Considering the cost-effectiveness of statins in family practice in Turkey from a payer perspective

Kockaya, G.; Wertheimer, Albert I.; Kockaya, P. Daylan; Esen, Ahmet Adil

doi:10.4236/health.2009.14044

Cited by 3 publications

(4 citation statements)

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“…Years of life lost (YLL) was used for the clinical effectiveness parameter. The life expectancy of healthy individuals according to the life expectancy at birth in Turkey was used for the response to therapy, and it was calculated again for each year in the model [ 27 ]. In the case of irresponsiveness to therapy, published complications and mortality transitions were used for the calculation of the YLL, and it was calculated again for each year in the model [ 11 , 12 , 14 , 16 , 19 , 22 – 26 ].…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness analysis of oral anti-viral drugs used for treatment of chronic hepatitis B in Turkey

Kockaya¹,

Kose²,

Yenilmez³

et al. 2015

Cost Eff Resour Alloc

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BackgroundAll international guidelines suggested that Tenofovir and Entecavir are the primary drugs at the first line therapy for the treatment of chronic hepatitis B (CHB). However, in Turkey these medications reimbursed at the second line therapy according to the Healthcare Implementation Notification. The aim of this study is to compare the cost effectiveness of oral antiviral treatment strategies in CHB for Turkey using lamuvidine, telbuvidine, entecavir, and tenofovir as medications.MethodsThe analysis was conducted using Markov models. The analysis scenarios based on first line treatment options with Lamuvidine, Telbuvidine, Entecavir, and Tenofovir as the medications. In the analysis, inadequate response or resistance after receiving 12 months of the treatment with Entecavir and Telbivudine were compared to the results found from switching from Entecavir to Tenofovir or from switching from Telbuvidine to Tenofovir. In additional, inadequate response or resistance after receiving 6 months of the treatment for Lamivudine was compared to the results found from switching from Lamivudine to Tenofovir. The study population included men and women, who were 40 years of age. The patients` compliance was estimated 100 % for all of the therapy options. The model duration was constructed to evaluate, treatment strategy duration of 40 years. The cost of medications, examinations/follow-ups and complications were included in the model. Years of Potential Life Lost was used as the health outcome. An incremental cost-effectiveness ratio analysis has been conducted.Results and discussionWhile the minimum years of life lost was found as 0.22 with tenofovir treatment in 5 years, treatment cost was calculated as 12,169 TL. These values were detected as 0.56 years and 7727 TL, 0.37 years and 12,770 TL, respectively for lamuvidine and telbuvidine treatments. The maximum years of life lost and treatment cost was with lamuvidine treatment were detected as 1.60 years and 18,813 TL and, secondly 0.89 years and 24,007 TL for lamuvidine-tenofovir treatment during 10 years. The minimum years of life lost and cost are 0.54 year and 35,821 TL for tenofovir treatment during 10 years. The minimum years of life lost and cost were determined as 1.21 years and 52,839 TL for tenofovir treatment strategy during 20 years. During 30 years period, tenofovir treatment was found to have the minimum years of life lost (1.73 years) and minimum cost (84,149 TL). When the results of 40 years period were analyzed, years of life lost and costs are 2.06 years and 119,604 TL, 2.13 years and 162,115 TL, 2.13 years and 161,642 TL, 6.52 years and 147,245 TL, 3.20 years and 132,157 TL, 4.10 years and 151,059 TL and 3.05 years and 138,182 TL for tenofovir, entecavir, entecavir-tenofovir, lamuvidine, lamuvidine-tenofovir, telbivudine and telbivudine-tenofovir.ConclusionsIn the model presented in this study, in cost effectiveness analysis about CHB treatments, Tenofovir was found to be one of the cost effective methods in comparison with other treatment strategie...

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Section: Methodsmentioning

confidence: 99%

“…If a treatment cost was lower than the next treatment cost and its effectiveness was higher, it was stated to be “superior,” and the assessment was performed with the next treatment. If the effectiveness was high along with a high cost, the ICER formulation was applied as follows [ 27 ]: …”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of oral anti-viral drugs used for treatment of chronic hepatitis B in Turkey

Kockaya¹,

Kose²,

Yenilmez³

et al. 2015

Cost Eff Resour Alloc

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“…Diğer taraftan rosuvastatinin, simvastatin haricinde diğer statinlere göre daha maliyet-etkili olduğu belirtilmiştir. Geri ödeme önerisi olarak da; statin tedavilerinde simvastatin ve rosuvastatine öncelik verilmesi önerisi getirilmiştir (4).…”

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Analysis of pharmaco-economic assessments on anti-hypertension and anti-lipidemia medicines for Turkey

Kockaya¹

2012

Anadolu Kardiyol Derg

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Kardiyovasküler hastalıklar gelişmiş ve gelişmekte olan ülkelerde her geçen gün daha da önemli olmaktadır. Gerek halk sağlığı üzerine etkisi, gerekse ülkelerin sağlık sistemlerinin bütçeleri üzerine etkisi, artan önemini daha da belirginleştirmektedir. Kardiyovasküler hastalıkla-ra bağlı ölümler tüm ölüm nedenlerinin Avrupa ülkelerinde yaklaşık %49`u, Avrupa Birliği ülkelerinde yaklaşık %42`sidir (1). Kardiyovasküler hastalıkların en önemlilerinden biri olan hipertansiyonu ele aldığımızda 2000 yılı itibari ile Dünya nüfusunun %25.6`sının hipertansiyonlu olduğu ve yapılan çalışmalarda 2025 yılında bu oranın %29.2`ye çıkacağı öngö-rülmektedir (2). Diğer taraftan hiperlipidemiye bağlı gözlenen koroner kalp hastalıklarının da benzer şekilde artış trendinde olduğu söylenebilir.Anti-hipertansiyon ve anti-lipidemik tedavilerin ülkelerin sağlık harcamalarında kapladığı yerin, bu hastalıkların görülme sıklığının artmasıyla beraber arttığı gözlenmiştir. Ülkemizde ilaç bütçesinin kontrolü için gerek Sosyal Güvenlik Kurumu gerekse Sağlık Bakanlığı nezdinde birçok çalışmalar yapılmak-tadır. Bu çalışmalardan en önemlilerini az örnek olmasına rağmen farmakoekonomik analizler oluşturmaktadır. 2008 yılından itibaren ilaçların geri ödeme sistemine dâhil edilmesindeki değerlendirme sürecinde, farmakoekonomik analizlerin zorunlu tutulması ile bu analizlerin önem-leri daha da artmıştır. Her ne kadar yapılmış çalışmalar veri yetersizliği, yetişmiş personel yetersizliği gibi nedenlerden dolayı az olsa bile antihipertansiflerden anjiyotensin reseptör blokerleri (ARB) ve statinler üzeri-ne yapılmış iki ayrı çalışma ülkemizde de bu tarz çalışmaların yapılabile-ceğini göstermektedir.ARB`nin irdelendiği çalışmada daha öncesinde yayınlanmış bir meta-analiz üzerine, karar ağacı yöntemi ile kurulan bir model ile 2010 yılı maliyet verilerine göre irbesartan, kandesartan, losartan ve valsartan ile bu ilaçların hidroklorotiyazid kombinasyonlarının maliyet-etkililik analizi gerçekleştirilmiştir. Bu analiz sonucunda losartan ve hidroklorotiyazid kombinasyonunun en uygun tedavi maliyeti sunduğu ve 1 yıllık hasta başına tedavi maliyetinin ortalama 423 TL olduğu belirtilmiştir. Diğer taraftan irbesartan`ın losartan haricinde diğer ARB`lere göre daha maliyet etkili olduğu belirtilmiştir. Geri ödeme önerisi olarak da; ARB tedavilerinde birinci sırada losartan ve kombinasyonlarını, başarı-sız olunduğunda ve anjiyotensin reseptör blokeri kullanılacak ise irbesartan ve kombinasyonları önerisi getirilmiştir (3).Statinlerin irdelendiği çalışmada daha öncesinde yayınlanmış meta-analiz üzerine, karar ağacı yöntemi ile kurulan model ile 2009 yılı maliyet verilerine göre atorvastatin, fluvastatin, pravastatin, rosuvastatin ve simvastatin ile maliyet-etkililik analizi gerçekleştirilmiştir.Simvastatin sahip olduğu fiyat avantajından dolayı en uygun tedavi maliyetini sunduğu ve 1 yıllık hasta başına tedavi maliyetinin ortalama 249 TL olduğu belirtilmiştir. Diğer taraftan rosuvastatinin, simvastatin haricinde diğer statinlere göre daha maliyet-etkili olduğu belirti...

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“…In the past, evaluation of statins' cost-effectiveness has included assessment of the prevalence and incidence of diseases treated by statins [1,2], costs of morbidity and mortality of these diseases [1,2], relative effectiveness and safety of statins compared to other treatment options [1][2][3][4][5][6][7][8], and the relative cost-effectiveness of available statins in comparison to each other [2,7]. The cost-effectiveness evaluation conducted by Kockaya, et al [2] was specific to family practice in Turkey and is particularly germane to the discussion in this commentary (http://www.scirp.org/journal/HEALTH/). The evaluations just described are extremely useful for decision-making, but typically are made under the assumptions that patients have adequate access to each compared medication and that the medications are used as directed in order to achieve outcomes similar to those identified through controlled clinical trials.…”

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confidence: 99%

Will a Fixed Price Reimbursement Policy for Statins be Cost-Effective for Turkey's Health Care System?

Kockaya¹,

Wertheimer²

2010

Innov Pharm

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Considering the cost-effectiveness of statins in family practice in Turkey from a payer perspective

Cited by 3 publications

References 9 publications

Cost-effectiveness analysis of oral anti-viral drugs used for treatment of chronic hepatitis B in Turkey

Cost-effectiveness analysis of oral anti-viral drugs used for treatment of chronic hepatitis B in Turkey

Analysis of pharmaco-economic assessments on anti-hypertension and anti-lipidemia medicines for Turkey

Will a Fixed Price Reimbursement Policy for Statins be Cost-Effective for Turkey's Health Care System?

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