Essay Example on Patient carer and employer Costs

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Direct costs The analysis takes on a payer perspective and only includes cost of physician visits and cost of interventions Patient carer and employer costs are not taken into account The resource used for each intervention is the product monograph based on the assumption that the population completed the course for each intervention as specified The total quantity of therapy is calculated based on the number of applications duration of treatment and quantity per application based on the maximum recommended dose per week As mentioned earlier no discount rate is applied and this is well justified The study calculates cost per DFD Productivity costs No productivity losses are considered Currency Euro EUR Denmark Krone DKK Norway Krone NOK Sweden Krona SEK and Swiss Franc CHF No conversions are undertaken Statistical analysis of costs The data are deterministic Mean median maximum and minimum values are used to describe total cost and total disease free days although the authors give neither p values nor confidence intervals for the different values stated 



Methods used to allow for uncertainty A probabilistic sensitivity analysis is performed to investigate uncertainty in the efficacy resource use and proportion rates assigned to each arm of the model Parameter distributions are not defined It is also not clear whether structural uncertainty and variability in data are investigated There is no mention of expected value of information performed Estimated benefits used in the economic analysis The outcomes of the model include a direct comparison of the cost of each intervention with the level of health benefits observed as the cost per disease free day Thus the mean costs per DFD are 30 46 lower with CPS maintenance compared with its vehicle maintenance The gain in DFDs from month 2 to month 6 ranges from 21 42 depending on the choice of alternative treatment No p values or confidence intervals are reported it is not clear if data are extrapolated beyond the trial period and no side effects of treatment are considered in this economic analysis Cost results

The mean total cost of CPS is EUR 1 137 DKK 1 957 NOK 1 222 SEK 1 456 and CHF 549 respectively The average total cost of the comparator is EUR 1 386 DKK 2 815 NOK 1 384 SEK 1 777 and CHF 799 respectively No confidence intervals are reported Adverse events are not documented in this study and therefore their costs are not considered Undiscounted total incremental costs are 27 858 0115 34 31 163 104 321 and 250 respectively in each of the nine European countries No sensitivity analysis is performed for benefits only Synthesis of costs and benefits A synthesis does not appear to have been undertaken by the authors since the intervention is the dominant strategy CPS is shown to be less costly and more effective than its vehicle An incremental analysis is performed and for 996 of 1000 simulations maintenance therapy with CPS is less costly than with vehicle Author s conclusions Based on the model clobetasol propionate is cost effective in maintaining the success achieved in moderate scalp psoriasis patients CRD Commentary Choice of comparator


 The authors chose placebo as a comparator for the intervention drug This allows the active value of the treatment to be evaluated but does not include an active agent as an alternative You should decide if this represents a valid comparator in your setting Alternative comparator choices could include other corticosteroids vitamin D3 analogues and salicylic acid or combinations used in standard practice Modelling The model structure is described in full detail including a graphical representation Both model parameters and their sources are reported in full The authors also investigate uncertainty in the model parameters through a probabilistic sensitivity analysis All parameter distributions are clearly defined and justified Results are presented in full and cost effectiveness acceptability curves are provided Validity of estimates of effectiveness The authors combine data from an existing model with data from several published clinical studies It is clear from the model inputs that some synthesis of the study results has taken place However no details of the methods used are provided The authors do not report any search methods or inclusion criteria nor do they provide any justification for their selection of the estimates

The treatment effect parameters are obtained from published randomised clinical trials which are highly ranked in the hierarchy of evidence and known for high levels of internal validity Although not explicitly stated there is compelling evidence to suggest that the population studied sample size method of random allocation and analysis are relevant representative and appropriate owing to the randomised double blinded placebo controlled multicenter clinical trial design Adverse events data are neither documented nor reported Validity of estimate of health benefit Disease free days DFDs are used as the summary benefit measure They are obtained directly from the effectiveness analysis Validity of estimate of costs It is explicitly stated that a payer perspective whether publicly or privately funded health care system was adopted Only two direct costs are considered namely physician visits and costs of intervention Sources of the resource use and unit cost data are reported No discount rate is applied which is appropriate for the time horizon 1 year This could have implications for the generalisability of the study beyond the study setting


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