Although the findings were not statistically significance, a positive correlation was found between the DRxFT and daily frequency of phone calls. More
frequent phone calls were associated with longer DRxFT and lower hourly prescription
throughput rate. Reducing the frequency of incoming daily phone calls could improve the
efficiency of pharmacy operation.
PHP23: DRUG UTILIZATION STUDY IN THE AMBULATORY SERVICE OF THE
NATIONAL HEALTH INSURANCE IN TAIWAN
Kao Yang YH1, Kuo SC2, Jia SW1, 1Cheng-Kung University, Tainan, Taiwan,
2Pittsburgh University, Pittsburgh, PA, USA
OBJECTIVE: This study was conducted to analyze the pharmaceutical expenditure and the
utilization frequency in the ambulatory service of the NHI. The concomitant uses of drugs
which may result in life-threatening interactions were also investigated. METHODS: The
NHI Research Database for the years of 1997, 1998 and 1999 was used as the study
material. The Anatomical Therapeutic Chemical (ATC) Classification System which was
developed and maintained by World Health Organization Collaborating Center for Drug
Statistics Methodology was used to index the NHI pharmaceutical subsidy and applied to
retrieve the pharmaceutical records in the claim data. SAS® System for Windows release
8.02 was used for data management and statistic analysis. RESULTS: The highest three
ATC categories of pharmaceutical expenditure in the ambulatory service were the cardiovascular system (24~25%), alimentary tract and metabolism (A, 19%) and nervous system
(N, 12~13%). The most frequently prescribed drugs were the respiratory system
(10,876~15,138 per 1,000 insured population), A (10,186~12,125 per 1,000 insured population) and N (5,424~6,142 per 1,000 insured population). The antiinfectives took a
greater percentage both in the pharmaceutical expenditure and the utilization frequency
within the primary care setting than regional hospitals and medical centers. When using
cisapride, macrolide antibiotics, azole antifungals, terfenadine and stemizole as indicator
drugs to detect their concomitant use, the event rates per 1,000 indicator drug prescriptions were 27.6, 27.2 and 18.3 for the year of 1997, 1998, and 1999, respectively.
Moreover, most of the cases were detected in the primary care setting. CONCLUSIONS:
Most expenditure of the NHI pharmaceutical subsidy was allocated in the cardiovascular
system in the ambulatory service, while the most frequently prescribed drug belonged to
the respiratory system. Life-threatening drug-drug interactions could be detected in this
study implying a need for improving the medication prescription.
PHP24: DEVELOPING A QUANTITATIVE SCORING SYSTEM FOR ADVERSE
DRUG REACTION ASSESSMENT USING GENETIC ALGORITHM
Koh Y, Yap CW, Li SC, National University of Singapore, Singapore
OBJECTIVE: To improve the scoring system of a newly developed ADR algorithm to measure the probability of ADR causality. METHOD: Several ADR cases obtained from
Pharmacoviligance Unit at Ministry of Health with known causality probability values were
used as reference points for the development of the scoring system. Based on a review of
ADR reports with definite causality assessment, several rules were developed to define all
possible combinations of criteria for ‘Definite’ ADR cases and some combinations for
‘Probable’ ADR cases. These parameters were used to determine the new scoring system
with the help of genetic algorithm. Testing of the new scoring system was performed on
37 ‘Definite’ ADR cases. In addition, sensitivity and specificity analysis were performed to
allow a comparison of performance between our algorithm and the algorithm used by
ADRAC. RESULTS: When this new scoring system developed by using genetic algorithm
was applied to the 37 ‘Definite’ ADR reports, 83.8% were identified as ‘Definite’ compared
to 21.6% by guidelines from ADRAC. Our new algorithm gave a sensitivity of 83.8% and
specificity of 71.0% (versus 21.6% and 98.4% respectively for ADRAC). Hence, our algorithm had more cases being classified correctly. CONCLUSIONS: The refining of the scoring system to reflect a quantitative scale has helped make this algorithm more sensitive
and increased its useful index, especially when used by clinicians, regulatory agencies or
drug companies to generate ADR alert signals. Using a quantitative method of assessing
causality also mean that rare ADRs and new ADRs can be detected since a quantitative
score can give more precisely the degree of ADR causality.
PHP25: MODULAR STUDY FOR MEDICAL SUPPLIES IN SUDDEN PUBLIC
HEALTH EVENTS
lulu Z1, Yuan L1, Guoquan R2, 1Second Military Medical University, Shanghai, China,
2General Logistics, PLA, Beijing, China
OBJECTIVE: Nowadays, how to prevent and handle sudden public health events has
become a popular talk in public health administration. Medical supplies in sudden public
health events play a more important role in the study of sudden public health events handling. Fine medical supplies is not only benefit to handle sudden public health events
quickly, but has good economic effect. Based on this analysis, we put forward a modularization method for medical supplies in sudden public health events. METHODS: We gathered proceeding related material, and analysed the characteristic of medicine demand and
consumption laws. We also studied disease composition of different sudden public health
events, severe degree of disease and different parameters of treatment for all kinds of diseases. In accordance with the principle of modularization, adopting system analysis and
statistics methods, we designed all kinds of basic modules and the combination methods
for these modules under every sudden public health event. First, to divide medical supplies
into a certain number of basic modules, then combine these basic modules into different
aggregates which compose the medical supplies modules. RESULTS: According to the
results of the data collection, we used modularization method and cluster analysis to
ascertain the scope of atreatment of basic module. On the basis of these studies, we
formed the standard of variety and quantity of basic modules. Then we used modularization combination method to complete the combination of basic modules under different
sudden public health events. CONCLUSIONS: When sudden public health events happen,
we can work out a supply plan quickly according to kind and severe degree ensuring the
timely handling of these events. Additionally, modularization for medical supplies provides
a new method to medicine reserve of preventing sudden public health events for us, which
must be helpful to save money and resources.
PHP26: HOW DO SURVEY RESPONDENTS INTERPRET AND UTILIZE SYMBOLS USED IN HEALTH VALUATION STUDIES?
Wee HL1, Li SC2, Zhang XH2, Xie F2, Luo N3, Cheung YB4, Machin D5, Fong KY1,
Thumboo J1, 1Singapore General Hospital,Singapore, 2National University of
Singapore, Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London
School of Hygiene & Tropical Medicine, London, UK, 5National Cancer Centre
OBJECTIVE: Symbols have been used in health valuation studies to aid respondents in
valuing health states. As it is unclear if symbols are culturally appropriate and useful in
Asians, we studied their usefulness in differentiating various severity levels of a health
state in a multi-ethnic, urban Asian population. METHODS: In in-depth interviews with
adult Chinese and Indian Singaporeans (selected to represent various ages/ educational
levels) conducted in English, Chinese or Tamil, respondents were shown a health state
with 6 levels (HUI3 vision), each linked with a symbol, with increasing severity implied by
increasing number of sides in each symbol. Respondents were asked if symbols were: 1)
useful in differentiating severity of each level (measured using both dichotomous and 0-10
VAS scales); 2)offensive, and 3)to assess seven alternative symbol sets. RESULTS: Of 46
subjects (54% Chinese, 54% female, median age: 42 years), 23 (50%) understood that
symbols represented various ranked health levels. However, only 11 of 46 subjects (24%)
felt symbols were useful in differentiating severity of each level. Reported usefulness of
symbols was low (median VAS score (IQR): 3.0 (0.0, 6.0), 12 (26%) subjects giving a score
above 5). No subject felt symbols were offensive. When asked to assess alternative symbol
sets, 14 (30%) respondents expressed no preference, 4 (9%) preferred numbers and 28
(61%) preferred alternative sets. Among these 28 subjects, squares of increasing size
were preferred by 35%, followed by squares of the same size in different shades of grey
(26%). CONCLUSIONS: Although symbols were culturally acceptable, less than one quarter
of Chinese in Indian subjects found them useful in differentiating various severity levels,
suggesting that symbols are useful only for a subgroup of subjects. Selection of the ideal
symbol set for use in health valuation would be difficult, given the preference for a wide
variety of symbol sets.
PHP27: WHAT FACTORS INFLUENCE THE RANKING OF IMPORTANCE OF
HEALTH DOMAINS? AN EXPLORATORY STUDY AMONG CHINESE AND INDIAN
SINGAPOREANS
Xie F1, Li SC1, Wee HL2, Zhang XH1, Luo N3, Cheung YB4, Machin D5, Fong KY2,
Thumboo J2, 1National University of Singapore, Singapore, 2Singapore General
Hospital, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of Hygiene
& Tropical Medicine, London, UK, 5National Cancer Centre Singapore, Singapore
OBJECTIVE: The relative importance of various health domains may vary among individuals. We sought to identify factors influencing the ranking of health domains in a multi-ethnic, urban Asian population. METHODS: In in-depth interviews with adult Chinese and
Indian Singaporeans (selected to represent various ages/educational levels) conducted in
English, Chinese or Tamil, respondents were asked to rank EQ-5D domains (mobility, selfcare, usual activities, pain/discomfort, anxiety/depression) from most to least important.
Mann-Whitney U tests/Chi-square tests and logistic regression models were used to determine the influence of ethnicity, age, gender, education, and presence of chronic medical
conditions on ranking for mobility or self-care as the most important domain (as ≤ 5
respondents ranked each of the remaining domains as most important). RESULTS: Of 46
respondents (54% Chinese, 54% female, median age: 42 years), 20 (44%) respondents
ranked mobility and 16 (35%) ranked self-care as most important respectively.
Respondents ranking mobility as most important were more likely to be older (49.1 vs
38.6 years, p=0.008) or ethnic Indians (70% vs 30%, p=0.005). Both variables were statistically significant in the logistic regression model (OR=1.06, 95%CI=1.00-1.11,
p=0.023, and OR=7.09, 95%CI=1.67-30.03, p=0.008, respectively). Respondents ranking
self-care as most important were more likely to be younger (37.6 vs 46.4 years, p=0.027).
This variable was close to attaining statistical significance in the logistic regression model
(OR=0.96, 95%CI=0.91-1.00, p=0.067). CONCLUSIONS: This exploratory study suggests
that ethnicity and age may influence the ranking of important health domains in a multiethnic urban Asian population in Singapore.
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PHP28: THE IMPACT OF TALKING ABOUT DEATH ON HEALTH STATE VALUATION: A STUDY AMONG CHINESE AND INDIAN SINGAPOREANS
PHP30: THE VALUE PROPOSITION OF OUTPATIENT TOWARDS OUTPATIENT
SERVICE.
Wee HL1, Li SC2, Zhang XH2, Xie F2, Nan L3, Cheung YB4, Machin D5, Fong KY1,
Thumboo J1, 1Singapore General Hospital, Singapore, 2National University of
Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA, 4London School of
Hygiene & Tropical Medicine, London, UK, 5National Cancer Centre Singapore,
Singapore
Sooksriwong CO, Mahidol University, Bangkok, Thailand, Vijitmakthong A, King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
OBJECTIVE: Cultural differences in willingness to discuss death may influence participation rates, accuracy of responses and cross-cultural comparability in health valuation studies. We therefore characterized perceptions and comfort in discussing death in a multiethnic, urban Asian population. METHODS: In in-depth interviews with adult Chinese and
Indian Singaporeans (selected to represent various ages/ educational levels) conducted in
English, Chinese or Tamil, subjects rated their ease in discussing death (EID) using a 0-10
visual analogue scale (VAS). Subjects also reported, using the same scale: 1) religiosity; 2)
acceptability of 8 descriptors for death (e.g. passed away, sudden death, immediate
death); and 3) preference for “pits” versus “all-worst”. Finally, subjects valued 3 hypothetical health states using 0-100 VAS followed by time trade-off (TTO). The influences of various factors on EID were compared using Mann-Whitney tests. Correlations between EID
and health utilities were evaluated using Spearman rank correlation. RESULTS: Among 46
subjects (54% Chinese, 54% female, median age: 42 years), median self-reported religiosity was significantly lower for Chinese (5.0 (0.0, 7.0)) compared to Indians (7.0 (5.0, 10.0),
p=0.004). Subjects were generally comfortable in discussing death (median (IQR): 8.0 (7.0
to 10.0)). Neither sociodemographic factors nor religiosity influenced subjects’ comfort
level. In relation to descriptors for death, both Chinese and Indian subjects felt “passed
away” (median (IQR): 8.0 (7.0, 10.0)) was more acceptable than “sudden death” (5.0 (3.0,
7.0)) or “immediate death” (5.0 (2.0, 7.0)). Subjects clearly preferred “all-worst” (median
(IQR): 8.0 (6.0, 9.3)) to “pits” (5.0 (0.8, 8.0)). Correlations between EID and health utility
score were generally weak (range –0.263 to 0.386 (VAS) and –0.283 to 0.162 (TTO)).
CONCLUSIONS: Chinese and Indian Singaporeans were generally comfortable in discussing death. The poor correlation between EID and health utility scores suggests that the
latter are unlikely to be influenced by willingness to discuss death.
PHP29: DOES RANKING OF HEALTH DOMAINS INFLUENCE HEALTH UTILITIES?
AN EXPLORATORY STUDY AMONG CHINESE AND INDIAN SINGAPOREANS
Xie F1, Li SC1, Wee HL2, Zhang XH1, Luo N3, Cheung YB4, Machin D5, Fong KY2,
Thumboo J2, 1National University of Singapore, Singapore, Singapore, 2Singapore
General Hospital, Singapore, Singapore, 3QualityMetric Inc, Lincoln, RI, USA,
4London School of Hygiene & Tropical Medicine, London, United Kingdom, 5National
Cancer Centre Singapore, Singapore, Singapore
OBJECTIVE: We hypothesized that an individual would likely express a lower utility for a
health state (HS) in which the health domain that s/he values is impaired, and explored
this in a multi-ethnic, urban Asian population. METHODS: In in-depth interviews with adult
Chinese and Indian Singaporeans conducted in English, Chinese or Tamil, respondents
were asked to; (i) sort and rank 3 EQ-5D HS (A, B and C) on 0-100 visual analogue scale
(VAS), and (ii) rank 5 EQ-5D domains from most to least important. Analysis was performed for mobility and self-care domains as few (≤5) respondents ranked other domains
as most important. We hypothesized that among subjects selecting 1)mobility: adjusted
VAS scores would be lowest for HS-B (greatest mobility impairment) and highest for HS-A
(least impairment); 2)self-care: adjusted VAS scores would be lowest for HS-C (greatest
self-care impairment) and highest for HS-A (least impairment). We performed separate
multiple linear regression (MLR) with VAS scores as the dependent variable and importance ranking (IR) as independent variables with adjustment for age, ethnicity, education
and presence of chronic medical conditions. RESULTS: Of 46 respondents (54% Chinese,
54% female, median age: 42 years), 20 (44%) ranked mobility and 16 (35%) ranked selfcare as most important respectively. MLR coefficients (95% CI) for HS-A, -B and -C were:
0.8 (-11.5 to 13.1), -0.6 (-10.5, 9.3), -11.3 (-24.8 to 2.2) for mobility and 8.0 (-3.3 to
19.4), -5.5 (-14.7, 3.7), 7.1 (-5.9, 20.1) for self-care, reaching clinical significance (of 5
points) in 4 instances but were not statistically significant. In addition, the hypothesized
trends were not observed. CONCLUSIONS: In this exploratory study, the influence of IR on
utility scores was at times clinically important, though not statistically significant. This suggests that IR may influence health utility scores, an association which needs to be tested
in larger studies.
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OBJECTIVE: The purpose of this study was to assess the out-patient’s value proposition of
outpatient service by importance-performance rating technique. The results are expected
to help in providing better services and increase patient satisfaction. METHODS: The civil
servant patient group, which contributed major hospital incomes was selected to be the
sample. The interviewing questionnaire was used for data collection from 358 out-patients
receiving outpatient service during April and May 2004 at King Chulalongkorn Memorial
Hospital. The questionnaire included important and performance assessment, general
information and factors affecting the patient’s decision in selecting hospital. RESULTS:
Most of the patients (64.5%) were female, 26.54% were between 45-54 years old (average 44.88 years), 61.5% held Bachelor degree. Most of them spent 1-2 hours in traveling
to hospital, but they were mostly satisfied in travel time. 29.6% were new patients who
visited the OPD at the first time. Among the old patient group, the average OPD visit times
were 3.44 times per year. The top three high value and high performance areas, which
were hospital’s strong points, were “medical service by physician”, “pharmacy service”,
and “providing service by gently and friendly officers”. Three important services with high
importance and low performance level which the hospital should concentrate on improving
were “having guarantee waiting time in each service center”, “adequate car park”, and
“clean and good hygiene restroom.” Factors affecting their decisions were “modern technology equipment”, “confidence in doctor and officer ability” and “government hospital”.
Comparison of the value proposition between groups of patients were provided. CONCLUSIONS: The hospital should promote its strong areas and improve its services rated as
high importance and low performance in order to increase the patients’ satisfaction.
PHP31: MEASUREMENT AND VALUATION OF HEALTH STATUS EQ-5D WITH
TIME TRADE-OFF IN SOUTH KOREA
Jo MW1, Yun SC2, Hwang IA1, Lee SI1, 1University of Ulsan College of Medicine,
Seoul, South Korea, 2Asian Medical Center, Seoul, South Korea
OBJECTIVE: To measure and value health status using EQ-5D with time trade-off\TTO in
South Korea. METHODS: We employed 42 hypothetical EQ-5D health states among 243
states for measuring value of health states like MVH study, UK. The Korean version of the
instrument and the TTO method was used to interview 500 members representatively
sampled from the public in Seoul and GyeonGi-Do and 100 members of retest group
among those people. We evaluated a validity using the result of visual analog scale(VAS)
and a percent of people who reported more than 3 inconsistencies and a reliability of survey using the result of retest. We also constructed a model for building up a tariff of
EuroQol values using random effect model. RESULTS: First in terms of validity, the correlation between TTO and VAS was 0.94(p<0.001) and a percent of more than 3 inconsistencies reporting people was 2.6% less than the result of MVH study(1995) and in terms of
reliability, ICC was 0.751 and we judged this study was valid and reliable. Secondly, as a
result of model construction, all domains of the EQ-5D were found to contribute significantly to the model, both at the moderate and severe levels. Inability to wash and dress
oneself was found to have the largest negative coefficient, followed by being extremely
anxious or depressed. Using this model, we estimated values of all 243 states. CONCLUSIONS: In conclusion, we constructed a value set for all EQ-5D states from measurement
and valuation of health states with TTO for some states.
PODIUM PRESENTATIONS
PODIUM SESSION I
11:15-12:15 Monday, 6 March 2006
ARTHRITIS Shanghai Room 1
AR1: COST-UTILITY ANALYSIS OF LINGZHI AND SEN MIAO SAN FOR THE
TREATMENT OF RHEUMATOID ARTHRITIS
Lee VWY, Lee KK, Li EK, Chu KY, Law CL, Ng TM, Tam LS, The Chinese University of
Hong Kong, Shatin, Hong Kong, P.R. China
OBJECTIVE: To evaluate the utilization of Lingzhi & Sen Miao San on the Quality of Life in
Chinese Rheumatoid Arthritis (RA) patients in economic aspect. METHODS: This project
consisted of 2 part of study including a 24-week double-blinded, placebo controlled clinical trial and a retrospective, observational cost utility analysis comparing adjunctive therapy of Lingzhi and Sen Miao San with placebo to the traditional treatment was performed in
Chinese RA patients for 24 weeks. Cost utility was analyzed to calculate net cost per quality-adjusted life year (QALY) gained in two treatment models. The Chinese (HK) version of
the SF-36 health survey questionnaire was used to study the quality of life and preferences of the patients. Patient compliance was assessed. RESULTS: 59 patients with RA
were included (83% female, median age 49 years old). In the 24-week study period, no
significant difference was found on the quality-adjusted life years gained between Lingzhi
and placebo treatment arms. The median treatment cost of placebo arm was HK$ 8,
096.54, and that of Lingzhi arm was HK$ 15, 542.70, which was significantly higher
(p<0.001). The cost per QALY gained between both treatment arms did not show significant difference. CONCLUSIONS: This study did not show any significant differences
between two treatment arms. However, Lingzhi is a generally safe, well-tolerated herbal
medicine that may have potential benefits on RA patients. This study can be regarded as
pioneer to pave way for further clinical studies with longer study duration, larger sample
size to demonstrate the full effect of Lingzhi.
AR2: WHAT HEALTH DOMAINS & ITEMS ARE IMPORTANT TO PATIENTS
WITH KNEE OSTEOARTHRITIS? A FOCUS GROUP STUDY IN A MULTIETHNIC
URBAN ASIAN POPULATION
Xie F1, Li SC1, Fong KY2, Lo NN2, Yeo SJ2, Yang KY2, Thumboo J2, 1National
University of Singapore, Singapore, 2Singapore General Hospital, Singapore
OBJECTIVE: To determine important health-related quality of life (HRQoL) domains and
items within each domain affected by knee OA, and identify ethnic variations in the importance of these domains and items among three ethnic groups in a multiethnic urban Asian
population in Singapore. METHODS: Focus groups were conducted among subjects with
knee OA categorised by gender, ethnicity, and language spoken. All focus groups were
audio-taped and transcribed verbatim, with subsequent translation into English for groups
conducted in other languages. Data analysis was performed by combining the key elements of grounded theory and content analysis with the assistance of the qualitative software ATLAS/ti 5.0. RESULTS: Five domains (pain, physical disability, other symptoms of
OA, mental health, and social health) were identified from the 74 items reported as important by at least one subject. These domains were important for subjects from all ethnic
groups with the exception of social health, which was more often important for Malay subjects. Items more commonly reported as important in the pain, physical disability, and
other symptoms of OA domains were generally similar across ethnic groups, In contrast,
important items in the mental and social health domains differed among ethnic groups.
CONCLUSIONS: The impact of knee OA on HRQoL is broadly similar in both Asian and
Western socio-cultural contexts. Both similarities and differences in important domains
and items were identified among subjects with knee OA from 3 major Asian ethnic groups.
AR3: COST-EFFECTIVENESS ANALYSIS OF CELECOXIB ON AN AVOIDANCE
OF GASTROINTESTINAL EVENTS IN PATIENTS WITH OSTEOARTHRITIS
onists (H2RA) or proton pump inhibitors (PPI) is cost-effectiveness in reducing gastrointestinal (GI) side effects. METHODS: Expected values of effectiveness in terms of number
of GI events avoided and health care cost in Thai Baht (40 Baht = 1 USD) were estimated
for a six-month time horizon using a decision analysis model. An incremental cost-effectiveness ratio (ICER) for celecoxib was determined based on health care provider perspective. Data on the likelihood of GI disturbance for celecoxib and NSAID were obtained from
Celecoxib Outcomes Measurement Evaluation Tools (COMET) study. Components of direct
health care costs associated with the use of celecoxib and NSAID comparators were based
on Thai health care context using a gastro-enterology expert opinion. Unit prices for the
competing drugs were abstracted from electronic drug dispensing databases of 18 provincial hospitals located in all four regions of Thailand. RESULTS: For a reference case analysis, use of celecoxib instead of NSAID (diclofenac) plus H2RA (ranitidine) in 1000 hypothetical patients would incur an incremental cost of approximately 4.6 million Baht and reduce
a total of 40.2 events of any GI side effects. This is equivalent to the ICER of 114,975 Baht
per GI event avoided for celecoxib. Compared with NSAID plus PPI (omeprazole), ICER for
celecoxib was as much as 948,611 Baht for an event avoided, equivalent to an incremental cost of 3.4 million Baht for lowering 3.6 GI events in 1,000 patients. These cost-effectiveness ratios were very sensitive to the unit price of celecoxib and GI-event risk categories. CONCLUSIONS: Use of celecoxib in Thailand was deemed not cost-effective unless
concerned parties were willing to pay such a high amount for avoiding any GI events
caused by the conventional NSAID.
AR4: ABATACEPT LEADS TO RAPID AND SUSTAINED IMPROVEMENTS IN
MULTIPLE ASPECTS OF QUALITY OF LIFE IN RHEUMATOID ARTHRITIS
PATIENTS WITH INADEQUATE RESPONSES TO METHOTREXATE
Li T1, Becker JC1, Emery P2, 1Bristol-Myers Squibb, Princeton, NJ, USA, 2University
of Leeds, Leeds, UK
OBJECTIVE: Health-related quality of life (HRQOL) and the ability to function in daily activities are significantly impaired in patients with rheumatoid arthritis (RA). Improving physical
function and well-being is an important treatment goal for RA. The effects of a biologic
agent, abatacept, on patient HRQOL were examined in a Phase III trial, AIM (Abatacept in
Inadequate responders to Methotrexate [MTX]). METHODS: AIM was a 1-year, doubleblind, placebo-controlled trial evaluating a fixed dose of abatacept versus placebo on a
background of methotrexate (MTX). Study drugs were given by monthly IV administration.
A battery of pre-specified measures on multiple aspects of HRQOL were assessed: general
quality of life including both physical and mental health by the SF-36, physical function by
the Health Assessment Questionnaire (HAQ), and sleep quality by the Medical Outcomes
Study Sleep Module (MOS-sleep), and fatigue by a 100 mm Visual Analog Scale. Analysis
of covariance adjusting for baseline value was used to compare the treatment groups.
RESULTS: In this study, 433 and 219 patients were treated with abatacept and placebo
respectively. After one month of treatment, significant greater improvements from abatacept were observed in five out of eight SF-36 subscales (bodily pain, role physical, general
health, vitality, and social functioning) and fatigue compared to placebo. By six months,
significant differences in favor of abatacept were seen in all HRQOL measures: physical
function (HAQ), all 8 subscales of the SF-36, PCS and MCS, sleep quality, and fatigue. The
improvements were deemed to be clinically meaningful using established criteria. The
effects were sustained and further improved to the end of the study at 1 year. CONCLUSION: Abatacept demonstrated significant and consistent improvements in a broad range
of HRQOL dimensions. These data suggest abatacept has the potential to provide real-life
benefits to RA patients.
CARDIOVASCULAR DISEASE Shanghai Room 2
CV1: CHOLESTEROL GOAL ATTAINMENT AMONG CHD PATIENTS IN HONG
KONG
Limwattananon S, Limwattananon C, Srisuk P, Loengpirom S, Khon Kaen University,
Amphoe Muang, Khon Kaen, Thailand
Lee VWY1, Alemao E2, Yin D2, Cook J3, Lee KK1, 1The Chinese University of Hong
Kong, Shatin, Hong Kong, China, 2Merck and Co, Whitehouse Station, NJ, USA,
3Merck and Co, Blue Bell, PA, USA
OBJECTIVE: To determine whether the use of celecoxib instead of a conventional nonsteroidal antiinflammatory drug (NSAID) combined with either histamine-2 receptor antag-
OBJECTIVE: While treatment guidelines recommend lowering cholesterol to target levels
appropriate for CHD patients, many remain above goal on current lipid lowering therapy
73
and hence unable to get the maximum benefit of cholesterol reduction. For these patients,
a recently published clinical trial showed that ezetimibe co-administration with existing
statin therapy gets 72% of patients to NCEP II goal versus 19% among patients continuing
on existing therapy. The objective here is to assess cost effectiveness of Ezetimibe 10mg
(EZ10) co-administration in CHD patients not attaining goal (LDL-C > 2.59mmol/dL) while
on statin therapy (atorvastatin, and simvastatin). METHODS: Decision-analytic model was
developed to project lifetime costs and benefits of lipid therapy. Clinical trial data were
used to estimate LDL-C reductions for different treatment strategies. Effect of lipid reductions on CHD event rates was estimated using Framingham risk equations and Hong Kong
national statistics on nonCHD-related mortality. Direct costs of CHD events and prices for
lipid lowering therapy in Hong Kong were used to project lifetime costs. The model was
run for a population consisting of all patients on simvastatin and atorvastatin in an observational lipid lowering treatment study in Hong Kong involving patients initiated on a statin
and had not reached goal at the first lipid measurement after treatment. RESULTS: Mean
age of study cohort of 67 CHD patients was 64.7 (SD10.8) years and 30% were female
with mean LDL-C of 3.23mmol/L and TC of 4.85mmol/L. EZ10 co-administered with statin
compared to statin titration is projected to increase life expectancy in this patient cohort
by 0.45 years with C/LY of $7,387 and C/QALY of $7,362. CONCLUSIONS: Based on the
model, treatment with ezetimibe co-administered with statin for CHD patients not at goal
is a cost-effective alternative to statin titration and is well below the $45,000 cost/QALY
threshold commonly used in these analyses.
tal costs and length of stays (LOS) were obtained from the inpatient expenditure by admissions claimed in the Bureau of National Health Insurance (BNHI) database between 1999
and 2001; drug costs were obtained from the Taiwan Pharmaceutical Benefit Scheme
(2000); and indirect costs were estimated by multiplying the LOS (days) by the mean daily
Taiwanese salary obtained from the Taiwanese government. Cost-effectiveness was
expressed in terms of costs (New Taiwanese Dollars) per life-year gained (LYG).
(1Euro≈NTD39.5). RESULTS: The base-case model resulted in a longer survival in the
clopidogrel on top of aspirin strategy compared to the aspirin alone strategy (9.77 LYG vs.
9.65LYG; incremental LYG=0.117). The model also yielded higher direct costs
(NTD252,011 vs. NTD248,344; incremental cost=NTD3,666) and lower indirect costs for
the clopidogrel on top of aspirin strategy (NTD1,011 vs. NTD1,264; incremental cost=NTD253). The resulting total ICER for the clopidogrel on top of aspirin strategy was
29,133NTD/LYG (≈ 737 Euros). This estimate is comparatively lower than estimates from
Sweden (1,365Euros/LYG for direct costs). CONCLUSIONS: This model indicated that
adding clopidogrel to standard therapy in patients with ACS results in a favorable costeffectiveness ratio in Taiwan.
CV2: LOW-HDL CHOLESTEROL IN SOUTH ASIAN POPULATION, IS IT A
MAJOR CONTRIBUTING RISK FACTOR FOR HIGH CORONARY HEART DISEASE
Loh SC, Tomlinson B, Chan JC, You JH, Lee KK, The Chinese University of Hong
Kong, Shatin, New Territories, Hong Kong, P.R. China
Pathan AN, Syed SH, Pfizer Laboratories Limited, Karachi, Sindh, Pakistan
OBJECTIVE: Cardiovascular disease is a leading cause of death in developing countries
including India & Pakistan. Steady increase in affluence, urbanization, sedentary lifestyle
associated with lipid abnormalities, metabolic syndrome and smoking appear to offer additional explanations. Risk factor studies have shown that urban Pakistanis have high
triglycerides and low HDL-Cholesterol levels but these findings are inconclusive. The present study was undertaken to investigate the changes in lipid profile in this population.
METHODS: A retrospective meta-analysis of relevant English articles retrieved by key
word searches of Pfizer Local Intranet, Google, Medline, Medscape, CPSP, JPMA, PJMS,
IHJ (January 1995 to date) and cited references. Only ten of the ninety-nine studies evaluated met the following inclusion criteria: (1) Prospective cohort study including clinical trial
on South Asian Subjects with age-range 20-72 years. (2) measuring lipid profile HDL-C,
LDL-C, TGs & TC. (3) not using adjuvant antihyperlipidemic drugs. Simple statistical calculations were done. Values were expressed as Mean + SD. Differences among different
groups were tested using Student’s t-test. RESULTS: Of the 3986 subjects, Mean + SD
concentrations of total cholesterol, HDL-Cholesterol, LDL-Cholesterol, and triglycerides
were found to be 185.31 + 3.83 mg/dl (p<0.0001), 39.26 + 0.86 mg/dl, 121.82 + 15.42
mg/dl, and 141.08 + 2.98 mg/dl (p=0.014), respectively. Serum triglycerides were seen
significantly high in patients with hypertension 195.61 + 8.91 (p<0.0001) and raised in
diabetic & CHD patients 175.48 + 18.01 & 157.26 + 86.99 respectively but not statistically significant. Similarly HDL-Cholesterol was seen significantly low in patients with CHD,
hypertension & diabetes mellitus, 36.01 + 1.99 (p=0.02, CI 35.94 – 36.07). CONCLUSIONS: High levels of serum triglycerides & low levels of HDL-Cholesterol are the most
prominent abnormalities that may contribute to the higher prevalence of coronary heart
disease in South Asian Population.
DIABETES Shanghai Room 5
DB1: THE METABOLIC EFFECTS OF ORLISTAT AND ROSIGLITAZONE ON
INSULIN ACTION IN A GROUP OF CHINESE PATIENTS AFFECTED BY THE
METABOLIC SYNDROME
Objectives: To examine the effects of orlistat and rosiglitazone and assess the changes of
cardiovascular risk factors in a group of Chinese patients affected by the metabolic syndrome. METHOD: In a prospective, six-months randomized single-blinded placebo-controlled study, 63 Chinese participants with type 2 diabetes or impaired glucose tolerance,
aged > 18 years with a BMI ≤ 23kg/m2 were administered orally 120 mg orlistat three
times daily, rosiglitazone 2mg twice daily or placebo three times daily. Changes in clinical
and metabolic parameters indicative of the metabolic syndrome were monitored, including
body weight, glycaemic control, lipid levels and drug tolerability. RESULTS: There were 20
individuals in the rosiglitazone group and 19 individuals in both the orlistat and placebo
groups. The orlistat group demonstrated improved lipid profiles, especially on the reduction
of total cholesterol (12% p ≤ 0.0005) and LDL (21%, p = 0.0002). This was accompanied
by an improvement in the body fat (p=0.008) and BMI (p=0.008) when compared with
control. In comparison, the rosiglitazone group exhibits maximum improvements in the
glycaemic indices e.g. fasting insulin (p = 0.004), 2hr-post OGTT insulin (p = 0.004) and
HOMA scores (p = 0.005). However, there is an increase from baseline in the LDL levels
(12%), body fat (3.7%) and hip circumference (1.5%). CONCLUSIONS: To prevent progression to type 2 diabetes mellitus and its complications, early detection and implementation
of appropriate treatment strategies for the metabolic syndrome is crucial. Other than
dietary therapy and exercise, rosiglitazone’s use as a primary prevention to treat metabolic
syndrome is ideal, since most of its problems derived from insulin resistance. On the other
hand, orlistat, with its effects on weight, lipids and glucose, may be a useful treatment
modality, especially in obese patients.
DB2: THE RELATIONSHIP BETWEEN HOSPITAL COMPETITION AND PRESCRIBING BEHAVIORS - A CASE STUDY OF ORAL HYPOGLYCEMIC AGENTS
IN AMBULATORY CARE
Ou HT, Liu YM, Yang Kao YH, National Cheng Kung University, Tainan, Taiwan
CV4: LONG-TERM COST-EFFECTIVENESS OF CLOPIDOGREL IN ACUTE CORONARY SYNDROMES – CURE MODEL TAIWAN ADAPTATION
Tarn TH1, Lin WA2, 1Taipei City Hospital, Taipei, Taiwan, 2National Defence Medical
Center, Taipei, Taiwan
OBJECTIVE: The CURE trial established that adding clopidogrel to standard therapy
(including aspirin) provides a 20% relative risk reduction in the composite outcome of cardiovascular death, myocardial infarction and stroke in patients with acute coronary syndromes (ACS). The purpose of this analysis was to assess the long-term cost-effectiveness
of adding clopidogrel to aspirin in Taiwan using the CURE trial results. METHODS: A costeffectiveness analysis was conducted from the societal perspective and incremental costeffectiveness ratios (ICER) were estimated using a long-term Markov model. Outcomes
data were derived from the CURE trial and resource use data were collected locally: hospi74
OBJECTIVE: 1) To estimate the relationship between hospital competition and prescribing
oral hypoglycemic agents (OHAs). 2) To estimate the relationship between hospital competition of three accreditation levels; medical, regional, and district hospitals, and prescribing
OHAs under various market structures. METHODS: Major data were obtained from National
Health Insurance (NHI) Research Database during the period 1997 to 2001 and the ATC 7digit coding system of NHI Pharmaceutical Subsidy. Hospital market was defined by geographic boundary, and hospital competition was measured by Herfindahl-Hirschman index.
Two types of prescribing behaviors are defined: prescribing new OHAs implied higher prescribing quality and prescribing the OHAs with higher risk of hypoglycemic effect implied
poor prescribing quality. RESULTS: There were 2110 observations of hospitals and 158,655
observations of outpatient visits documented with diabetes in six years. There was a positive relationship between hospital competition and prescribing poor quality OHAs in overall
hospital markets (Adj. R2 0.40, p <0.05). Identifying the competition of each accreditation
level of hospital, there was a negative relationship between regional or district hospital
competition and prescribing poor quality OHAs in the market distributed three accreditation
levels of hospitals (Adj. R2 0.27, p <0.01; Adj. R2 0.29, p <0.05). However, there was a
positive relationship between regional hospital competition and prescribing poor quality
OHAs in the market distributed regional and district hospitals (Adj. R2 0.43, p <0.01). CONCLUSIONS: We found the negative impact of hospital competition on the prescribing quality
in general hospital markets. In addition, our result implied market mechanism may improve
the prescribing quality of regional and district hospitals in the market distributed three levels of hospitals. We presumed there might be abundant medical resources in the market
distributed three levels of hospitals, likely being able to provide more pharmaceutical services and information for alleviating asymmetric information.
DB3: THE CORE DIABETES MODEL – SIMULATING LONG-TERM EFFECTS OF
IMPLEMENTING HEALTH POLICIES FOR MANAGEMENT OF DIABETES
Palmer A1, Valentine WJ1, Ray JA1, Lurati FM1, Foos V1, Minshall ME2, Roze S1,
1CORE - Center for Outcomes Research, Binningen, Switzerland, 2CORE - Center for
Outcomes Research, Fishers, IN, USA
OBJECTIVE: We developed an Internet-based simulation model to determine the long-term
health and economic outcomes associated with type 1 and type 2 diabetes and the effects
of different treatment policies. The model performs real-time simulations to account for
insulin therapy, new devices and delivery systems, oral hypoglycemic medications, screening and treatment strategies for micro- and end-stage complications and multi-factorial
interventions. METHODS: The model is based on a series of inter-dependent, linked submodels that simulate diabetes-related complications (cardiovascular disease, retinopathy,
hypoglycemia, ketoacidosis, nephropathy, neuropathy, and non-specific mortality). Each
sub-model isa Markov-based model using time, state and diabetes type dependent probabilities derived from published sources. Cohorts can be defined in terms of age, gender,
baseline risk factors and pre-existing complications. First- and 2nd-order Monte Carlo
simulation using tracker variables confers memory within the model, and accounts for
uncertainty in multiple input parameters. Cohort definitions, economic and clinical data in
the disease management module can be edited by the user, allowing for the inclusion of
recently available data, country-, HMO- or provider-specific perspectives as well as hypothetical analyses. A program is currently collecting Thai epidemiology and cost data for
future analyses. Time horizon can be varied from 1-year to patient lifetimes. Clinical and
economic outcomes calculated by the model include life expectancy, quality-adjusted life
expectancy, incidence, prevalence and time to onset of diabetes-related complications,
direct and indirect medical costs and incremental cost-effectiveness ratios. The CORE
Diabetes Model has been peer-reviewed, thoroughly validated and documented. It is widely used to generate health economic outcomes for submission to decision-makers globally.
CONCLUSIONS: The CORE Diabetes Model allows results obtained from short-term trials
to be extrapolated to long-term outcomes. Diabetes management strategies can be compared in different patient populations in a variety of clinical settings, allowing investigations geared towards improving the quality of care for diabetes patients.
DB4: STATIN UTILIZATION IN PRIMARY PREVENTION IN PATIENTS WITH
DIABETES MELLITUS IN HONG KONG
Lee VWY, Chan WS, Ho IC, Tam KY, Lee KK, The Chinese University of Hong Kong,
Shatin, Hong Kong, P.R. China
OBJECTIVE: Diabetes mellitus (DM) is associated with a 2-4 fold increase in the risk of
both coronary heart disease (CHD) and stroke, emphasizing the importance of primary prevention in this high-risk patient group. Management of dyslipidemia with the use of lipidlowering agents as primary prevention was found to be beneficial. This study was
designed to describe the current lipid control patterns and related resources allocation in
local diabetic patients. METHODS: Patients who were diagnosed with DM with no prior
history of CHD or strokes and were followed up at both Ruttonjee Hospital and Tung Wah
Eastern Hospital during January 1, 2002 to December 31, 2003 were recruited.
Retrospective chart review was conducted for a period of 2 years, starting from the date of
hospital admission. Patients’ demographics, baseline and follow-up cholesterol laboratory
values and statins treatment data were collected. Patients were then divided into 2
groups: those receiving lipid lowering agents (LLA) and those who were not. RESULTS: A
total of 222 patients were included. Only 33. 8% of patients received one or more LLA for
primary prevention. In contrast, nearly 50% of patients who were not treated with LLA had
dyslipidemia problems (i.e. low density lipoprotein concentration [LDL-C] > 2.6 mmol/L).
The most commonly prescribed LLA for primary prevention was statin. Only 21.2%
patients attained target LDL-C level. The overall incidence of cardiovascular complications
was 11.7% that was slightly higher in those prescribed with LLAs. Absence of routine
screening of risk, suboptimal utilization and inadequate dosage titration of LLAs were
identified and might contributed to the cardiovascular events. CONCLUSIONS: Primary
prevention of cardiovascular complication with LLA should be reinforced. There is room for
improvement of the use of LLA for primary prevention in DM patients. Development and
implementation of local guidelines could be considered to promote the use of LLA in primary prevention.
HEALTH CARE USE & POLICY STUDIES I Shanghai Room 6
HP1: INCOME INEQUALITY IN HEALTH CARE UTILIZATION : EMPIRICAL DATA
OF NATIONAL HEALTH INSURANCE IN TAIWAN.
Liang LY1, Li PC2, Huang SM2, Lan CF1, 1Yang Ming University, Taipei, Taiwan,
2Department of Health, Taipei, Taiwan
OBJECTIVE: Based on the empirical data of Taiwan’s National Health Insurance (NHI) program, this study intends to analyze health care utilization at the individual level among five
quintiles and to test the following hypotheses: a) Per capita medical care expenditure
(MCE) increases with income, and b) Under-utilization among dependent people (under
age 14 and over 65) occurs primarily in the lower income quintile. METHODS: Since 1995,
a compulsory social health insurance scheme is implemented and has covered about 97%
of the total Taiwan population. This study linked the survey of family income and expenditure data (year 2004) from the Directorate-General of Budget Accounting and the insurance claim data (2004) from the Bureau of NHI by identification number to analyze the
relationship between MCE and income. RESULTS: There are 91.8% beneficiaries who
used at least once outpatient service which accounts for 73% of total MCE, and 8.02%
beneficiaries who used inpatient service. The per capita poorest spent the largest (US$
623) MCE for outpatient service, and the per capita richest spent the largest (US$ 2306)
MCE for inpatient service. The MCE disparity ratio of inpatient and outpatient service from
the poorest to the riches was 2.6, 3.5, 3.8, 5.2 and 5.6, respectively. After age 60, the
poorest and richest quintile spent 74.1% and 38.5% of total inpatient MCE among five
quintiles. Under age 45, the per capita inpatient MCE increases with income. The gender
ratio of inpatient service from the poorest to the richest was 1.21, 1.09, 0.95, 0.96 and
0.99, respectively. CONCLUSIONS: The poorest suffered from Diabetes Mellitus, cardiovascular diseases and liver cirrhosis.
HP2: DYNAMIC FINANCIAL MODELS OF EMERGENCY CARE IN THAILAND
Srijariya W, Riewpaiboon A, Chaikledkaew U, Mahidol University, Bangkok, Thailand
OBJECTIVE: To constructs, validate and dynamically simulate a financial model of emergency care. METHODS: 199,334 data have been assembled during a period of 2002-2004
of the 30 baht scheme (Universal Coverage) – the biggest of a three major health insurance systems that cover 75 percents of all Thai citizens. The National Health Security
Office (NHSO), an independent body of the Ministry of Public Health takes a major responsibility for implementing and managing this scheme. Data were categorized into 2 groups:
group I, model building data set and group II, validation data set. Multiple linear regression
technique was used to determine of explanatory variables relative to emergency care
budget of NSHO. Although the emergency care claim system is based on DRGs method for
inpatient and capitation method for outpatient, the question arises whether it is possible to
predict a budget for NSHO to managing emergency fund. So, STELLA software was used
to simulate effect of changing health care factors. RESULTS: Factors affecting emergency
patient cost are patient type (OPD/IPD), medical procedure, length of stay, accident, hospital type, age, and hospital location. The power of analysis is 76.62. Sensitivity analysis of
this regression model, the STELLA software showed that useful for the explicit recognition
of scheme’s operations by gives dynamic financial models the power to illustrate the links
between strategies and results. CONCLUSIONS: These models make a unique contribution
to the analytical tools available for performing budgeting analysis for NHSO. Dynamic
financial models are valuable in effectively dealing with the complex interrelationships of
variables relevant to insuring scheme future results.
75
METHODS & CONCEPTS Auditorium
MC1: NONPARAMETRIC ANALYSIS OF INCREMENTAL NET BENEFITS: STATISTICAL OPTIMALITIES
Jiang JG, Cephalon, Inc, Frazer, PA, USA
For analyzing cost-effectiveness data, Stinnett and Mullahy (1998) proposed the use of
incremental net benefits by presenting point and interval estimates as a function of
threshold ratio graphically. When the underlying distributions are non-normal or unknown,
they proposed a nonparametric confidence interval for the incremental net benefits using
bootstrapping techniques, based on the empirical joint distribution of costs and effectiveness for different treatments. This presentation examines its statistical optimalities and its
connection to the bootstrap version of Fieller’s interval. We illustrate these approaches by
applying them to a numerical example.
MC2: APPLYING EXPECTANCY-VALUE MODEL TO UNDERSTAND HEALTH
PREFERENCE- AN EXPLORATORY STUDY
Zhang XH1, Xie F1, Wee HL2, Thumboo J2, Li SC1, 1National University of
Singapore, Singapore, 2Singapore General Hospital, Singapore
OBJECTIVE: To investigate factors influencing health preference with expectancy-value
model (EVM). METHODS: EVM, a model widely used to explore underlying factors of attitudes, was applied to study health preference, which was categorized as attitude in psychology. The factors include attitudinal attributes (AAs) and external variables. AAs are
measured in a sum of multiplications of one’s subjective probability (expectancy) and perceived value of attributes. In one-to-one interviews, four AAs were identified in focus group
discussion, namely, reduction in quality of life (RQoL), burden to family (BTF), dependence
on others (DOO) and inability to work (ITW) were assessed using 7-point Likert scales to
measure expectancy and value of each attribute. Health preference was measured using
visual analogue scales (VAS, range 0-100). Univariate analyses were used to identify external variables (age, gender, ethnicity, education, housing, marital status, and concurrent
chronic diseases) that cause significant difference in VAS. Multiple linear regression model
(MLR) was used to investigate the explanative power of AAs and possible significant external variable(s) separately or in combination. RESULTS: Twenty-five Chinese and 21 Indians
(mean (SD) age: 45.0 (15.55) years, 55.6% female) were interviewed. Ethnicity was identified as the only independent variable causing significant difference in VAS (p<0.05). RQoL,
BTF, DOO, ITW were found to explain the variation of VAS of 26.5%, 27.2%, 23.2%, 17.1%
respectively in separate MLR models (p<0.05). Combining ethnicity together with the sum
of AAs explained up to 27.3% of the variation in VAS, while a model with ethnicity alone
only accounted for 10.7% (p<0.05). When MLR was done to examine different predicting
power of AAs by ethnicity, ITW failed to predict VAS of Indians (0.3%,p=0.80) while the
other 3 AAs moderately explained from 9.1% to 22.9% of the variation (p<0.05). CONCLUSIONS: EVM may be helpful in explaining the variations in health preference and predicting important factors.
MC3: DEVELOPING THE GUIDELINES FOR ECONOMIC EVALUATION OF PHARMACEUTICALS IN KOREA
Bae EY, Health Insurance Review Agency, Seoul, South Korea
OBJECTIVE: To draft the guidelines for economic evaluation of pharmaceuticals which are
intended to be listed on the benefit schedule. METHODS: MOHW of Korea decided to
amend Official Notification to stipulate the use of economic evidence in the reimbursement
decision in 2001. Health Insurance Review Agency (HIRA) has been in charge of developing
draft guidelines for economic evaluation of pharmaceuticals. At the outset of drafting the
guidelines, HIRA reviewed the existing international guidelines and other research papers
to screen the key issues. Then, named individuals were invited to discuss the theoretically
and practically controversial issues of this area and determine the direction of guidelines.
After five consultation meetings, HIRA drafted the guidelines and asked advice from academia and industry. A Second draft was openly discussed at the workshop which was
hosted by HIRA and the Korean Association of Health Economics and Policy. RESULTS: The
guidelines comprise two parts, guidance and explanatory notes. According to the guidelines, all the pharmacoeconomic studies submitted to the HIRA should be done with social
perspectives. With regard to the productivity cost, HIRA recommends excluding it in a base
case analysis, and doing a sensitivity analysis or presenting the results including the productivity cost separately. CEA and CUA are the recommended approaches, and the final
outcomes such as LYs or QALYs are welcomed. Uncertainty and generalizability are also
76
important issues in HIRA guidelines. CONCLUSIONS: HIRA guidelines will be the first official pharmacoecnomic guidelines in Asia. For the upcoming two or three years, it will be
voluntary for the companies to submit the economic evidence and practicability of the
guidelines will be tested. With growing experience and theoretical development in this
area, HIRA guidelines will be revised periodically.
MC4: VALUE OF INFORMATION: AN APPLICATION IN HEALTH ECONOMIC
EVALUATION OF RENAL REPLACEMENT THERAPY IN THAILAND
Teerawattananon Y, International Health Policy Program, Nonthaburi, Thailand
OBJECTIVE: Calculation of the expected value of perfect information(EVPI) in health economic modelling has been an increasing interest in examining the need for further
research to reduce uncertainty in making decisions, and quantifying the value of obtaining
further information on chosen parameters. This study aims to demonstrate how EVPI calculation can be performed using data from the economic evaluation of palliative management vs. peritoneal dialysis(PD) and haemodialysis(HD) in Thailand. METHODS: A probabilistic Markov model applied to end-stage renal disease patients aged 20-70 years was
developed using the societal viewpoint. Input parameters were extracted from a national
cohort and systematic reviews where possible. The Monte Carlo simulation technique was
carried out to evaluate effects of sampling uncertainty around input parameters and to
obtain overall and partial EVPI. All processes were conducted using a widely available software, Microsoft Excel. RESULTS: The results presented in cost-effectiveness acceptability
curves suggest that for ceiling ratio below 450,000 and higher than 900,000 Baht/QALY
the model can confidently conclude which method was the most cost-effective. However,
for the ceiling ratio between 450,000 and 900,000 Baht/QALY there was no confident conclusion and then the expected opportunity loss of making a wrong decision can be identified. The overall EVPI was 30,000 million Baht for the next 10 years at a ceiling ratio of
650,000 Baht/QALY. The medical cost of PD and HD were the first and second most important parameter requiring further research to collect perfect information. Utility values for
patients treating by PD and HD, costs of treated co-morbidity, and survival function were
among the following important parameters. CONCLUSIONS: Illustrative worked examples
of EVPI calculation will further encourage analysts to present such results that are comprehensive to handle real-life situation faced by policy decision-makers who need to make
a judgment under sub-optimal information.
PODIUM SESSION II
10:45-11:45 Tuesday, 7 March 2006
GI DISORDERS Shanghai Room 1
GI2: COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF SACRAL
NERVE STIMULATION (SNS) WITH INTERSTIM ® IN FAECAL INCONTINENCE
(FI) PATIENTS IN SPAIN.
Navarro A1, Muñoz A1, Brosa M2, Rodriguez JM3, Serrano-Contreras D3, Minda K4,
1Hospital Mutua de Terrassa, Terrassa, Barcelona, Spain, 2Oblikue Consulting,
Barcelona, Spain, 3Medtronic Iberica, Madrid, Spain, 4Medtronic S.A, Tolochenaz,
Morges, Switzerland
Interstim® therapy has shown a higher effectiveness and safety compared to surgical
procedures like dynamic graciloplasty or artificial anal sphincter in patients with intact
anal sphincter (IAS) and before Sphincteroplasty in patients with structural deficient anal
sphincter (SDAS), a condition with a high impact on psychological and social life in healthy
people. OBJECTIVE: To assess the cost-effectiveness of two FI management scenarios,
with and without SNS, and to estimate the potential budget impact of its progressive introduction in the Spanish setting. METHODS: A decision analytic model was developed, representing the possible clinical paths for each of the scenarios (with and without SNS), as
well as its clinical and economical consequences in mid-long term with a Markov model.
Clinical and resource use data were retrieved from literature and validated by a clinician
expert’s panel. Efffectiveness was measured with both QALYs and symptom free years
(SFY). A 3% discount rate was used for future costs and benefits (time horizon= 5 years).
Prevalence figures where combined with Interstim sales forecasts to estimate the total
number of patients to receive therapy the next years and the associated budget impact.
RESULTS: The introduction of Interstim® in the therapeutic management of FI has an
associated cost-effectiveness of 22,910 (IAS patients) and 22,546 (SDAS patients) per
QALY gained. The progressive introduction of Interstim® in 150 to 250 patients/year will
have an estimated budget impact of 320,049 , 490,550 and 667,824 for next three
years (net increase of 0.3% to 0.5% of total costs in patients with IF). CONCLUSIONS:
Introducing Interstim® in the management of FI in IAS and SDAS patients in the Spanish
setting, has shown to be an efficient measure with a C/E rate below the accepted Spanish
threshold (30,000 /QALY), and with a relatively low additional cost for the Spanish NHS.
GI3: COMPARATIVE EFFECTIVENESS OF LAMIVUDINE MONOTHERAPY FOR
PATIENTS WITH CHRONIC HEPATITIS B
Sun X1, Zhou R2, Li P2, Li Y3, Guyatt G4, 1The Chinese Cochrane Centre, West
China Hospital, Sichuan University, Chengdu, China, 2West China Hospital, Sichuan
University, Chengdu, Sichuan, China, 3Chinese Evidence-Based Medicine Center,
West China Hospital, Chengdu, Sichuan, China, 4Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
OBJECTIVE: To investigate effectiveness of lamivudine monotherapy compared to other
antivirals for patients with chronic hepatitis B. METHODS: Systematic review and metaanalysis of randomized trials were conducted. Medline, Cochrane Trial Register, Current
Contents, SCI-E and CBMdisc were searched. Complementary screening of references of
included studies was also conducted. Randomized trials that compared lamivudine
monotherapy with single use of other antivirals for patients with chronic hepatitis B were
eligible. Studies that included patients with co-infection of HCV and HIV, and with decompensate liver diseases were excluded. Outcomes measures were loss of HBeAg, seroconversion, loss of HBV-DNA, and normalization of ALT. Egger’s regression and funnel plot
were used to identify publication bias. Meta-regression, subgroup analysis and sensitivity
analysis were used to investigate heterogeneity. Type of comparison, duration, doses, and
ethnicity were considered for heterogeneity. RESULTS: A total of eleven included trials
formed thirteen comparisons, without publication bias identified (coefficient=-1.52, 95%CI:
-3.85-0.81). Of these, seven compared with interferon-alpha, five with nucleic analogues,
and one with thymocin-alpha. Seven of eleven trials (63.6%) were moderate in quality, and
three trials (27.3%) were high. Lamivudine was inferior to other antivirals in loss of HBeAg
(OR=0.45, 95%CI: 0.30-0.67), without heterogeneity identified (chi-square=5.47, df=6,
p=0.485). Although heterogeneous across trials in loss of HBV-DNA (chi-square=47.33,
df=11, p=0.000), no specific factors were identified. It showed that lamivudine was comparable to other antivirals (OR=1.39, 95%CI=0.67-2.88). The comparison of lamivudine
with interferon also identified no significant difference. Ethnic difference was the prognostic factor for addressing heterogeneity in normalization of ALT (coefficient=2.56,
95%CI=0.62-4.51, P=0.015). Lamivudine could produce more significant normalization of
ALT than other antivirals in Chinese. Lamivudine was comparable to other antivirals in
seroconversion. CONCLUSIONS: There was advantage of lamivudine in normalization of
ALT. However, it was clinically inferior to other antivirals in decreasing HBeAg.
GI4: OUTCOMES AND COSTS OF GENERIC AND TRADE RANITIDINE USE IN
THE UNITED STATES AND JAPAN
Kamae I1, Yanagisawa S1, Oderda GM2, Otsuka M3, Jorgenson J4, Otsuka K1,
Brixner D2, 1Kobe University, Kobe, Japan, 2University of Utah College of Pharmacy,
Salt Lake City, UT, USA, 3Musashino University, Nishi-Tokyo, Japan, 4University of
Utah Hospital and Clinics, Salt Lake City, UT, USA
Generic drugs are available in the United States and Japan. In the US between 40% and
50% of all prescriptions are generic products. Although the cost advantage of generic
drugs is recognized in Japan, physicians are still concerned about the potential for a difference in outcomes from generic vs trade name products. OBJECTIVE: To investigate
whether the outcomes in patients taking generic vs. trade name Ranitidine differ in the
United States and, based on the results of the study in the US, to assess the difference of
treatment costs in generic vs. trade Ranitidine in Japan. METHODS: In the US, Medstat
MarketScan (commercial claims) 2000-2001 data was used. Patients 18 and older with at
least one prescription for oral Ranitidine were identified. The first Ranitidine prescription fill
was the index date. Incidence of GI perforations ulcers or bleeds (PUB) or Other GI events
(OGI, e.g. gastritis), and costs were determined for patients with generic or trade name
therapy. In Japan, a decision analytic model was introduced to evaluate the costs assuming the same outcomes as in the US. RESULTS: In the US 97,387 generic and 5,117 trade
patients were identified. Drug costs ($2538 vs. $4070) and total costs ($9647 vs. $12,501)
were lower for generic vs. trade patients. There was no difference in mpr (medication possession ratio) or the incidence of PUB (1.9%). Other GI events were higher (19.7%, 17.7%)
for generic Ranitidine. The higher proportion in OGI reduced the advantage of a lower cost
generic drug by 10.7% ($51 to $46), estimating the average treatment costs per patient of
gastritis/duodenitis for four-week follow-up in Japan. CONCLUSIONS: US Patients on
generic ranitidine had lower costs, a similar incidence of PUB and somewhat higher OGI
incidence. Also, the higher incidence in OGI reduced the value of generic Ranitidine therapy in Japan.
HEALTH CARE USE & POLICY STUDIES II Auditorium
HP5: CATASTROPHIC AND POVERTY IMPACTS OF OUT-OF-POCKET HEALTH
PAYMENTS BEFORE AND AFTER THE UNIVERSAL HEALTH CARE COVERAGE
IMPLEMENTATION IN THAILAND
Limwattananon S1, Prakongsai P2, Tangcharoensathien V3, 1Khon Kaen University,
Amphoe Muang, Khon Kaen, Thailand, 2International Health Policy Program, Amphoe
Muang, Nonthaburi, Thailand, 3International Health Policy Program, Nonthaburi, Thailand
OBJECTIVE: To determine the impacts of out-of-pocket (OOP) health payments on household economic status before and after an implementation of the universal health care coverage (UC) policy in Thailand. METHODS: Analysis of socio-economic surveys on consumption expenditures of national representatives of households during 2000 (N=24,747),
2002 (N=34,785) and 2004 (N=34,843). RESULTS: Proportion of households whose OOP
payments for health care deemed catastrophic (i.e., above 10% of total consumption
expenditure) reduced from 5.4% in 2000 (pre-UC period) to 3.3 and 2.8% in 2002 and
2004 (post-UC periods), respectively. For the beneficiaries of Low-Income Card (LIC) and
Voluntary Health Card (VHC) schemes, the health care catastrophe appeared in 4.7% of the
households during the pre-UC period. The catastrophic incidence reduced to 3.2% and
2.6% among the UC beneficiaries during the post-UC periods. The percentage of households impoverished by the OOP health payments reduced after the UC implementation,
from 4.4% in 2000 to 2.5% and 1.8% in 2002 and 2004. The post-OOP poverty incidence
among the poorest quintile households reduced substantially from 18.3% to 10.3% and
8.0% over the same periods. An increase in the poverty headcounts (using national poverty line) as a result of OOP payments dropped from 2.1 percentage points during the preUC period to 0.8 and 0.5 percentage points during the post-UC periods. For the post-OOP
impoverished households, an increase in the poverty gap reduced slightly from 0.7 percentage points in 2000 to 0.4 and 0.2 percentage points in 2002-2004. CONCLUSIONS:
Reduction in the health care catastrophe and household impoverishment due to OOP payments is evident after the implementation of UC policy that provides comprehensive coverage of health care with a very small nominal fee of 30 Baht (or 0.75 USD) upon a visit or
admission to health care facility for a comprehensive range of health services.
HP6: ECONOMIC ANALYSIS OF HYPERLIPIDEMIA RISK FACTORS AND PRIMARY PREVENTION
Yamada T1, Chen CC2, Liu GG3, 1Rutgers University, Camden, NJ, USA, 2Columbia
University, New York, NY, USA, 3Peking University Guanghua School of Management,
Beijing, China
OBJECTIVE: Coronary artery disease remains the No. 1 killer of both men and women in
the United States. The correlation with hyperlipidemia is alarmingly clear: More than half of
cases of heart disease are attributable to lipid abnormalities. The goal of this paper is to
advocate the importance of controlling hyperlipidemia to reduce the incidence of heart disease. Risk assessment tool for estimating hyperlipidemia is essential for clinical outcomes
and cost studies. The risk factors for hyperlipidemia will be evaluated and categorized as
follows: (1) disease (diabetes, hypothyroidism, total cholesterol, low-density lipoproteins,
kidney problems, etc.) (2) lifestyle (smoking, excessive alcohol use, fatty diets, exercise,
obesity etc.), (3) medication (birth control pills, estrogen, corticosteroids, certain diuretics,
beta-blockers, etc.), and (4) health stock (age and gender). METHODS: A hybrid structural
equation model, which can be viewed as syntheses of path and measurement models, is
used in this study. The specification of a hybrid model allows us to examine hypotheses
about direct and indirect causal effects of risk factors on hyperlipidemia patients. A hybrid
model also incorporates a measurement model that represents observed variables and
unobserved variables (i.e. latent variables) as the risk assessment for hyperlipidemia
patients. RESULTS: Disease factors of diabetes and low-density lipoproteins are statistically significant. The coefficients of smoking and fatty diets indicate the path familial risk
with statistically significant. For the risk of medication, birth control pills and beta-blockers
are highly correlated with hyperlipidemia. CONCLUSIONS: Primary prevention of diabetes
and low-density lipoproteins should be an important goal of every primary care physician.
All patients should undergo careful assessment of future risk and should be counseled
about lifestyle modification. Patients at high risk can further benefit from cautious use of
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lipid-lowering drugs. Gender and age related lipid-lowering therapy is likely to reduce clinical outcomes and costs.
1Chulalongkorn University, Bangkok, Thailand, 2Food and Drug Administration
Office, Nonthaburee, Thailand
HP7: SURVEILLANCE OF ANTIMICROBIAL RESISTANCE AND USE IN THE
COMMUNITY: A TIME-SERIES STUDY.
OBJECTIVE: Nevirapine-based triple combination antiretroviral (ARV) therapy has been
used as first line drug for HIV patients in Thailand. However, negative consequence from
adverse events is of concern when compared to the Efavirenz-based ARV. The aim of this
study is to compare the incidence of Nevirapine-based and Efavirenz-based therapy.
METHODS: Nineteenth general hospitals were recruited in the Intensive Adverse Drug
Reaction (ADR) Monitoring program. One or two pharmacists from each of these hospitals
were trained to understand the concept of pharmacoepidemiology, pharmacologic measure, and how to complete adverse event reports and antiretroviral drug utilization data.
Adverse event data of the hospital completely reporting utilization of ARV within six months
period from January to June, 2005, were used for the study. The incidences of adverse
events of Nevirapine-based and Efavirenz-based ARV therapy were calculated and compared. RESULTS: Six hospitals (31.6%) completed the drug utilization report. Of the 1,185
patients using Nevirapine-based ARV, 39 cases had adverse event. Of the 369 patients
usingh Efavirenz-based therapy, nine cases had adverse event. The ADR incidence of
Nevirapine and Efavirenz was 3.29 and 2.44 per 100 persons per six months. Sixteen
cases (1.35%) had to quit Nevirapine and three cases (0.81%) had to quit Efavirenz. Six
cases (0.51%) in Nevirapine-based ARV group had severe and life-threatening ADR resulting in hospitalization including Steven Johnson Syndrome, oedema, dyspneoa, and skin
exfoliation. Within Efavirenz-based group, only one case (0.27%) had Fixed Eruption and
was hospitalized. CONCLUSIONS: For overall ADR, Nevirapine-based ARV had the ADR
incidence higher than Efavirenz-based ARV. The serious or life threatening ADR seems to
be greater in Nevirapine group. Data from Intensive ADR monitoring program could be
used for assessing the ADR incidence which could be incorporated in pharmacoeconomic
calculation.
Thatte UM1, Kulkarni RA2, Holloway KA3, Sørensen TL4, Koppikar GV2, Shinkre
NN2, Chaudhury RR5, 1BYL Nair Charitable hospital, Mumbai, Maharashtra, India,
2BYL Nair Ch hospital, Mumbai, Maharashtra, India, 3World Health Organisation,
Geneva, geneva, Switzerland, 4Bispebjerg Hospital, Bispebjerg, Netherlands,
Netherlands, 5Delhi Society for Promotion of Rational Use of Drugs, Delhi, India
OBJECTIVE: To determine resistance to antibiotics in E. coli isolated from stools of
patients from a specified area of Mumbai and use of these same antimicrobials by prescribers in these facilities and chemist shops with the objective of developing a surveillance system for AMR and drug use in the community. METHODS: Prospective, time series
study over 24 months. Setting: 1 hospital, 9 municipal dispensaries, 10 GP clinics and 10
chemist shops randomly selected each month in ‘E’ ward of Mumbai. Study Population:
4800 (200 per month) stool samples of patients with or without diarrhoea attending various facilities were collected. E. coli isolates from these were tested for antimicrobial susceptibility using standard methods. 7200 antibiotic containing prescriptions (300 per
month) for all clinical conditions were collected from patients attending the same facilities.
Consumption data from the municipal facilities was also examined. Outcome Measures: %
patients prescribed antimicrobials, % patients prescribed specific antimicrobial, No. DDD’s
of antimicrobial consumed per catchment population, % resistance of E. coli to specified
antimicrobials. RESULTS: Across facilities, 25-30% of medicines prescribed were antibiotics. Commonly used antimicrobials in municipal facilities was Cotrimoxazole (7.27 &
20.67% respectively), Amoxicillin and Quinolones at GPs and chemists (8.7 & 7.84%amoxicillin; 8.64 & 9.17%-quinolones). DDD of Co-trimoxazole, Amoxycillin, Cephalexin
and Quinolones was 463.45, 102.98, 18.95, 82.24 mg/1000 inhabitants/day respectively
at municipal facilities and 56.87, 92.63, 3.02, 136.12 mg/1000 inhabitants/day respectively at GPs. Resistance of E. coli to Cotrimoxazole, Amoxycillin, Quinolones and
Cephalosporins varied between 24-66%, 22-68%, 22-87% and 2-53% respectively over
time. Antimicrobial resistance patterns correlated with use patterns. There was high E. coli
sensitivity to cefotaxime, which was less used in the community. CONCLUSIONS: This
study demonstrates a system of surveillance of AMR and use in the community that can
be used to monitor interventions to improve antimicrobial use and contain resistance.
HP8: OPTIMAL CONTRACT DESIGN UNDER PRICE-VOLUME AGREEMENTS
Zhang H, Zaric GS, The University of Western Ontario, London, ON, Canada
OBJECTIVE: Price-volume contracts between public payers and drug manufacturers are
seen as one way of controlling drug expenditures. However, the manufacturer may have
more information than the payer regarding the eventual market size. Thus, price volume
agreements may not entirely reduce the financial risks faced by a payer. METHODS: We
developed a mathematical model of the contract design problem. We modeled the contract
design process from the perspectives of both the payer and the manufacturer. We
assumed a sequence of events as follows: the payer determines a rebate schedule; then
the manufacturer submits sales forecasts as part of a formulary submission; then the
payer either accepts or rejects the submission; and finally the manufacturer determines
the appropriate level of marketing effort. We applied game theoretic tools to identify an
optimal contract from the perspective of the payer. The sequence of events was resolved
through Stackleberg equilibrium methods. RESULTS: An optimal contract exists for both
the payer and the manufacturer. The manufacturer’s marketing effort is positively related
with anticipated demand. Although the manufacturer may have private information about
market size and future marketing effort, the payer can design the contract so that it is in
the manufacturer’s best interest to reveal any private information. CONCLUSIONS: In an
optimal contract the payer can infer any private information held by the manufacturer
regarding anticipated market size or marketing effort. Thus, a payer can eliminate uncertainty regarding market size through a carefully designed contract. In this way, a carefully
designed price-volume agreement can be used to reduce a payer’s risk.
IN2: PRODUCTIVITY COSTS AND CARER BURDEN OF HOME PARENTERAL
ANTIBIOTIC THERAPY
Neilson GS, Neilson JS, Whitby M, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
OBJECTIVE: The aim of the study is to measure productivity in both home parenteral
antibiotic patients and their carers and carer burden. The model of drug delivery to early
discharged hospital patients is self-administration of home parenteral antibiotics.
Productivity and carer burden have not previously been examined in this group of patients.
METHODS: A labour questionnaire has been designed to collect individual patient employment information and data concerning the return to normal activities to enable the inclusion of a value for household duties and leisure. Employment was stratified according to
the Australian Bureau of Statistics’(ABS) Australian Standard Classification of Occupations.
This enabled the use of the ABS gender-specific average weekly wages for nine major
work groups. Data from the multidimensional Caregiving Distress Scale (CDS) was collected to measure carer burden. Further, data concerning employment and leisure loss by carers was collected to measure loss of productivity. The labour questionnaire and the CDS
instruments were mailed to patients on completion of therapy. RESULTS: A total of 123
patients completed the employment survey and 60 carers completed carer burden surveys. A total of 73% of patients who were employed prior to hospitalisation returned to
work during home parenteral antibiotic treatment for a total of 299 days with a value of
$AUD 47,864. For the remainder of the patients, the value of leisure time and a return to
normal daily activities was $AUD 140,982. For carers, 23% lost employment time for a
total of 115 days with a value of $AUD 19,187. The value of lost leisure or time for normal
daily activities was $AUD 83,767. The average score for the CDS was 21 (95% CI, 17.324.8) which indicates that carer burden was low. CONCLUSIONS: Productivity gains of
home parenteral antibiotic patients exceeded the lost productivity of carers. Carer burden
was low.
IN3: ECONOMIC EVALUATION OF VACCINATION AGAINST POLIOMYELITIS IN
MALAYSIA: ORAL POLIO VACCINE (OPV) VS INACTIVATED POLIO VACCINE
(IPV)
Aljunid SM, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
INFECTION Shanghai Room 5
IN1: ADVERSE EVENTS OF ANTIRETROVIRAL THERAPIES CONTAINING NEVIRAPINE OR EFAVIRENZ BASED ON INTENSIVE ADR MONITORING DATABASE
Kulsomboon V1, Maleewong U1, Suwankaesawong V2, Jameekornkul C2,
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OBJECTIVE: To conduct an economic evaluation of switching from the current regime
using combination of DTwcPHib + OPV to new combined vaccine DTwcPHib + IPV(monovalent) and DTacPHibIPV(combination). METHODS: Incremental cost-effectiveness
approach was used in the methodology. Cost of the vaccination programmes includes
price of vaccines, cost of vaccine wastage, cost of transportation and maintenance of cold
chain, cost of vaccines administration and cost of managing adverse events. The outcomes measured in this study are the number of cases of Vaccine Associated Paralytic
Polio (VAPP) and other adverse events avoided such as mild fever, high fever and convulsions. A time-motion survey was conducted in one government health centre to obtain the
human resource cost of vaccine administration. Cost of VAPP was estimated from an
expert group discussion while the cost of other adverse events (high fever and mild fever)
was obtained from interviews with 400 mothers and children attending three government
clinics. The cost of managing convulsions was obtained from a survey of 46 patients
admitted to HUKM and Hospital Kuala Lumpur. RESULTS: The current program at the cost
of RM 77.14 per dose of DTwcPHib +OPV vaccine would cost the country of RM115 million annually. At RM 91.98 per dose of DTwcPHib +IPV (monovalent), the total cost of program would incur RM137 million and at RM 85.94 per dose of the DTacPHib IPV, the total
cost of program was RM128 million. Incremental cost effectives ratio when switching from
current programme to DTwcPHib +IPV cost RM 11 million per case of VAPP avoided.
However, the incremental cost effectiveness ratio when switching form current programme
to DTacPHibIPV cost only RM three million per case of VAPP avoided. CONCLUSIONS:
Switching from the current programme to DTacPHib IPV (combination) is more cost-effective as compared to DTwcPHib +IPV (monovalent).
recruited through a Schizophrenia Fellowship in Australia. Participants completed a mail out
questionnaire that included questions about the carer, the person they care for, time spent
caring, costs associated with caring, impact of caring on paid employment and unpaid
activities (n=73). Carers valued their HRQL using the Assessment of Quality of Life (AQoL)
multi-attribute utility instrument. RESULTS: The mean age of carers was 61 years and the
majority were females caring for their son or daughter. Respondents spent 5.3 days per
week caring. On these days, the average time spent caring was 5.4 hours. Costs incurred
by carers included purchasing food (mean: AUD$36.80/week), living expenses (mean:
$27.40/week), travel expenses ($13.90/week) and cigarettes ($14.05/week). Of those who
were in paid employment (45%), 28% indicated that they were less able to carry out their
work due to caring on average 5.8 days/month. Carers that had reduced their work hours
and/or changed job (22%) in the past year because of caring for someone with schizophrenia, had their income reduced by an average $84/week. Of the carers that had taken part in
unpaid activities during the last month (67%), 26% had to reduce the amount of unpaid
work due to caring for someone with schizophrenia. The mean AQoL utility value of the carers included in this study was 0.64±0.25 (SD). CONCLUSIONS: This study shows that caring for someone with schizophrenia has a substantial impact on the carers’ life. Caring is
associated with both direct and indirect costs. The results from the AQoL suggest that the
HRQL of the carer is markedly lower than a person in normal health.
IN4: MODELING ECONOMIC BENEFITS OF SUPPRESSING VIRAL REPLICATION IN CHRONIC HEPATITIS B (CHB) PATIENTS IN CHINA: A COST-EFFECTIVENESS ANALYSIS OF ENTECAVIR AND LAMIVUDINE BASED ON A PHASE
III CLINICAL TRIAL
MH3: THE QUALITY OF LIFE IN DEPRESSED OUTPATIENTS: 6 MONTH FOLLOW-UP STUDY IN SHANGHAI, CHINA
Yuan Y1, Iloeje U2, Li H3, Hay J4, Yao GB5, 1Bristol-Myers Squibb Company,
Plainsboro, NJ, USA, 2Bristol-Myers Squibb Company, Wallingford, CT, USA, 3BristolMyers Squibb Co, Wallingford, CT, USA, 4University of Southern California, Los
Angeles, CA, USA, 5Jin An District Hospital & Shanghai Fudan University, Shanghai,
China
OBJECTIVE: Of estimated 112 million persons infected with CHB in China, 15-40% will
eventually develop liver complications. Most of the patients do not actively seek antiviral
agents for treatment probably due to high cost and uncertain long-term outcomes.
Entecavir is a new therapeutic option for CHB patients and the purpose of this study was
to evaluate the cost effectiveness of entecavir treatment in China, based upon estimated
clinical benefits. METHODS: We took the perspective of the Chinese Social Security program. Multivariate-adjusted relative risks with viral load (VL) categories were estimated
from a published Taiwan CHB cohort with 42,115 person-years of follow-up, and applied
to patients enrolled in a randomized phase III trial in China in which HBV DNA was a primary endpoint after 48 weeks of therapy with either entecavir or lamivudine monotherapy.
Entecavir and lamivudine daily prices were assumed RMB yuan 40 and 16.71, respectively. Life expectancy tables were based on China vital statistics. Direct medical cost of and
utility scores for different phases of CHB were estimated from published China specific
data, and costs were adjusted to year 2005 value using Chinese Consumer Price Index
information. Probabilistic sensitivity analyses were conducted to evaluate parameter
uncertainty on event distribution and treatment failure rates beyond trial period. RESULTS:
519 subject started double-blind treatment; males (82%); HBeAg+ (87%); mean age 30
years. Entecavir was superior to lamivudine as the proportion of subjects who achieved
HBV DNA<300 copies/ml by PCR assay at Week 48, 78.7% versus 46.7%, respectively,
(P<0.05). In the base case, compared with lamivudine, one year of entecavir therapy yielded a net cost saving of 2123 yuan and 0.71 quality-adjusted life year (QALY) gain, with
98.5% of 1000 Monte Carlo simulation estimates below 5000 RMB/QALY. CONCLUSIONS:
Entecavir is a highly cost effective choice of treating hepatitis B patients in China.
MENTAL HEALTH Shanghi Room 6
MH2: THE IMPACT OF SCHIZOPHRENIA ON CAREGIVERS: BURDEN OF ILLNESS AND QUALITY OF LIFE
Adams J1, Nand V2, Le Reun C3, Mudge M1, Crowley S4, Eggleston A2, Schrover
R5, Brown A1, 1Medical Technology Assessment Group, Chatswood, NSW, Australia,
2Janssen-Cilag Pty Ltd, North Ryde, NSW, Australia, 3M-TAG Pty Ltd, Chatswood,
Australia, 4University of Melbourne, North Ryde, NSW, Australia, 5Janssen-Cilag Pty
OBJECTIVE: To determine the burden of illness and health related quality of life (HRQL) of
carers for people with schizophrenia. METHODS: Carers of people with schizophrenia were
Ji JL1, Chen XB2, Tan-Mulligan A3, Sheng F3, 1Zhongshan Hospital, Fudan
University, Shanghai, China, 2Fudan University, Shanghai, China, 3GlaxoSmithKline
OBJECTIVE: The aim of this study was to assess the quality of life of patients with
depression using Paroxetine at baseline, three months and six months. METHODS: It is a
multi-center collaborative QOL follow-up study conducted in six general hospitals and 1
mental health center in Shanghai. The patients were treated with Paroxetine (1020mg/day) for six months and assessed with HAMD-17, HAMA-14 and SF-36 at baseline,
three-month and six-month. RESULTS: 1) A total of 196 outpatients met the diagnostic criteria of major depression in accordance with the DSM-IV participated in the study at baseline,180 patients finished six months follow-up, including 54 pure depression patients and
126 co-morbidity patients. 2) At baseline, co-morbidity patients had a higher impaired
quality of life compared with pure depression patients, especially in PF, VT, SF and MH
(p<0.05). 3) After three months treatment, co-morbidity patients had more improvement in
QOL, especially in RP, RE and GH (p<0.05). 4) After six months treatment, co-morbidity
patients had further improvement in QOL, especially in RP, BP and RE (p<0.05). 5)
Paroxetine is an effective anti-depressant which let 59% of patients were free of depressive symptoms (HAMD<8 score) and 88% of cases were free of anxiety symptoms
(HAMA<8 score) after six-month treatment. CONCLUSIONS: 1) Depression imposed a
huge humanistic burden on the patients, whose quality of life were impaired badly; 2)
Paroxetine significantly improved patients’ Quality of Life, both in pure depression and comorbidity patients; 3) Co-morbidity patients have more improvement in Quality of Life
compared with pure depression patients; 4) Longer treatment with Paroxetine showed a
higher improvement in Quality of Life.
MH4: PHARMACOECONOMIC EVALUATION OF RELAPSED AND NONRELAPSED GENERALISED ANXIETY DISORDER PATIENTS
Jorgensen TR1, François C2, Despiegel N2, 1H. Lundbeck A/S, Valby, Copenhagen,
Denmark, 2H. Lundbeck A/S, Paris, France
OBJECTIVE: Assess the impact of relapse and non-relapse on patient reported outcomes
(PRO) and resource utilisation in patients with Generalised Anxiety Disorder (GAD).
METHODS: An economic evaluation conducted alongside a double-blind, placebo-controlled, 6-month relapse prevention clinical trial compared PRO and costs of relapsed and
non-relapsed GAD patients (n=195). Relapse was defined as an increase in HAM-A score
to 15 or more. PRO was assessed using the SF-36 quality of life (QoL) scale at randomization (week 12), weeks 36, 60 and 88 or at early termination for relapsed and non-relapsed
patients. Resource utilisation was assessed at the same time points. RESULTS: Patients
reported significant improvement in QoL during the 12-week open-label period of escitalopram treatment (p>0.0001). After randomization, relapsed patients reported significantly
lower QoL scores than non-relapsed patients in all SF-36 mental health dimensions
(p<0.001). On the SF-36 physical dimensions, relapsed patients reported significant worsening in general health (p>0.001) and role physical dimensions (p>0.0.15) but no change
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in the physical functioning or bodily pain dimensions. The difference in cost (including
medication cost) between patients experiencing relapse and those that did not was 2363
over 76 weeks. CONCLUSIONS: Relapsed GAD patients reported significantly lower QoL as
assessed by the SF-36 scale compared with non-relapsed patients. The difference was 10
to 33 points in the mental health dimensions, which is superior to the accepted clinically
relevant 10-point difference. Relapsed patients cost significantly more than non-relapsed
patients. This highlights the need for long-term treatment with drugs that are effective in
preventing relapse in GAD patients.
URINARY/KIDNEY DISORDERS Shanghai Room 2
UK1: A REGIONAL ASIAN ANALYSIS OF THE COST-EFFECTIVENESS OF
EARLY IRBESARTAN TREATMENT VERSUS CONVENTIONAL ANTIHYPERTENSION TREATMENT, AND LATE IRBESARTAN TREATMENT IN PATIENTS WITH
TYPE 2 DIABETES HYPERTENSION AND KIDNEY DISEASE
Demarteau N1, Annemans L2, Hu S3, Lee TJ4, Morad Z5, Thanom S6, Yang WC7,
1IMS Health, Brussels, Belgium, 2IMS Health and Ghent University, Brussels,
Belgium, 3Fudan University (former Shanghai Medical University), Shanghai, shanghai, China, 4College of Medicine, Hallym University, Chuncheon, South Korea,
5Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, 6Phramongkutklao Army Hospital,
Bangkok, Thailand, 7Veteran General Hospital and National Yang-Ming University,
School of Medicine, Taipei, Taiwan
OBJECTIVE: The prevalence of type 2 diabetes, often leading to diabetic nephropathy,
increases around the world and even more in Asia. Irbestartan has been shown to slow
down progression of kidney disease in clinical trials conducted at early (microalbuminaria)
and late (proteinuria) stages of nephropathy in hypertensive type 2 diabetic patients. A
Markov model based on these results has demonstrated that in Western regions (US,
Europe) early irbesartan results in significant clinical (life year gained - LYG) and economic
(savings) benefits compared to conventional therapy or late irbesartan. The objective of
this study was to adapt this analysis to the Asian context. METHODS: The 25 years time
horizon model was developed in MSExcel and adapted to China, Malaysia, Thailand,
South-Korea and Taiwan from a health care perspective. The effectiveness parameter was
LYG. All costs were converted to 2005US$ using official exchange rates and price indexes.
Local data were sought for costs data, and for transplantation, dialysis, and death probabilities. Upon local availability, official databases or published data were used. Probabilities
regarding disease progression with the investigated drugs were extracted from 2 published clinical trials. A probabilistic analysis provided mean values and 95% confidence
intervals (95%CI). RESULTS: Early irbesartan gave the largest clinical and economic benefits, reducing the need for dialysis by 62% versus conventional treatment in all regions,
and total costs by 6% (95%CI [-32%;20%] (Thailand) to 41%[-67%;-6%] (Taiwan), and
increasing LYG by 0,5 years (range 0.47[0.09;0.84] to 0.56[0.12;0.98]). The second best
alternative, late irbesartan, also led to higher LYG and lower cost, as compared to conventional treatment in all regions, although to a lower extent (total costs in Taiwan reduced by
16% versus conventional treatment). CONCLUSIONS: Although absolute results vary in different settings (Western countries, Asia), reflecting differences in epidemiology, management and costs, early irbesartan remains a cost-effective alternative.
UK2: ESTIMATED ANNUAL COST OF OVERACTIVE BLADDER IN THAILAND
Prasobsanti K1, Ponprasit K2, 1Chulalongkorn University Hospital, Bangkok,
Thailand, 2Pfizer Thailand Ltd, Bangkok, Thailand
OBJECTIVE: To estimate the annual direct and indirect costs of overactive bladder (OAB) in
indigenous Thai people aged 18 years and over, attending a Urology Clinic in Bangkok in
2005. METHODS: Epidemiologically based models using diagnostic and treatment algorithms
from clinical practice guidelines and current disease prevalence data were used to estimate
direct and indirect costs of OAB. Prevalence and event probability estimates were obtained
from the literature, national data sets, and expert opinion. Costs were estimated from a small
survey using a cost questionnaire and from unit cost.Sensitivity analyses were performed on
all variables. RESULTS: The annual cost of OAB in Thailand is estimated as 4.2 billion USD
which includes 3.25 billion USD for direct medical costs, 0.82 billion USD for direct, nonmedical costs and 0.13 billion USD for indirect costs of lost productivity. Costs for women
were greater than the costs for men. The largest costs category was direct treatment costs
of comorbidities associated with OAB followed by costs of transportation. The more patients
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were treated, the less direct treatment costs of OAB consequences would be. Costs of OAB
medication accounted for 7% of the total costs of OAB. It is estimated that 1.2 billion USD
per year could be saved if all OAB patients were treated. Costs were most sensitive to
change in OAB prevalence. CONCLUSIONS: OAB is a costly condition. It is estimated to consume 2.46% of national GDP. Based on information from direct and indirect costs of OAB, it
is recommended that physicians increase their level of appreciation of the disease and initiate early treatment so as to reduce the impact of the higher cost of treating co morbidities
conditions associated with OAB. It may also be beneficial that a more humanistic approach
to the problem would help improve quality of life of these patients.
UK3: ETHICAL DIMENSION OF RESOURCE ALLOCATION: THE CASE OF SCALING UP ACCESS TO RENAL REPLACEMENT THERAPY IN THAILAND
Tangcharoensathien V1, Prakongsai P2, Kasemsup V3, Teerawattananon Y4,
1International Health Policy Program, Nonthaburi, Thailand, 2International Health
Policy Program, Amphoe Muang, Thailand, 3Mahidol University, Bangkok, Thailand,
4International Health Policy Program - Thailand, Nonthaburi, Thailand
OBJECTIVE: To investigate policy options for the introduction of access to renal replacement therapy (RRT) under universal coverage (UC) in Thailand. METHODS: Literature
reviews, secondary data analysis, in-depth interviews with stakeholders and the analysis of
policy options based on the WHO manual on ethical dimensions of health resource allocation. RESULTS: The incidence rate of end-stage renal diseases (ESRD) patients requiring
RRT ranges from 100 to 300 per million populations. Forecasting indicates demand for RRT
would exceed 50,000 cases in year five, and 100,000 cases in year ten, if universal access
to RRT is adopted. The program requires 5.5% and 24% of total UC budget in year 1 and
15, respectively. By year 15, RRT would cost 7.7% of total national health expenditure, if
neither strategy to reduce the costs for RRT nor case selection is in place. This huge forecast outlay is not affordable by the country. Analysis indicates neither hemodialysis nor peritoneal dialysis was cost-effective, as their cost per life year saved were greater than 5.2
times of GNI per capita. CONCLUSIONS: Though not cost-effective, protecting households
against financial catastrophe justifies public funding; and to be financially feasible, rationing
is unavoidable. This study advocates prevention of ESRD and providing RRT to every
patient, up to an age cut-off, or to every patient with a fix number of RRT years by providing
more years to the younger patients is financially feasible (due to discontinuation of RRT
beyond the cut off point) while observes ethical principles of providing equal chance to all
patients.
UK4: ECONOMIC ANALYSIS OF ORAL CARBONACEOUS ADSORBENT AST-120
IN DELAYING THE INITIATION OF DIALYSIS TREATMENTS AMONG PATIENTS
WITH CHRONIC RENAL FAILURE
Kang HY1, Cho WH1, Lee SM2, Kim HJ3, Woo TW4, 1Yonsei University, Seoul, South
Korea, 2Yonsei University, Graduate School, Seoul, South Korea, 3Pochon CHA
University, Pochon, Kyoung-gi, South Korea, 4CJ Corp, Seoul, South Korea
OBJECTIVE: To enable comprehensive evaluation as a treatment option for patients with
chronic renal failure (CRF), an economic assessment of oral adsorbent AST-120 was carried
out. METHODS: We sought to evaluate the economic value of AST-120 by estimating cost
savings due to its effect of delaying the initiation of dialysis. A decision analytic model was
developed with conventional treatments for CRF accompanied by AST-120 therapy as 'a
treatment choice' and conventional treatments only as 'an alternative choice.' Direct medical and non-medical costs and productivity loss costs were considered. Information regarding the effects of AST-120 was obtained from results of earlier clinical studies. Cost information was derived from administrative data for 40 hemodialysis (HD) and 20 peritoneal
dialysis (PD) patients from two dialysis centers located in Seoul, Korea. By computing the
weighted average for the cases delaying the initiation of HD and PD, the expected per-capita cost savings due to the use of AST-120 by a patient with CRF was obtained. RESULTS:
Depending on the probability of AST-120 showing the effect of delaying the initiation of dialysis (52.3-68.1%) and the duration of the delay (1, 2, or 4 years), the present value of
cumulative cost savings per patient with CRF from societal perspective would be
12,476,000-19,940,000, 24,361,000-38,938,000 or 46,469,000-174,271,000 Korean Won.
CONCLUSIONS: The cost savings estimated to be resultant from AST-120 therapy confirm
that its effect of delaying the initiation of dialysis has considerable economic value.
81
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Outcomes Research
Roche
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ISPOR would like to thank the
following companies for their
support of delegates
attending the Conference:
ISPOR would like to
thank all of our exhibitors
and supporters for
helping make this
conference a success.
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AstraZeneca
Bayer
Baxter
Eli Lilly
Glaxo Smith Kline
Pfizer
Roche
Sanofi-Aventis
Shanghai Pharmaceuticals Co.
Xian-Janssen Pharmaceuticals
ISPOR
LEADERSHIP
DIRECTORY
AND
INITIATIVES
89
2005-2006 BOARD OF DIRECTORS
90
PRESIDENT
DIRECTOR (2004-2006)
Peter Neumann ScD
Isao Kamae MD, DrPH
Center for the Evaluation of Value
and Risk in Health,
Tufts University, School of Medicine
Boston, MA, USA
Professor of Biostatistics and
Health Decision Sciences
Graduate School of Medicine, Kobe
University Kobe, Japan
PRESIDENT-ELECT
Michael Drummond PhD
Joyce Cramer
Professor of Health Economics,
Centre for Economics
University of York
York, UK
Associate Research Scientist
Yale University, School of Medicine
West Haven, CT, USA
PAST PRESIDENT
Lieven Annemans PhD, MSc, Mman
Scott Ramsey MD, PhD
Professor & Senior Consultant
Ghent University, HEDM and IMS Health
Meise, Belgium
Associate Member
Hutchinson Cancer Research Center
Seattle, WA, USA
TREASURER (2004-2007)
Laurie Burke MPH, RPh
Lorne Basskin PharmD
Director, Study Endpoints and Label
Development Office of New Drugs
CDER, FDA
Rockville, MD, USA
Director, Pharmacy Services
Healthsouth Sunrise Rehab Hospital
Fort Lauderdale, FL, USA
EXECUTIVE DIRECTOR
Jens Grueger PhD
Head of Pricing and Health Economics
Department, Novartis Pharmaceuticals AG,
Basel, Switzerland
ISPOR
Lawrenceville, NJ, USA
ISPOR 2005-2006 LEADERSHIP DIRECTORY
ISPOR ASIA CONSORTIUM
ISPOR ASIA CONSORTIUM EXECUTIVE
COMMITTEE
2004-2006 Chair:
Gordon G. Liu PhD, Professor and Chair,Department
of Health Economics and Management, Guanghua
School of Management, Peking University, Beijing, P.R
China
Chair-elect and 2006-2008 Chair:
Kenneth KC Lee JP, BSc(Pharm), MPhil, PhD,
Professor, School of Pharmacy, Faculty of Medicine,
The Chinese University of Hong Kong, Shatin, N.T.,
Hong Kong, China
Members:
China (Mainland):
Wen Chen PhD, Professor and Associate Dean,
School of Public Health, Fudan University, Shanghai,
China
Zhiqiang Guan MD, MPH, Director, National Institute
for Social Insurance, Beijing, China
Shanlian Hu MD, MSc, Professor, Training Center for
Health Management, School of Public Health, Fudan
University, Shanghai, P.R.China
Gordon G. Liu PhD, Professor and Chair, Department
of Health Economics and Management, Guanghua
School of Management, Peking University, Beijing, P.R
China
Alison Tan-Mulligan PhD, MBBS, Health Outcomes
& Epidemiology Manager, GlaxoSmithKline
Pharmaceuticals (China) Investment Co. Ltd,
Hong Kong:
Professor, School of Pharmacy, Faculty of Medicine,
The Chinese University of Hong Kong, Hong Kong,
China
Taiwan:
Tony Yen-Huei Tarn MS, PhD, President, Taiwan
Socity for Pharmacoeconomics and Outcomes
Research, and Director, Department of Pharmacy,
Taipei City Hospital, Taipei, Taiwan
Ming-Chin Yang PhD, Associate Professor, School of
Public Health, National Taiwan University, Taipei,
Taiwan
Hsiao-Yi Lin MD, Rheumatologist, Taipei Veteran
General Hospital, Taipei, Taiwan
India:
Urmila Mukund Thatte PhD, DNB, MD, MBBS,
Professor and Head, Department of Clinical
Pharmacology, Topiwala National Medical College, BYL
Nair Charitable Hospital Mumbai Central, Mumbai,
India
Jawahar S. Bapna PhD, MD, MB, Professor,
Pharmaceutical Management, Indian Institute of
Health Management Research, Jaipur, India
Japan:
Isao Kamae MD, DrPH, Professor of Health Sciences
and Informatics, Research Center for Urban Safety
and Security (RCUSS), Graduate School of Medicine,
Kobe University, Kobe, Japan
Shunya Ikeda MD, MS, DMSc, Lecturer, Department
of Health Policy and Management, School of
Medicine, Keio University, Japan
Takashi Fukuda Ph.D, Associate Professor,
Department of Pharmacoeconomics, Graduate School
of Pharmaceutical Sciences, University of Tokyo,
Tokyo, Japan
Hiroyuki Sakamaki MBA, Director and Chief
Researcher, Research Department, Institute for Health
Economics and Policy, Tokyo, Japan
Malaysia:
Syed Mohamed Aljunid MD, MSc, PhD, FAMM,
Professor of Health Economics and Head of
Department of Community Health, Faculty of
Medicine, Universiti Kebangsaan Malaysia, Kuala
Lumpur, Malaysia
Pakistan:
Aamir Hameed FCPS, MBBS, Senior Instructor &
Consultant Cardiologist, Cardiology section,
Department of Medicine, The Aga Khan University,
Karachi, Pakistan
Singapore:
Shu-Chuen Li PhD, MS, MBA, Associate Professor,
Department of Pharmacy, National University of
South Korea:
Bong-Min Yang PhD, Professor of Economics, and
Dean, School of Public Health, Seoul National
University, Seoul, South Korea
Eui-Kyung Lee PhD, Chair, Korean
Pharmacoeconomics Working Group, Senior
Research Fellow and Director, Division of Health Policy
Research, Korea Institute for Health and Social Affairs,
Seoul, Korea
Sang-Cheol Bae MD, PhD, MPH, Professor, Head,
Division of Rheumatology, and Head, Section for
Clinical Epidemiology and Economics, The Hospital for
Rheumatic Diseases, Hanyang University, Seoul, Korea
Eun-Young Bae PhD, Senior Researcher, Research
Department, Health Insurance Review Agency, Seoul,
Korea
Thailand:
Nathorn Chaiyakunapruk PharmD, PhD, Assistant
Professor, Department of Pharmacy Practice, School
of Pharmacy, Naresuan University, Pitsanuloak,
Thailand
Surachat Ngorsuraches, PhD, RPh, Head of
Pharmacy Administration Department, Faculty of
Pharmaceutical Sciences, Prince of Songkla
University, Hatyai, Songkhla, Thailand
Vithaya Kulsomboon PhD, President, ISPOR Thailand
Chapter, and Assistant Professor in Social Pharmacy,
Chair of Social Pharmacy Department, Faculty of
Pharmaceutical Sciences, Chulalongkorn University,
Patumwan, Bangkok, Thailand
Advisory Committee Chair:
Hong Li PhD, MPH, Director, OR-ROW Liaison,
Department of Global Epidemiology and Outcomes
Research, Bristol-Myers Squibb Company, Wallingford,
CT , USA
ISPOR ASIA CONSORTIUM ADVISORY COMMITTEE
2005-2007 Chair:
CT, USA
Chair-elect and 2007-2009 Chair:
Jeff J. Guo, B. Pharm, PhD, Associate Professor of
Pharmacoepidemiology and Pharmacoeconomics,
College of Pharmacy, Faculty Research Fellow,
Institute for Health Policy and Health Service
Research, University of Cincinnati Medical Center,
Cincinnati, OH, USA
Members:
Residence: Asia
Academia and other Institute
Carol Cheng, Secretary General, International
Research-Based Pharmaceutical Manufactures
Association (IRPMA),Taipei, Taiwan
Hye-Young Kang, R.Ph, PhD, Assistant Professor of
Health Policy and Administration, Graduate School of
Public health, Yonsei University, Seoul, South Korea
Rong Shao, Professor and Associate Dean, College of
International Pharmaceutical Business, China
Pharmaceutical University, Nanjing, Jiangsu, P.R.
China
Asia
Industry
Wanyu Cai, Vice General Manager, Zhangzhou
Pientzehuang Pharmaceutical Co., Ltd, Shang Street,
Zhangzhou, Fujian, P.R. China
Kevin C. Chen, Vice President, Asia, International
Research-based Pharmaceutical Manufacturing
Association, Taipei, Taiwan
Xusheng Kong, Vice General Manager, Hong Kong
Wan Ji Group, Shenzhen Wanji Pharmaceutical Co.,
Ltd., Shenzhen Wanji New and Special Medicine Co.
Ltd., Shenzhen, P.R. China
Feng Lu, President/General Manager, SFFT
Pharmaceutical Developing Co., Ltd, Hangzhou,
Zhejiang, P.R. China
Yin-Nan Sun, President, Chunghwa Yuming
Healthcare Co., Ltd, Taipei, Taiwan
Weiguo Tang, Vice General Manager, Jinling
Pharmaceutical Co., Ltd., Nanjing, Jiangsu, P.R. China
Lillian Yu-Jen Wang MS, Health Economics and
Market Access Manager, Boehringer Ingelheim Taiwan
Limited, Taipei, Taiwan
Youchi Xu BS, President and CEO, LeePhick
Pharmaceutic Industry Group, Longyan Economic &
Technological Developing Zone, Longyan City, Fujian,
P.R.China
Lixing Yang, General Manager/President, Beijing
Jiaden Pharmaceutical Company, Building B-1-1,
TaiLiMing garden, Wandingmenwei, Beijing, P.R.
China
Residence: Not-Asia
Academia
Rajesh Balkrishnan PhD, Merrell Dow Professor,
Ohio State University College of Pharmacy and School
of Public Health, Columbus, OH, USA
Kin-Wei (Arnold) Chan MD, ScD, FISPE, Adjunct
Associate Professor of Epidemiology, Department of
Epidemiology, Harvard School of Public Health,
Boston, MA, USA
Jalpa Doshi PhD, Research Assistant Professor,
General Internal Medicine, University of Pennsylvania,
Philadelphia, PA, USA
Jeff J. Guo, B. Pharm, PhD, Assistant Professor of
Pharmacoepidemiology and Pharmacoeconomics,
College of Pharmacy, Faculty Research Fellow,
Institute for Health Policy and Health Service
Research, University of Cincinnati Medical Center,
Cincinnati, OH, USA
91
2005-2006 LEADERSHIP DIRECTORY
Ya-Chen Tina Shih PhD, Associate Professor, Section
of Health Services Research, Department of
Biostatistics and Applied Mathematics University of
Texas, M.D. Anderson Cancer Center, Houston, Texas,
USA
Dong-Churl Suh MBA, PhD, Associate Professor,
Department of Pharmacy Practice and Administration,
College of Pharmacy--Busch Campus Rutgers, the
State University of New Jersey, Piscataway, NJ, USA
Non-Asia
Consulting
Bruce Crawford MA, MPH, Director, Patient Reported
Outcomes and Regulatory Consulting-Operations Mg,
Mapi Values, Boston, MA, USA
Jim Doherity PhD, Independent, Former Director,
Pharmaeconomics Department, Pharmacia, Inc. Japan
Non-Asia
Industry:
William Bishop, Director, Corporate Affairs, Wyeth
K.K. (Japan), Kyobashi, Chuo-Ku, Tokyo, Japan
Wanju Dai MD, DrPH, VP and Global Head,
Epidemiology, Global Pharmacovigilance and
Epidemiology, Sanofi-aventis, Bridgewater, NJ, USA
Sandeep Duttagupta PhD, Director, Worldwide
Outcomes Research, Asia Region, Pfizer Global
Pharmaceuticals, Pfizer Inc., New York, NY, USA
Amy Guo PhD, Associate Director, Baxter Healthcare
Corporation, Deerfield, IL, USA
Xing-Yue Huang, Global Project Leader, Health
Economics and Reimbursement, Bayer
Pharmaceuticals Corporation, West Haven, CT, USA
Bruno Jolain MD, Director, Health Economics Intercontinental Region, Sanofi-Aventis, Paris, France
Sheldon Kong PhD, Executive Director, Outcomes
Research and Pricing Support, Merck & Company,
Inc., Whitehouse Station, NJ USA
Linda C. Koo PhD, Director, Discovery Medicine and
Epidemiology, AstraZeneca LP,Wilmington, DE, USA
CT, USA
Siew Hwa Ong MSc, Health Economist, New Product
Pricing and Health Economics, Novartis Pharma AG,
Basel, Switzerland
Fang Wang PhD, Director, Global Health Outcomes
Assessment, Wyeth Research, Collegeville, PA, USA
Yize Richard Wang MD, PhD, Public Policy,
AstraZeneca Pharmaceuticals, Wilmington, DE, USA
Jasmanda Hsiao-Hui Wu PhD, Senior Epidemiologist
in Outcomes Research & Management, US Human
Health, Merck & Co., Inc, West Point, PA, USA
Cheryl Xu PhRMA, China Representative and director
of ADPAC, Shanghai, P.R. Chair
Mingliang Zhang PhD, Director, Health Economics,
Pricing and Market Access, Asia Pacific and Japan,
PGSM, Johnson & Johnson, Raritan, NJ, P.R. Chair
Zhongyun Zhao PhD, Health Outcomes Research
Scientist, Global Health Outcomes, Eli Lilly and
Company, Indianapolis, IN, USA
ISPOR CHAPTERS IN ASIA PACIFIC
HONG KONG CHAPTER
CHINESE MEDICIAL DOCTOR ASSOCIATIONPHARMACOECONOMICS CHAPTER
President, ISPOR Hong Kong Chapter, and Professor,
School of Pharmacy, Faculty of Medicine, The Chinese
University of Hong Kong, Hong Kong, China
Yingying Tang, Deputy Executive Secretary,
Pharmacoeconomics Professional Committee, Chinese
Medical Doctor Association
TAIWAN CHAPTER
THAILAND CHAPTER
Tony Yen-Huei Tarn MS, PhD, President, ISPOR
Taiwan Chapter, and Director, Department of
Pharmacy, Taipei City Hospital, Taipei, Taiwan
Vithaya Kulsomboon PhD, President, ISPOR Thailand
Chapter, Assistant Professor in Social Pharmacy, and
Chair of Social Pharmacy Department, Faculty of
Pharmaceutical Sciences, Chulalongkorn University,
Bangkok, Thailand
ISPOR NATIONAL UNIVERSITY OF SINGAPORE
STUDENT CHAPTER
Xu-Hao Zhang, President, ISPOR National University
of Singapore Student Chapter, National University of
ISPOR ASIA-PACIFIC MEDICAL DEVICE & DIAGNOSTICS COUNCIL
Australia
George Faithfull, Vice-President
Regulatory Affairs and Quality Assurance,
Stryker Pacific, St. Leonards, Australia
China (Mainland)
Zhigiang Guan, MD MPH, National
Institute of Social Insurance, Ministry of
Labor and Social Security
Beijing, China
Jie Chen, Director, Full Professor, Key
Lab of Health Technology Assessment,
MOH, China (Fudan University)
Shanghai, China,
Han Feng, Director, Medical Insurance
Branch, China Social Insurance
Association, Beijing, China
Taiwan
Ming-Chin Yang, MD, PhD, College of
Public Health, National Taiwan University,
Chairman of Taiwan Society for
Pharmacoeconomics and Outcomes
Research, Taipei, Taiwan
Hsien-Li Kao, MD, Department of
Internal Medicine, National Taiwan
University Hospital, Advisory Board,
Taiwan Society of Cardiovascular
Intervention, Taipei, Taiwan
Yen-Huei Tarn, MS, PhD, Director,
Department of Pharmacy, Taipei City
India
Ashoke Bhattacharjya PhD, Executive
Director, Health Policy and Economics,
Johnson & Johnson
Japan
Isao Kamae MD, Professor of
Biostatistics and Health Decision
Sciences, Graduate School of Medicine,
Kobe University, Chuou-ku, Kobe, Japan
Toshio Nagae, President of CMIC MPSS
(Marketing Promotion & Sales Support)
and that of PCN, Patient Community
Network, Tokyo, Japan
Huimin Wang, Corporate Vice President,
Edwards Lifesciences, Tokyo, Japan
Malaysia
Sim Kui Hian, Head, Dept of Cardiology
& Head, Clinical Research Centre (CRC),
Sarawak General Hospital, Sarawak,
Malaysia
Philippines
Madeleine R. Valera, Vice President,
Quality Assurance Research and Policy
Development Group, Philippine Health
Insurance Corporation, Philippines
Singapore
Kai Hong Phua, AB SM PhD, Professor,
Lee Kuan yew School of Public Policy,
National University of Singapore,
Singapore
Lim Meng Kin, Community Occupational
& Family Medicine, National University of
Peter Mack, Associate Director, Office of
Healthcare Management Development,
SGH Postgraduate Medical Institute,
Singapore General Hospital (SGH),
Ministry Of Health (MOH), Singapore
South Korea
Hye-Young Kang PhD, Professor, School
of Public health, Yonsei University, Seoul,
Korea
Eui-Kyung Lee PhD, Senior Research
Fellow and Director, Korea Institute for
Health and Social Affairs, Seoul, Korea
Sang Soo Lee MBA, BA Genetic
Engineering. Medtronic, Korea
James Reinstein, Boston Scientific
Korea Co. Ltd, Seoul, Korea
ISPOR ASIA PACIFIC MEDICAL DEVICE & DIAGNOSTICS ADVISORY COMMITTEE
Chair: Nancy Travis, Associate Vice President, Global
Strategy and Analysis (Asia), Advanced Medical
Technology Association (AdvaMed), Washington, DC, USA
Teng Chuan Khoo, Vice President, Strategic Medical
Affairs, Johnson & Johnson Medical Asia-Pacific,
Paul Barry, Boston Scientific, Washington, DC, USA
Jean-Luc Butel, Senior Vice President, President,
Medtronic Asia Pacific, Tokyo, Japan
Craig Kramer, Vice President, Government Affairs,
Johnson & Johnson, New Brunswick, NJ USA
Jeff Farkas, Sr. Director, Health Policy & Payment,
Medtronic, Inc., Washington, DC USA
92
Brigitte Casteels RPh, Director Health Policy, Kyphon
Europe, Belgium
Stephen Hull, Vice President, Global Strategy & Analysis
Dept, Advanced Medical Technology Association
(AdvaMed), Washington, DC, USA
Antoinette Wenk Lang MS, Director Health Economics &
Reimbursement Europe, Boston Scientific, Switzerland
Randel Richner MPH, Vice President, Federal Affairs,
Reimbursement and Outcomes Planning, Boston
Scientific Corp, USA
Miguel Valentin, Director, International Health Economics
& Government Affairs, Boston Scientific, Natick, MA, USA
2005-2006 LEADERSHIP DIRECTORY
ISPOR PAST PRESIDENTS
2004-2005
2002-2003
Lieven Annemans PhD, MSc,
Mman
Professor and Senior
Consultant
Ghent University,
HEDM & IMS Health
Meise, Belgium
Peter Davey MD, FRCP
Head of Pharmacoeconomics,
University of Dundee,
Dept. of Clinical
Pharmacology, Ninewells
Hospital & Medical School,
Dundee, Scotland
2003-2004
2001-2002
Sean Sullivan PhD
Professor, University of
Washington,
Department of Pharmacy
Seattle, WA, USA
Eva Lydick PhD
Chief Research Officer,
Epidemiology and Applied
Health Economics,
Lovelace Foundation
Albuquerque, NM, USA
2000-2001
1998-1999
1996-1997
Jon Clouse RPh, MS
Director, Pharmacoeconomic
Evaluations,
United Health Care,
Brevard, NC, USA
Robert S. Epstein MD, MS
Chief Medical Officer,
Senior Vice President,
Medical Affairs, Merck-Medco
Managed Care, LLC,
Franklin Lakes, NJ, USA
James Smeeding RPh, MBA
Associate Director Center
for Pharmacoeconomic
Studies, University of Texas,
Athens, GA, USA
1995-1996
1999-2000
Bryan Luce PhD, MBA
Founder and
Senior Research Leader,
The MEDTAP Institute at UBC,
Bethesda, MD, USA
1997-1998
Jean Paul Gagnon PhD
Director, Public Policy,
Aventis Pharmaceuticals Inc.,
Bridgewater, NJ, USA
William McGhan PharmD,
PhD
Professor, University of the
Sciences in Philadelphia,
Philadelphia, PA, USA
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Director, Publications
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Senior Manager, Member Services
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Rita Williams
Daniel Klim
Director, Meetings & Communications
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Rebecca Corey
Manager, Member Services
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Director, Grant Development
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Zandra Z. Yin
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International Society for Pharmacoeconomics
and Outcomes Research
Bridging Health Care Research and Practice
ISPOR SPECIAL INTEREST GROUPS
Special Interest Groups are very important for ISPOR to achieve its mission of
Bridging Health Care Research and Practice.
Their objectives are SMART:
Their goals are to:
Specific
Measurable
Achievable
Relevant
Time-based
•
•
•
•
•
Develop consensus
Stimulate debate
Advance knowledge/understanding
Publish good research practices
Develop indices & tools for researchers and
decision-makers
• Compile health care information for public
• Respond to health care public policy
A Special Interest Group consists of 2 or more Working Groups. The goal of each Working Group is to produce a tangible product, such as a paper in Value in Health or ISPOR Connections, compilation of information for the ISPOR website,
such as the ISPOR Digest of International Databases, or other tangible outcomes to further the mission of the Society.
The ISPOR Special Interest Groups are:
ISPOR Evidence-Based Reimbursement
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Special Interest Group membership is open to all ISPOR members.
The majority of communication and projects conducted are through email. In addition,
SIG and working group members participate in conference calls and meet at the
ISPOR Annual Meeting and/or European Congress
94
ISPOR Asia-Pacific Conference
Floor Plans
LEVEL 1
Grand Ballroom
Convention Centre Level 1
LEVEL 2
Fudan University Dinner
Monday 6 March
LEVEL 3
95
SHANGHAI WORLDFIELD CONVENTION HOTEL
SHANGHAI, CHINA • 5 - 7 M A R C H 2 0 0 6
Corporate Supporters
ISPOR would like to thank the following companies for their generous contributions to
the ISPOR 2nd Asia-Pacific Conference:
Gold Supporters
AstraZeneca (China)
Pfizer Inc.
F. Hoffmann-La Roche Ltd
Sino-American Shanghai Squibb Pharm. Ltd
Bronze Supporters
AstraZeneca
Medtronic
Novartis Infectious Disease Group
Boston Scientific
Merck China
Pfizer Hong Kong Ltd
Bristol-Myers Squibb Company
Novartis
Sanofi Aventis
Xian Janssen

ISPOR 2nd Asia-Pacific Conference SHANGHAI WORLDFIELD CONVENTION HOTEL SHANGHAI, CHINA

Transcription

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