Recent cost-effectiveness analysis on regimens approved for Hepatitis C virus genotypes 1 & 4:
Abstract
Background: Numerous economic models have been published evaluating treatment of chronic hepatitis C virus (HCV) infection, but none provide a comprehensive comparison among new antiviral agents. Objective: Evaluate the cost-effectiveness of all recommended therapies for treatment of genotypes 1 and 4 chronic HCV. Methods: Using data from clinical trials, observational analyses, and drug pricing databases, Markov decision models were developed for HCV genotypes 1 and 4 to compare all recommended drugs from the perspective of the third-party payer over a 5-, 10-, and 50-year time horizon. A probabilistic sensitivity analysis (PSA) was conducted by assigning distributions for clinical cure, age entering the model, costs for each health state, and quality-adjusted life years (QALYs) for each health state in a Monte Carlo simulation of 10 000 repetitions of the model. Results: In the lifetime model for genotype 1, effects ranged from 18.08 to 18.40 QALYs and total costs ranged from $88 107 to $184 636. The lifetime model of genotype 4 treatments had a range of effects from 18.23 to 18.43 QALYs and total costs ranging from $87 063 to $127 637. Grazoprevir/elbasvir was the optimal strategy followed by velpatasvir/sofosbuvir as the second-best strategy in most simulations for both genotypes 1 and 4, with drug costs and efficacy of grazoprevir/elbasvir as the primary model drivers. Conclusions: Grazoprevir/elbasvir was cost-effective compared with all strategies for genotypes 1 and 4. Effects for all strategies were similar with cost of drug in the initial year driving the results.
Using 340B drug discounts to provide a financially sustainable medication discharge service:
Abstract
The 340B Drug Pricing Program was intended to stretch federal resources by providing significant discounts to covered entities providing care to underserved populations. Program implementation and evidence of expanding services to higher income patients has brought more scrutiny and calls for elimination of the program. While additional review and reform may be warranted, profitability from 340B discounts enables covered entities to provide additional services that may not be feasible in absence of the program. This case report demonstrates one institution’s use of 340B discounts to financially justify providing bedside medication delivery services for patients at the time of discharge from an inpatient admission. A simple financial model was developed using hospital data and inputs from available literature to estimate gross profit and earnings before interest, taxes, depreciation, and amortization (EBITDA) with and without 340B discounts. Without the 340B drug price discounts, the service would operate at a financial loss, and further investigation must be done to determine whether other clinical or economic benefits would warrant discharge medication delivery at the institution.
Recent economic model of net income for pharmacy school graduates:
Abstract
Objective. To compare new practitioners in 2009 and 2014 by modeling net income from available salary, expenditure, and student loan data. Methods. A Monte Carlo simulation with probabilistic sensitivity analysis was conducted to model net income for graduating pharmacists in 2009 and 2014. Mean and standard deviations were recorded for each model parameter. Student t-tests were used to compare the mean differences between 2009 and 2014 cohorts. Results. Pharmacist salary and disposable income were higher on average in 2014 compared with 2009. Consumer expenditures were higher in 2014, offsetting the higher salary resulting in a 2014 discretionary income that was less than in 2009 [95% CI: -$2,336, -$1,587]. Net income decreased from 2009 to 2014 for all pharmacy school types. Conclusion. Regardless of loan payment strategy, net incomes for pharmacists graduating from public and private institutions were less in 2014 compared with 2009.