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Maarten J Postma

Publications and source records attributed to Maarten J Postma.

33 records · Page 2Linked to original sources
PubMed2004

Cost-effectiveness of antenatal HIV-testing: reviewing its pharmaceutical and methodological aspects.

This paper reviews the pharmacoeconomic aspects of antenatal testing for HIV. HIV is a retrovirus which is transmitted among humans through sexual contact, infected blood or blood products (needle sharing or percutaneous accidents) and from mother to child (vertical transmission). Vertical transmission from the HIV-infected mother can occur in utero during and after delivery, through breastfeeding. Effective interventions available to reduce the risk of vertical transmission include: pharmacotherapy prior, during and after delivery; voluntary caesarean section; and replacing breastfeeding by bottle-feeding [1,2]. The existence of these effective interventions underlies the need to detect yet undiagnosed HIV-infection in pregnancy through antenatal testing. Contemporary pharmacotherapy consists of a combination of three or more antiretroviral drugs, also referred to as highly-active antiretroviral therapy (HAART). For newly detected HIV-infected mothers, the Centers for Disease Control suggests the use of a zidovudine-comprising combination with one other nucleoside analogue reverse transcriptase inhibitor and a protease inhibitor (PI) [3]. As HIV in pregnancy may be asymptomatic, structured antenatal HIV-testing therefore seems to offer an attractive prevention strategy. Two broad types of approaches exist: selective or targeted testing versus universal testing. The availability of effective - but expensive - combination therapies since 1996 has greatly enhanced the importance of pharmacoeconomic assessments in the field of HIV-infection. Treatment of the mother will incur additional costs but will also make any programme more effective. Furthermore, avoiding children becoming infected with HIV will also incur monetary benefits, as children are also being treated with HAART. In summary, the background of antenatal HIV-testing has undergone major changes compared with the early 1990s. This review of the pharmacoeconomics of antenatal HIV-testing followed a systematic approach as it was performed according to prespecified criteria, allowing valid comparisons in methodologies and findings of those studies that have yet been conducted in this area.

Anti-HIV Agents↗
PubMed2004

A multicentre study of patient survival, disability, quality of life and cost of care: among patients with AIDS in northern Italy.

OBJECTIVE: To describe the epidemiological, clinical and economic changes that occurred in the HIV epidemic in Italy prior to and after the introduction of highly active antiretroviral therapy (HAART). DESIGN: A prospective, observational, multicentre case-control study was conducted comparing data, collected over 6 months, from an AIDS cohort in 1998 with that of a cohort in 1994. Out of 77 patients with AIDS in the 1998 cohort, 74 survived. These 74 patients were matched for severity of illness with 74 patient survivors from the 1994 cohort to enable valid comparisons of mortality, disability-dependency (DD), health-related QOL (HR-QOL), and direct costs. RESULTS: Overall, a considerable difference was observed in mortality (33.8% in 1994 vs 3.9% in 1998) between unmatched patients of the two cohorts. As for matched patients, the number of hospital admissions was 1.7 in 1994 and 0.8 in 1998; the average length of stay was 28.1 days in 1994 and 12.6 days in 1998. The direct cost per patient per year was euro15 390 and euro11 465 for the 1994 and 1998 cohorts, respectively (1999 values). The 1998 patient cohort had significantly better HR-QOL at 6 months in two domains of the instrument used (emotional reaction and energy) and the percentage of totally dependent patients was significantly lower compared with the 1994 cohort (1.4% vs 6.8%). CONCLUSIONS: This is the first study to present a comprehensive comparison of direct costs, DD and HR-QOL of patients with AIDS between two time periods. The use of a case-control design has enabled changes in costs and outcomes to be linked to the introduction of HAART in Italy in 1997.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Valuing prevention through economic evaluation: some considerations regarding the choice of discount model for health effects with focus on infectious diseases.

In cost-effectiveness analysis, the valuing of costs and health effects over time remains a controversial issue. The debate mostly focuses on whether the discount rates for health and money should be equal and which discounting model and time preferences are most appropriate. In this paper we add to the debate by arguing that the assessment of effectiveness of a preventive intervention may influence the choice of the discounting procedure for health. Health effects in cost-effectiveness analysis are commonly expressed in life-years gained, QALYs gained or lives saved. These denominators are only indirect and partial measures of the effects of a preventive intervention. The actual effect of the intervention is a reduction of the risk of mortality and morbidity in a given period of time. This risk reduction will not always coincide with the moment at which the impact on (quality-adjusted) life-years gained is made (i.e. at risk exposure), for example when preventing chronic disease with an asymptomatic stage. In this paper we show that truly acknowledging the origin of health benefits could have implications for the discounting procedure. We present a discounting model that adequately focuses on the reduction of risk. This model recognises the potential interpretation of risk reduction for infection as an economic good to be acquired with associated mortality reductions as later indirect effects. This implies that our suggested discounting model focuses on the moment(s) of risk reduction. A numerical example illustrates our approach. We discuss the associated potential implications for public health policy and discuss how the effects of the intervention can be additionally corrected for societal preferences.

Economics, Pharmaceutical↗
PubMed2003

A pharmacoeconomic comparison of the efficacy and costs of pantoprazole and omeprazole for the treatment of peptic ulcer or gastroesophageal reflux disease in The Netherlands.

BACKGROUND: The focus of treatment of patients with peptic ulcer or gastroesuphageal reflux disease has changed during the last 15 years, with a shift from histamine2-receptor antagonists to proton-pump inhibitors (PPIs). From 1993 to 2000, expenditures for omeprazole (90% of total market share of PPIs) increased in The Netherlands from 68 million euros to 230 million euros. In 1999, expenditures for pantoprazole accounted for the majority of the rest of the market share for PPIs. OBJECTIVE: The objective of this study was to compare the efficacy and costs of treatment with pantoprazole and omeprazole in The Netherlands. METHODS: First, we reviewed clinical studies that compared the efficacy of different dosages of omeprazole and pantoprazole. Second, we analyzed data from a nationwide database of drug prescriptions to determine the dosages used in daily practice in 1999. The data were based on a representative sample of approximately 40% of the Dutch community pharmacies. Third, we modeled the outcome of potential substitution of pantoprazole for omeprazole and the corresponding scenarios for nationwide cost savings using the prescription information from the nationwide database. Potential savings within the Dutch health care system were estimated. RESULTS: The 1999 prescription data indicated that pantoprazole treatment cost a mean 1.59 euros/d, compared with 2.12 euros/d for omeprazole (1.00 euro = 1.0487 US dollars). The mean cost per defined daily dose of omeprazole was 1.65 euros, compared with 1.59 euros for pantoprazole. Following the summary of product characteristics, treatment with pantoprazole appeared to be less costly for all indications. The projected annual cost savings for substituting pantoprazole for omeprazole on 90% of treatment days were estimated at 40.8 million euros. However, these projected savings may be offset by the costs of switching and the costs of upward dose adjustments that some patients may require. CONCLUSIONS: Based on the available documentation about effectiveness and costs of omeprazole and pantoprazole, pantoprazole may provide a more favorable pharmacoeconomic profile than omeprazole. However, this is only true if the substitution of omeprazole by pantoprazole can be achieved without loss of efficacy or tolerability.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Cost-effectiveness of transfusion of platelet components prepared with pathogen inactivation treatment in the United States.

BACKGROUND: The Intercept Blood System (IBS) for platelets has been developed to reduce pathogen transmission risks during transfusions. OBJECTIVE: This study was a comprehensive economic analysis of the cost-effectiveness of using the IBS for single-donor apheresis platelets (AP) and random-donor pooled platelet concentrates (PC) versus AP and PC without the IBS in the United States in patient populations in which platelets are commonly transfused. METHODS: All data used in this analysis were summarized from existing published sources (primarily indexed in MEDLINE) and data on file at Baxter Healthcare Corporation (Chicago, Illinois) and Cerus Corporation (Concord, California). A literature-based decision-analytic model was developed to assess the economic costs and clinical outcomes associated with the use of AP and PC treated with the IBS for several conditions and procedures that account for a considerable proportion of the platelet usage in the United States: acute lymphocytic leukemia, non-Hodgkin's lymphoma, coronary artery bypass graft, and hip arthroplasty Risks of infection with HIV, hepatitis C virus (HCV), hepatitis B virus, human T-cell lymphotropic virus type 1, or bacterial agents were incorporated into the model. Possible benefits of reduction of the risk of emerging HCV like pathogens and elimination of the need for gamma irradiation were explored in sensitivity analyses. RESULTS: The incremental cost per quality-adjusted life-year gained by using AP + IBS versus untreated AP ranged from 1,308,833 dollars to 4,451,650 dollars (without bacterial testing) and 4,759,401 dollars to 22,968,066 dollars (with bacterial testing). Corresponding figures for PC + IBS versus untreated PC ranged from 457,586 dollars to 1,816,060 dollars. Inclusion of emerging HCV like virus and the elimination of the need for gamma irradiation improved the cost-effectiveness to a range of 177,695 dollars to 1,058,127 dollars for AP without bacterial testing, 176,572 dollars to 1,330,703 dollars for AP with bacterial testing, and 22,888 dollars to 153,564 dollars for PC. The model was most likely to be affected by mortality from bacterial contamination, IBS effect on platelet utilization, and the inclusion of potential benefits (ie, gamma irradiation and/or emergent HCV-like virus). The model was relatively insensitive to changes in the IBS price and viral transmission risks. CONCLUSIONS: The cost-effectiveness of pathogen inactivation via the IBS for platelets is comparable to that of other accepted blood safety interventions (eg, nucleic acid amplification technology). The IBS for platelets may be considered a desirable strategy to increase the safety of platelet transfusions and a potential insurance against the threat of emerging pathogens.

Bacterial Infections↗
PubMed2003

Impact of pharmacist recommendations on the cost of drug therapy in ICU patients at a Malaysian hospital.

OBJECTIVES: To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions. METHODS: A clinical pharmacist reviewed drug prescriptions during one month. Drug-related problems were documented on a prepared from including a suggestion for a change in prescribing. Such recommendations were submitted to the nursing/medical staff. Acceptance of the recommendation was entirely at the discretion of the medical staff. All recommendations were analysed with respect to potential pharmaco-economic impact: cost savings, cost avoidance or cost addition. RESULTS: The ICU pharmacist made 57 recommendations, of which the medical staff rejected only 5%. The majority of detected drug-related problems referred to unnecessary drug therapy (37%). Recommendations resulted in net cost savings of RM 15,227 (USD 4,007). This corresponded with RM 634 per patient intervened by the pharmacist. CONCLUSION: Pharmacists interventions in the ICU of a Malaysian hospital resulted in significant cost savings in terms of drug expenses and can therefore be suggested as a routine practice in our hospital.

Cost Savings↗
PubMed2003

Pharmacoeconomic research.

Efficacy and safety are crucial considerations in judging drugs, for example, whether or not to include them in a local formulary. More and more, pharmacoeconomic aspects are becoming of additional importance. How should we interpret such pharmacoeconomic studies? To enhance accurate interpretation of such studies among our readership, we present the basic concepts of pharmacoeconomics in this commentary.

Cost-Benefit Analysis↗
PubMed2003

Pharmacoeconomic aspects of losartan treatment to delay progression of renal disease in patients with Type 2 diabetes.

There is growing evidence from clinical trials that losartan (Cozaar, Merck & Co., Inc.) and other angiotensin (A)-II-receptor antagonists have beneficial effects on the progression of renal disease among Type 2 diabetic patients beyond the benefits derived from the effect of blood-pressure lowering alone [corrected]. Comparators used is the studies were not angiotensin-converting enzyme-inhibitors but typically conventional hypertensive therapy plus placebo, placebo alone and in one case, amlodipine. These trials have reported reductions in progression to end stage renal disease (ESRD) (losartan and irbesartan) and to nephropathy (irbesartan). An important pharmacoeconomic question is whether potential cost-savings on reduced progression to ESRD and nephropathy outweigh the extra costs of A-II-antagonist treatment. This paper will review the published economic studies for A-II-receptor antagonists and their pharmacoeconomic implications. In particular, potential pharmacoeconomic implications and related methodological aspects of the recent RENAAL trial for losartan are considered.

Angiotensin II↗
PubMed2003

Pharmacoeconomics of elderly vaccination against invasive pneumococcal infections: cost-effectiveness analyses and implications for The Netherlands.

We performed a review of cost-effectiveness of elderly pneumococcal vaccination to prevent invasive disease. It concerns studies in the USA, Canada, Netherlands and Spain and a multinational study of five European countries. Cost-effectiveness of elderly vaccination against invasive pneumococcal infections varies from cost-saving to EUR 33,000 per life-year gained. The Dutch study estimates cost-effectiveness at EUR 10,100 per life-year gained (price level: 1995). This is below the level that has recently been defined for treatment of high cholesterol (EUR 20,000 per life-year gained) and may therefore be considered as favorable. Almost all studies base their estimate of vaccine efficacy on the same case-control study from the USA. We identify a need for a systematic review on the efficacy of the pneumococcal vaccine. Also, we suggest further analysis with respect to potential effects on cost-effectiveness of extended influenza vaccination for the Dutch elderly in recent years and inclusion of pneumococcal re-vaccination. Pending this additional information, we conclude that cost-effectiveness of vaccination against invasive pneumococcal infections for Dutch elderly is favorable (as in several other countries) and justifies implementation from a pharmacoeconomic point of view.

Aged↗
PubMed2002

Cost-effectiveness of widespread screening for Chlamydia trachomatis.

Screening for sexually transmitted diseases is included in routine health care for several infectious agents in many western European countries. Current considerations on extensions of these programs include widespread screening strategies for Chlamydia trachomatis. In women, C. trachomatis infection may lead to sequelae such as infertility and ectopic pregnancy. This paper reviews the goal of screening and subsequent therapy and the available compounds for testing and treating. Furthermore, the current best practice - in particular with respect to economic performance - is discussed, and those factors that most crucially influence the economic profile are described. Illustrations are drawn from recent work in The Netherlands, which may also be representative for other settings.

Chlamydia Infections↗
PubMed2002

Cost-benefit analysis of the detection of prescribing errors by hospital pharmacy staff.

OBJECTIVE: Prescribing errors are a major cause of iatrogenic patient morbidity and therefore interventions aimed at preventing the adverse outcomes of these errors are likely to result in cost reduction. However, it is unclear whether the costs associated with these preventive measures are outweighed by the cost reductions (benefits). Therefore, a study was set up to analyse costs and benefits of detecting prescribing errors by hospital pharmacy staff. DESIGN: During 5 consecutive days in two Dutch hospitals in February 2000 all medication orders, in which prescribing errors were detected, were analysed. A cost-benefit analysis was performed, based on direct medical costs only. The benefit-to-cost ratio was calculated by taking into account the net time hospital pharmacy staff needed for the prevention of the error (this included potential time saving for nursing staff, when an error was prevented by hospital pharmacy staff instead of nursing staff), as well as taking into account the possible consequences of the prescribing error (were the error not prevented). RESULTS: A total of 3540 orders, of which 351 contained prescribing errors (9.9%), were analysed. During the 1-week period investigated, time-investment of the pharmacy staff had net costs of EUR285 (2000 values). During the same period estimated benefits related to this investment were EUR9867. The finding of higher benefits than costs was robust in sensitivity analysis. CONCLUSIONS: From this study it can be concluded that prevention of prescribing errors by hospital pharmacy staff results in higher benefits than the costs related to the net time investment.

Cost-Benefit Analysis↗
PubMed2002

Pharmacoeconomics of influenza vaccination for healthy working adults: reviewing the available evidence.

A favourable pharmacoeconomic profile has been well established for influenza vaccination in the elderly. For employers relevant benefits seem to exist for vaccinating healthy working adults to avert absenteeism and related production losses. From a pharmacoeconomic point of view it is relevant to consider whether societal benefits of vaccination for healthy working adults is worthwhile given the costs of vaccination for the community. We searched Medline and Embase using the key words influenza (vaccination) in combination with cost, cost-benefit, cost-effectiveness, efficiency, economic evaluation, health-policy and pharmacoeconomics. From this primary search, we selected 11 studies concerned with the group of healthy working adults. We reviewed these studies according to several criteria: benefit-to-cost (B/C) ratio;vaccine effectiveness, influenza incidence, number of days of work absence due to illness; and relative cost of the vaccine. Three studies on vaccinating healthy working adults found costs exceeding the benefits (B/C-ratio <1). The remaining eight pharmacoeconomic studies found a B/C-ratio of almost two or more. Cost savings are strongly related to the inclusion of indirect benefits related to averted production losses. After exclusion of indirect costs and benefits of production gains/losses, only one of the eight studies remains cost saving. Considering the available pharmacoeconomic evidence, vaccination of healthy working adults in Western countries may be an intervention with favourable cost-effectiveness and cost-saving potentials if indirect benefits of averted production losses are included. Excluding indirect benefits and costs of production losses/gains, cost-saving potentials are limited. Recent international guidelines for pharmacoeconomic research advise the inclusion of production gains and losses in the preferred societal perspective. Hence, on the basis of the available evidence, influenza vaccination of healthy working adults may be recommended from pharmacoeconomic point of view. Pharmacoeconomics do, however, present only one argument for consideration aside from ethical issues, budgetary limits and psychosocial aspects.

Adult↗
PubMedDate not supplied

Systematic screening for Chlamydia trachomatis: estimating cost-effectiveness using dynamic modeling and Dutch data.

OBJECTIVE: To estimate the cost-effectiveness of a systematic one-off Chlamydia trachomatis (CT) screening program including partner treatment for Dutch young adults. METHODS: Data on infection prevalence, participation rates, and sexual behavior were obtained from a large pilot study conducted in The Netherlands. Opposite to almost all previous economic evaluations of CT screening, we developed a dynamic Susceptible-Infected-Susceptible (SIS) model to estimate the impact of the screening program on the incidence and prevalence of CT in the population. SIS models are widely used in epidemiology of infectious diseases, for modeling the transmission dynamics over time. Subsequently, a predictive decision model was used to calculate the complications averted by the screening program. Cost-effectiveness was expressed as the net costs per major outcome averted (MOA) and was estimated in the baseline analysis and in sensitivity analysis. RESULTS: The overall prevalence decreased from 1.79% to 1.05% as a result of the screening program directed at both men and women. The program costs were mainly offset by the averted costs, although not fully. Resulting net costs per MOA were 373 euro sin the baseline analysis. Sensitivity analysis showed that partner treatment and sending a reminder are important aspects improving cost-effectiveness. Additionally, restricting the screening to women only was estimated to save costs. CONCLUSIONS: Our cost-effectiveness analysis shows that the Dutch society has net to pay for the prevention of CT-complications through screening young men and women. One could argue although that 373 euros per MOA presents a reasonable cost. A screening program consisting of screening women only should always be adopted from a pharmacoeconomic point of view. Our dynamic approach appreciates better the specific characteristics of an infectious disease, such as CT.

Adult↗