Healthcare costs associated with progressive diabetic retinopathy among National Health Insurance enrollees in Taiwan, 2000-2004

<p>Abstract</p> <p>Background</p> <p>Diabetic retinopathy is one of the most common microvascular complications of diabetes and one of the major causes of adult visual impairment in national surveys in Taiwan. This study aimed to identify the healthcare costs of Taiwan's National Health Insurance program on behalf of diabetic patients with stable or progressive retinopathy.</p> <p>Methods</p> <p>A retrospective cohort study was conducted with 4,988 medication-using diabetic retinopathy subjects ≥ 40 years of age under National Health Insurance Program coverage between 2000 and 2004. Study cohort subjects were recorded as having diabetic retinopathy according to ICD-9-CM codes. States of diabetic retinopathy were strategically divided into stable and progressive categories according to subjects' conditions at follow-up in 2004. Expenditures were calculated and compared for the years 2000 and 2004.</p> <p>Results</p> <p>During the 4-year follow-up (2000 through 2004), 4,116 subjects (82.5%) of 4,988 diabetic subjects were in the stable category, and 872 (17.5%) were in the progressive category. Average costs of those in the normal category increased by US $48 from US$1921 in 2000 to US $1969 in 2004 (p = 0.594), whereas costs for those progressing from normal to non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) increased by US$1760, from US $1566 in 2000 to US$3326 in 2004 (p < 0.001). The PDR category had the highest average costs at US $3632 in 2000. The NPDR-to-PDR category experienced the greatest increase in costs at US$3482, from US $2723 in 2000 to US$6204 in 2004 (p = 0.042), and the greatest percentage of increase at 2.3% (2.2% when adjusted by comparing to normal category).</p> <p>Conclusions</p> <p>This large-scale longitudinal study provides evidence that increased healthcare costs are associated with progressive diabetic retinopathy among diabetic NHI enrollees in Taiwan.</p

Antidepressant use and suicide prevention: a prescription database study in the region Friuli Venezia Giulia, Italy.

OBJECTIVE

Analisi costo-efficacia di rituximab + CHOP versus CHOP in soggetti affetti da linfoma non Hodgkin aggressivo

Cost-effectiveness analysis of rituximab + CHOP versus CHOP in patients with aggressive Non-Hodgkin lymphoma Objective: Aim of this study was to evaluate the cost-effectiveness of rituximab + CHOP (R-CHOP) versus CHOP alone, in Italian patients with aggressive Non-Hodgkin lymphoma (NHL), in the NHS' perspective. Design: The economic analysis is based on an existing Markov model which was developed to evaluate costs and effects for two hypothetical cohorts of patients aged ≥ 60 years or aged < 60 years respectively, over a time frame of 15 years after administration of chemotherapy. The model is based on five health states (start therapy, complete response, no response, progression, death) and combines efficacy data from published clinical trials (GELA-98-5) with costs of therapies and follow-up after chemotherapy, based on Italian treatment patterns. Costs and effects were discounted respectively at 6% and 1.5% per year. Extensive 1-way and Monte Carlo sensitivity analyses were conducted to test the robustness of results. Results: For the two cohorts (age ≥ 60 or age < 60 years), incremental discounted survival gains with R-CHOP vs. CHOP were respectively 1.08 and 1.02 years per patient; incremental QALYs were 1.15 and 1.04 per patient; incremental cost/patient was €14 838 and €13 938; the incremental cost per life-year gained (cost/LYG) was therefore €13 732 and €13 717, while the incremental cost/QALY gained was €12 879 and €13 362. Conclusions: The clinical advantage of R-CHOP is supported by values of incremental cost/LYG and cost/QALY gained, which are well below the thresholds commonly indicated both in the international and Italian literature. R-CHOP is a substantial improvement in the treatment of aggressive NHL, at a reasonable cost, in the perspective of the Italian NHS