Background:Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem.Objectives:To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile.Methods:A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty.Results:The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1–$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs.Conclusion:Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

Background: A cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC. Methods: Participants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively. Results: Patients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), compared to UC (n = 370) which resulted in an ICER of $2277 (95% CI $681.49-3811.22) per QALY. Conclusion: Economic findings suggest that implementation of MAS within the Australian context is cost effective.

Aim: To assess the trial-based cost–effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost–effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost–effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20–996.03). Conclusion: The intervention was cost-effective in the public primary care setting.

A225 ombitasvir/dasabuvir) +/-ribavirin compared with Harvoni® (sofosbuvir/ledipasvir) in the United States. METHODS: A cost-effectiveness Markov model, based on previous HCV models, had 13 health states: 8 disease progression states (F0-F4, decompensated cirrhosis, hepatocellular carcinoma, and liver transplant), 3 sustained virologic response states, and 2 mortality states (liver-related and nonliver-related death). Transition rates were obtained from previous models. Adverse events, treatment-related disutility, and efficacy rates were based on phase 3 clinical trials. Baseline patient characteristics were derived from AbbVie 3D phase 3 clinical trials. Treatment durations were 24 weeks for GT1a experienced cirrhotic patients with AbbVie 3D and 8 weeks for 26% of GT1 treatment naïve patients with Harvoni. Direct medical costs were based on a systematic literature review and drug costs were based on December 2014 Red Book. The model was run over a lifetime horizon, discounting at 3% annually. Outcomes were measured in quality-adjusted life-years (QALYs). Probabilistic simulation analysis (PSA) was conducted by varying all parameters simultaneously. RESULTS: AbbVie 3D resulted in discounted lifetime costs per patient of $99,753 and 16.20 QALYs. Harvoni resulted in lifetime costs of $108,430 and 16.18 QALYs. With lower costs (-$8,677) and higher QALYs (0.02), AbbVie 3D dominated Harvoni. AbbVie 3D was superior in 98.4% of PSA simulations when QALYs were valued at $100,000 each. CONCLUSIONS: With higher QALYs and lower costs, AbbVie 3D dominated Harvoni in GT1-HCV-infected patients.OBJECTIVES: Evaluate the cost-effectiveness of universal rotavirus vaccination of children below age of five years old in the Philippine setting METHODS: We developed an age-stratified dynamic transmission model which compared four settings (baseline of no vaccine with 34% exclusive breastfeeding rate (EBR), two-dose monovalent vaccine (RV1), three-dose pentavalent vaccine (RV5), and no vaccine with 80% EBR) in the Philippine population over a 5-year time horizon. Model parameters such as cost and vital statistics were Philippine specific and other parameters such as vaccine efficacy and utility were extrapolated from literature. Univariate one-way and multivariate probabilities sensitivity analyses were conducted. RESULTS: Compared to baseline, the model showed that vaccination could lead to significant reduction in rotaviral morbidity and mortality in the 0 to < 5 age group as well as inducing herd immunity in the older groups. The incremental cost-effectiveness ratios (ICER) of vaccination versus baseline from a societal perspective were US$ 13,184/DALY for RV1 and US$ 11,836/ DALY for RV5; these are higher than the the current government cost-effectiveness threshold equal to the Philippine GNI per capita of US$ 3,134. Comparing 80% EBR to baseline, ICER is US$ 256,417/DALY. ICERs were sensitive to changes in case fatality, proportion of diarrhea cases due to rotavirus, and vaccine efficacy. The vaccine was cost-effective in less tha...

IntroductionDaclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources.MethodsA Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed.ResultsPIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$ 16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$ 6,375/QALY at a price of US$ 38,710; and US$ 1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$ 38,710 was 91.6% while there is a 21.43% probability that DCV/ASV dominates PR if the total treatment price was US$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.ConclusionsDCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.