摘要:

Although the advantages of disseminating health information on the world wide web are well recognized, there has been considerable concern about the quality of online information. There has also been some debate as to whether organizations with a vested interest in a product, such as pharmaceutical companies, can provide balanced and appropriate information on the web. However, there is very little published information about the content, quality or impact of pharmaceutical websites. This paper considers the issues, arguments and empirical evidence for and against the practice of direct-to-consumer advertising by pharmaceutical companies. It also describes a selected set of pharmaceutical company sites that provide consumer information about major public health problems or about health conditions corresponding to frequently used search engine terms. The pharmaceutical sites surveyed were characterized both by positive attributes (such as a breadth and depth of information, specification of medication adverse effects, and inclusion of potentially useful consumer aids such as symptom diaries and screening tests) and negative features (such as failure to disclose authorship and scientific sources, failure to provide clear and accessible information about the absolute and relative efficacy of the treatments mentioned, and absence of an editorial board or independent review process).We note that these attributes are not necessarily indicative of the quality of the content or the utility of websites and argue that there is a need for systematic studies comparing the accuracy of the content of pharmaceutical sites and nonpharmaceutical sites. Such studies would need to be conducted by content experts using evidence-based information as a gold standard. Many consumers are not in a position to assess the quality of the content of pharmaceutical sites and do not place a high level of trust in pharmaceutical companies. We suggest that it might be in the interests of the companies to encourage the independent review and certification of their sites. A consortium of companies could contribute funds to an independent authority that in turn could contract third party content evaluators to undertake quality assessments of pharmaceutical sites. In the future, initiatives such as the MedCERTAIN collaboration might provide consumers with certification information on a range of health sites including pharmaceutical websites. Not only would such evaluations provide a means for consumers to identify high quality sites, they might also assist pharmaceutical companies to optimize the quality and credibility of the health information they provide on the web.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Increasingly, primary care physicians are being given budgets based on capitation formulae in the belief that such budgets will be fairer than budgets based on the historical utilization of funds. A second reason for giving primary care physicians budgets based on capitation formulae is that governments hope this will lead to beneficial changes in the behavior of physicians, for example, leading to healthcare resources being used more efficiently and appropriately. Ultimately capitation formulae are expected to produce financial benefits that can be reinvested in better clinical services for patients. In this paper these three key objectives are discussed using examples where capitation formulae have been used.There is limited evidence of the benefits of using capitation formulae but this evidence mainly comes from observational studies that are prone to bias and confounding. A major deficiency with the current capitation formulae used to allocate budgets to primary care physicians in England is that they generally only contain weightings for age, sex, and one or more ecological measures of need. Risk adjustment models have been used in the US but these models can explain only a small proportion of the variation in healthcare costs.At present in the UK it is uncertain whether capitation-based budgets and the enforced collaborative working arrangements for general practitioners will lead to a more efficient and equitable National Health Service. Continued evaluation of how capitation formulae are developed, the methods to adequately adjust for clinical risk, and how capitation formulae change clinical practice are required.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

This paper assesses the role that pharmacy benefit managers (PBMs) could play in facilitating improved Medicare beneficiary access to pharmaceutical care (which includes access to pharmaceuticals as well as disease management coverage). Based on a literature review and original survey results, PBMs currently facilitate access to pharmaceuticals for an estimated 26% of Medicare beneficiaries. In the short term, with implementation of the Bush Administration’s prescription drug discount plan, or in the longer term, with the passage of Medicare prescription drug benefit legislation, PBMs could increase their presence in the Medicare market considerably.Nevertheless, a number of issues concerning how to structure contracts with PBMs and how to meet certain political challenges to PBM-mediation remain unresolved. All PBMs surveyed have developed and are expanding disease management programs that include Medicare beneficiaries. However, disease management budgets remain modest. Furthermore, three-quarters of the PBMs surveyed adopted a focused view of disease management that may limit their ability to optimally facilitate cost-effective access to pharmaceutical care for Medicare beneficiaries.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

The absence of government regulation in the US has left pharmaceutical companies free to set their own prices based on a number of market considerations. Historically, these have included not only ingredient, research and development costs, but also advertising, the drug’s marginal effectiveness, competition, and market size. However, within the last two decades, two parallel trends have combined to bring a new consideration into the pricing decision: consumer price tolerance, or willingness to pay. The costs of prescriptions have increased markedly and patients have been increasingly organized into large groups based on insurance companies or defining characteristics such as the American Association of Retired Persons and AIDS groups. Consumers have found a voice for their concern over the high price of pharmaceuticals in these organizations, and together they have forged several avenues to effect price reductions. Consumer groups may apply indirect pressure by lobbying insurance companies to expand coverage or by invoking the threat of government regulation. Furthermore, direct pressure may be applied through letter-writing campaigns and public protests. Pharmaceutical companies are not only responding but also attempting to pre-empt these measures by eliciting consumer input in the early stages. This is being achieved through the creation of consumer advisory board positions and the conduct of willingness-to-pay analyses prior to bringing a drug to market.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Quality measurement has achieved a powerful momentum across the spectrum of healthcare, driven primarily by the search for strategies to contain rapidly rising healthcare costs without sacrificing quality of care. Because pharmaceutical care is involved in almost all elements of healthcare, it is subject to the general impact of quality measurement on the healthcare system as well as quality measurements of pharmaceutical care. The assumption that measuring quality improves the processes and outcomes of care lies behind the drive for quality measurement, but this assumption remains largely untested. Whether the assumption is true depends upon the attributes of measures (importance, perspective, reliability, validity and responsiveness), the quality of the data used, and how and by whom the measures are collected, interpreted and used. Focusing attention on aspects of care that get measured may ‘crowd out’ attention on equally important, but unmeasured elements and may not contribute to allocative efficiency. Successfully turning quality measurement into quality improvement in pharmaceutical care will require two essential elements: continued research to develop, refine and update measures of quality, and education in how to use them.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

BackgroundHeart failure (HF) is as common in Hispanic as it is in non-Hispanic populations. However, there do not appear to be any published reports of HF disease management programs which include Hispanic populations.ObjectiveTo test the effectiveness of a standardized telephonic disease management intervention, Pfizer Inc.'sAt Home With Heart Failure™, in decreasing acute care resource use and cost in Hispanic patients with HF.Participants and methodsA factorial design was used to analyze data obtained in a randomized controlled clinical trial. Patients with HF were enrolled in the trial when admitted to hospital, randomized to the intervention or usual care control groups, and followed for 6 months. Of the 358 participants, 93 (26%) were Hispanic (35 in the intervention group, 58 in the usual care group). Data were analyzed to determine if comparable decreases in acute care resource use were evident in Hispanic and non-Hispanic intervention group patients.InterventionRegistered nurses telephoned patients after hospital discharge to provide advice, solve problems, encourage adherence, and facilitate access to needed services.ResultsAcute care resource use was lowered as effectively in the Hispanic patients as in the non-Hispanic patients, despite significant between-group differences in education, income, and living situations. When a fully crossed (language by group) analysis was conducted, no significant differences were found between the Hispanic and non-Hispanic intervention groups. However, in most categories there was a trend towards lower resource use in the Hispanic intervention group. The cost of inpatient care was more than $US1000 (2000 values) less in the Hispanic than the non-Hispanic intervention group.ConclusionThe results of this study suggest that Hispanic patients with HF are receptive of, and responsive to, a case management intervention provided in a culturally competent manner, despite differences in cultural views on chronic illness and self-care as discussed in the literature.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

BackgroundConcerns regarding the effectiveness and impact of disease management are largely based on disease compliance measures. Although disease management programs have measured improvements in compliance and quality of life and cost savings from reductions in hospitalizations and emergency room visits, few programs have focused on changing behavioral health risks not directly related to the specific disease. The basic relationship between behavioral health risks and healthcare costs shows that those individuals with more high-risk behaviors are associated with higher healthcare costs compared with those with low-risk behaviors. The concept of excess costs associated with excess risks is a calculation of theoretical maximum percent savings for an entire group assuming everyone reduces to low risk, and changes in healthcare costs follow the changes in risks.ObjectiveTo establish the magnitude of excess healthcare costs associated with excess health risks, given a diagnosed chronic disease.Methods135 251 current and retired employees of General Motors Corporation who had completed a Health Risk Appraisal (HRA) were evaluated. Participants were continuously enrolled in traditional or Preferred Provider Organization (PPO) medical plans from 1996 to 1999 and had completed at least one HRA between 1996 and 1998.ResultsThose with and without self-reported disease averaged 19.2 and 9.1% excess healthcare costs associated with excess health risks, respectively. However, the magnitude of the impact differed across age groups and diseases. Individuals less than 45 years of age with self-reported disease were most affected by the presence of additional health risks (44% excess costs) while those aged ≥65 years without disease were least affected (8.2% excess costs). Among those with diseases, those with diabetes mellitus and bronchitis/emphysema were most affected (19.2 and 21.0%, respectively).ConclusionsDisease management programs should ideally provide a systematic approach to assist patients with interventions that improve overall health, as well as focusing on disease compliance measures. The implications for disease management programs are that, even given the presence of disease, promoting and/or maintaining low-risk status can result in potential cost savings.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

摘要:

Paclitaxel belongs to the group of antitumor agents called the taxanes. Its efficacy in advanced ovarian cancer has been established in large, randomized phase III clinical trials. When used in combination with cisplatin for first-line treatment of advanced ovarian cancer, it is superior to cyclophosphamide/cisplatin, with gains in median survival of around 1 year. Paclitaxel plus carboplatin has similar efficacy to paclitaxel plus cisplatin. There is now consensus that paclitaxel plus either carboplatin or cisplatin is the recommended first-line therapy for patients with advanced ovarian cancer. The particular combination employed may vary between institutions and geographical regions, although paclitaxel plus carboplatin is generally better tolerated (i.e. lower incidence of non-hematologic adverse events) than paclitaxel plus cisplatin and is widely used in many countries. Paclitaxel is also used as monotherapy in second-line (salvage) treatment of ovarian cancer.Pharmacoeconomic analyses performed to date have primarily focused on first-line therapy comparing the combination of paclitaxel/cisplatin with cyclophosphamide/cisplatin. All studies incorporated clinical outcomes data, most commonly from the Gynecologic Oncology Group (GOG) 111 trial, showing a survival advantage for paclitaxel/cisplatin. These studies report incremental cost-effectiveness ratios (ICERs) ranging from $US6395 per additional life-year gained (LYG) in Spain (1995/96 values) to US$44 690 per additional progression-free LYG in France (year of costs not reported). Five studies were based in the US and Canada and these reported very similar ICERs of $US13 135 (year of costs not reported) to $US25 131 (1993 costs) per additional LYG. In all of these studies the incremental costs of paclitaxel/cisplatin therapy fall well within the commonly cited threshold limit of $US50 000 for new therapies and compare well with incremental costs reported for other oncologic and life-saving therapies.Patient preferences and quality of life are important issues due to the short survival of patients with ovarian cancer. Two cost-utility studies reported similar incremental cost-utility ratios (ICURs). In the study based on US costs, the ICUR of paclitaxel/cisplatin treatment was $US18 200 per additional quality-adjusted life-year (QALY) [1995 drug costs]. In a Canadian study the ICUR ranged from 11 600 Canadian dollars ($Can) to $Can24 200 (1996 costs) per additional progression-free QALY depending on the choice of second-line treatment.ConclusionsPaclitaxel used in combination with cisplatin offers survival and utility gains versus cyclophosphamide plus cisplatin, when used as first-line treatment in patients with stage III or IV ovarian cancer. The incremental cost for these gains is within the accepted range for healthcare interventions. However, pharmacoeconomic analyses of paclitaxel plus carboplatin − a combination widely accepted for use in women with advanced ovarian cancer and with clinical advantages over paclitaxel plus cisplatin in terms of ease of administration and tolerability profile − are currently lacking. Nevertheless, results of available pharmacoeconomic data support the clinical use of paclitaxel/platinum combinations, particularly paclitaxel plus cisplatin, as a first-line chemotherapy treatment option in patients with advanced ovarian cancer.

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:2002

数据来源: ADIS