Pharmacoeconomics: Open Access

Objective: To investigate the resource use and costs associated with the management of metastatic anaplastic lymphoma kinase inhibitors (ALK+) NSCLC in Greece. Methods: The resource use was based on the outcomes of a Delphi panel with seven oncologists and unit costs derived from officially published sources. Results: The average per patient cost in the current treatment pathway (chemotherapy, crizotinib, chemotherapy, palliative care) was estimated at €67,391. The average per patient cost in future scenario 1 (crizotinib, ceritinib, chemotherapy, palliative care) was estimated at €104,571 (treatment duration 26 months) while in future scenario 2 (chemotherapy, ceritinib, chemotherapy, palliative care) was estimated at €134,215 (treatment duration 29.3 months). Conclusion: Ceritinib as second line treatment leads to an increase in total costs reflecting the longer survival

Human prototheca meningitis was rarely reported in the world; here we present another case report. A 23 year old young man was admitted to department of infectious disease of the third affiliated hospital of Sun Yat-sen university, complaining of fever, headache and vomiting. Before admission, he had been diagnosed as tuberculous meningitis. After taking chemical therapy with antituberculous drugs combined with adrenocortical hormones for two months, his condition deteriorated. Cerebrospinal fluid (CSF) was collected through lumbar punture for the patient, and prototheca species, which was sensitive to amphotericin B and nystatin, was discovered in CSF after culture. During hospitalization, the patient’s condition once ameliorated when the total amount of amphotericin B reached to 2400 mg three months later. However, the secondary bacterial infection in central nervous system, abdomen, and lungs might contribute to the death of the patient when amphotericin B reached to 6000 mg after 11 months. Prototheca species, though rarely been described, may also have a significant pathogenic potential in human.

In Ireland 68.3 m drug items were prescribed in 2010, a national average prescribing rate (APR) of 14.9 items per person. Regional APRs ranged from 13.2 items in the East to 17.1 items in the South-East region. We construct a model of regional prescribing rates in Ireland that embeds the effects of the national prescribing rates under each of Ireland’s three main community drug schemes, the regional coverage rates of those schemes and each region’s health status. Drawing on the CPS Composite Health Index to measure regional health status and the Primary Care Reimbursement Service database for all other variable, we estimate the model by Ordinary Least Squares (OLS). We find that variations in regional prescribing rates were mainly due to the different regional coverage rates of Ireland’s community drug schemes, especially its GMS (General Medical Services) community drug scheme and, to a lesser extent, to differences in each region’s health status. We simulate the estimated model and find that a percentage point reduction in each region’s GMS coverage rate would reduce the number of items prescribed nationally twice as much as a percentage point gain in each region’s health status. We find that regional prescribing rates respond most to changes in national prescribing rates in low-income regions that have high GMS coverage rates and poor health status. At the height of Ireland’s public debt crisis in 2010, government policy pressured GMS national prescribing rates down by around 2% in an effort to contain public drug costs. That reduced regional prescribing rates most in low-income regions that had high GMS coverage rates and poor health status.