Economic Evaluation of Lipid-Lowering Therapy in the Secondary Prevention Setting in the Philippines

AbstractObjectiveTo determine the cost-effectiveness of lipid-lowering therapy in the secondary prevention of cardiovascular events in the Philippines.MethodsA cost-utility analysis was performed by using Markov modeling in the secondary prevention setting. The models incorporated efficacy of lipid-lowering therapy demonstrated in randomized controlled trials and mortality rates obtained from local life tables. Average and incremental cost-effectiveness ratios were obtained for simvastatin, atorvastatin, pravastatin, and gemfibrozil. The costs of the following were included: medications, laboratory examinations, consultation and related expenses, and production losses. The costs were expressed in current or nominal prices as of the first quarter of 2010 (Philippine peso). Utility was expressed in quality-adjusted life-years gained. Sensitivity analyses were performed by using variations in the cost centers, discount rates, starting age, and differences in utility weights for stroke.ResultsIn the analysis using the lower-priced generic counterparts, therapy using 40 mg simvastatin daily was the most cost-effective option compared with the other therapies, while pravastatin 40 mg daily was the most cost-effective alternative if the higher-priced innovator drugs were used. In all sensitivity analyses, gemfibrozil was strongly dominated by the statins.ConclusionsIn secondary prevention, simvastatin or pravastatin were the most cost-effective options compared with atorvastatin and gemfibrozil in the Philippines. Gemfibrozil was strongly dominated by the statins

Economic Burden of Community-Acquired Pneumonia among Adults in the Philippines: Its Equity and Policy Implications in the Case Rate Payments of the Philippine Health Insurance Corporation

AbstractObjectivesTo determine 1) the cost of hospitalization, the 1-week postdischarge cost, the total cost, and the economic burden of community-acquired pneumonia among patients aged 19 years or older in the Philippines and 2) the difference between the estimated costs and the Philippine Health Insurance Corporation (PhilHealth) pneumonia case rate payments.MethodsThe study involved two tertiary private hospitals in the Philippines. Using the societal perspective, both health care and non–health care costs were determined. A base-case analysis and sensitivity analyses were performed, and the economic burden of pneumonia was determined using PhilHealth claims.ResultsThe estimated cost of hospitalization for community-acquired pneumonia-moderate risk (CAP-MR) ranged from Philippine peso (PHP) 36,153 to 113,633 (US $852–2678) and its 1-week postdischarge cost ranged from PHP1450 to 8800 (US$34–207). The cost of hospitalization for community-acquired pneumonia-high risk (CAP-HR) ranged from PHP104,544 to 249,695 (US $2464–5885) and PHP101,248 to 243, 495 (US$2386–5739) using invasive and noninvasive ventilation, respectively. The postdischarge cost for CAP-HR ranged from PHP1716 to 10,529 (US $40–248). If only health care cost was considered, the cost ranged from PHP24,403 to 89,433 for CAP-MR and PHP92,848 to 213,395 for CAP-HR. The present PhilHealth case rate payments are PHP15,000 (US$354) and PHP32,000 (US $754) for CAP-MR and CAP-HR, respectively. Based on the number of PhilHealth claims for 2012 and the estimated health care cost, the economic burden of pneumonia in 2012 was PHP8.48 billion for CAP-MR and PHP643.76 million for CAP-HR.ConclusionsThe estimated health care cost of hospitalization is markedly higher than the PhilHealth case rate payments. As per the study results, the economic burden of pneumonia is, thus, significantly higher than PhilHealth estimates

Rhinorrhea, cough and fatigue in patients taking sitagliptin

Sitagliptin is a dipeptidyl peptidase-4 (DPP IV, CD26) inhibitor indicated for treatment of Type II diabetes as a second line therapy after metformin. We report fifteen sitagliptin intolerant patients who developed anterior and posterior rhinorrhea, cough, dyspnea, and fatigue. Symptoms typically developed within 1 to 8 weeks of starting, and resolved within 1 week of stopping the drug. Peak expiratory flow rates increased 34% in 8 patients who stopped sitagliptin. Similar changes were found in 4 out of 5 persons who had confirmatory readministration. Chart review identified 17 patients who tolerated sitagliptin and had no symptomatic changes. The sitagliptin intolerant group had higher rates of clinically diagnosed allergic rhinitis (15/15 vs. 6/18; p = 0.00005), Fisher's Exact test) and angiotensin converting enzyme inhibitor - induced cough (6/13 vs. 1/18; p = 0.012). Nasal and inhaled glucocorticoids may control the underlying allergic inflammation and abrogate this new sitagliptin - induced pharmacological syndrome. Potential mucosal and central nervous system mechanisms include disruption of neuropeptides and/or cytokines that rely on DPP IV for activation or inactivation, and T cell dysfunction

Cost Analysis for the Management of Acute Coronary Syndrome using Different Quality of Care Indicators

Objective. This study determined the economic burden for nonfatal uncomplicated acute coronary syndrome (ACS) using 100% compliance to certain a) non-invasive or b) invasive and non-invasive diagnostic and therapeutic interventions with class I recommendations in the American College of Cardiology-American Heart Association (ACC-AHA) clinical practice guidelines for ACS in three tertiary hospitals using the societal perspective. It also determined the costs using the patient’s perspective in the setting of one private tertiary hospital. Methods. This study was a cost analysis that included a) costs of patient’s resources, b) production losses, and c) costs of other resources or sectors, from hospitalization to one month post-discharge for ACS. Several models were constructed due to variations in the costs of diagnostic and therapeutic interventions in the three settings. Results. Using the societal perspective, one model for noninvasive options yielded the following (costs as of January 31, 2009): hospital A, Php87,014 - 124,799; hospital B, Php75,592 - 96,072; hospital C, Php71,969 - 92,148. Excluding fibrinolytic therapy, the lowest total cost would be Php65,000. However, if coronary angiography was added to the models for hospital C, the cost was Php107,154 - 134,574 (coronary angiography was not available in hospitals A and B). Using the patient’s perspective, the adjusted mean cost for the model which used the least expensive medication was Php96,421 (Standard Deviation = 34,076). Conclusion. The economic burden for nonfatal uncomplicated ACS may range from Php65,000 - 134,574

Cost-utility analysis of add-on dapagliflozin in heart failure with reduced ejection fraction in the Philippines

Aim We aim to determine the cost-effectiveness of dapagliflozin in addition to standard therapy versus standard therapy alone among patients with heart failure with reduced ejection fraction (HFrEF) using the public healthcare provider\u27s perspective in the Philippines. Methods and results A thousand Filipino patients with HFrEF (with or without type 2 diabetes mellitus) were included in a simulation cohort using a lifetime Markov model. The model, which was developed based on the results of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial, was composed of three health states. These were ‘alive without an event’ (chronic heart failure state), ‘alive but was hospitalized for heart failure’ (worsening heart failure), and ‘dead’ (death from any cause). Data regarding costs and utilities were obtained from previous studies and local data. These were used to estimate the incremental cost per quality-adjusted life-year (ICER). A 3% annual discount rate was used for both costs and effects. One-way (deterministic) and probabilistic sensitivity analyses as well as scenario analyses were performed. The ICER for the addition of dapagliflozin to standard therapy among HFrEF patients was PHP177 868 (US$3434) and PHP160 983 (US$3108), respectively, if the present price (PHP44.00) and possible negotiated unit cost of dapagliflozin 10 mg tablet (PHP40.00) were used. These were deemed cost-effective because they were both below the threshold ICER which was equivalent to the gross domestic product per capita of the Philippines in 2019, PHP180 500 (US$3485). Using the unit costs of dapagliflozin previously mentioned, the ICERs among HFrEF patients with diabetes were PHP132 582 (US$2560) and PHP120 249 (US$2321), respectively. Doing PSA involving Monte Carlo simulation of 10 000 iterations and plotting the resulting ICERs against the threshold ICER in the cost-effectiveness acceptability curves, these ICERs for HFrEF among diabetics were determined to be 72% and 76% cost-effective. Conclusion Dapagliflozin added to standard therapy for HFrEF patients is likely to be cost-effective using the perspective of the Philippine public healthcare provider

Economic burden of community-acquired pneumonia among pediatric patients (aged 3 months to \u3c 19 years) in the Philippines

© 2017 Objective 1) To determine the hospitalization, follow-up and total costs, and the economic burden of community-acquired pneumonia among pediatric patients aged 3 months to age; 2) To compare the estimated cost of hospitalization to the pneumonia case rate payments of the Philippine Health Insurance Corporation (PhilHealth). Methods Using the societal perspective, both healthcare and non-healthcare costs were estimated. This was done through two tertiary private hospitals in the Philippines. A base-case and sensitivity analyses were performed using 2012 as the reference year. The PhilHealth claims were the basis for the economic burden. Results The estimated healthcare-related hospitalization cost for PCAP-C was PHP24,332 – 75,409 (US$576 – 1,786). For PCAP-D, it was PHP77,460 – 121,301 (US$1,834 – 2,872) without mechanical ventilation and PHP97,993 – 141,834 if mechanical ventilation was used. These amounts are markedly higher than the PhilHealth case rates of PHP15,000 for PCAP C and PHP32,000 for PCAP D. The post-discharge cost was PHP1,175 – 1,531 for PCAP C and PHP1,275 for PCAP D. The total hospitalization cost were PHP 31,332 – 93,609 for PCAP C and PHP117,103 – 160,944 for PCAP D. The exact economic burden due to pneumonia among the pediatric population was not definitely ascertained due to lack of specific number of PhilHealth claims for this age group. Conclusions There is a huge disparity between the PhilHealth case rates for PCAP C and PCAP D and the study results. Hence, the estimated economic burden of hospitalization for pneumonia would be markedly higher