Pharmacoeconomic modelling in an assessment of acute respiratory disease treatment under etiological uncertainty
Keywords:
Cost-effectiveness; mathematical modeling; pharmacoeconomic; pneumonia; viral infection
Abstract
Background: The rising of medical innovative treatment costs, combined with limited resources, have resulted in an explosion in the number of pharmacoeconomic assessments currently being conducted. In parallel with the escalating prices of novel pharmacological entities, pharmacoeconomic assessments have become increasingly relevant in decision-making. Methods: The aim of this study was to provide a theoretical justification and develop the scientific and methodological underpinnings of the efficacy of pharmacotherapy of viral infections using a mix of pharmacoeconomic analysis and mathematical modelling methodologies. The general concept of modelling was based on patient recovery or death using various pharmacotherapy technologies in the presence and absence of a viral infection, as well as using speed of recovery as a favourable prognostic sign and criterion for the effectiveness of the applied pharmacotherapy technology. Results: Two alternative approaches were compared on the basis of decision trees, with the derivation of a universal criterion for the cost-effectiveness of introducing an additional treatment. The practical implementation of the proposed model was shown using the example of inclusion of the drug vitaglutam as an additional antiviral pharmacotherapy for patients with community-acquired pneumonia. Conclusions: Modelling of the normalisation of clinical and laboratory parameters combined and the duration of hospitalisation showed that the cost-effectiveness of additional pharmacotherapy for community-acquired pneumonia of viral-bacterial etiology could be reduced by an average of 29 %, based on the dynamics of normalisation of clinical and laboratory parameters compared with days of hospitalisation. This indicates that resource savings can be made by introducing this method to analyse the effectiveness of pharmacotherapy.
References
REFERENCES
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Bebu, I., Mathew, T., Lachin, JM. (2016). Probabilistic measures of cost-effectiveness. Statistics in Medicine, 25, 3976–3986
Berger, M.L., Bingefors, K., Hedblom, E.C., Pashos, C.L., Torrance, G.W. (2003). Health care cost, quality and outcomes: ISPOR book of terms.
Charlton, C.L., Babady, E., Ginocchio, C.C., Hatchette, T.F., Jerris, R.C., Li, Y., et al. (2018). Practical guidance for clinical microbiology laboratories: viruses causing acute respiratory tract infections. Clinical Microbiology Reviews, 32(1), e00042-18.
Chisholm-Burns, M.A., Graff Zivin, J.S., Lee, J.K., Spivey, C.A., Slack, M., Herrier, R.N., et al. (2010). Economic effects of pharmacists on health outcomes in the United States:a systematic review. American Journal of Health-Systempharmacy, 67:1624–1634. https://doi.org/10.2146/ajhp100077
Drysdale, S.B., Milner, A.D., Greenough, A. (2012). Respiratory syncytial virus infection and chronic respiratory morbidity – is there a functional or genetic predisposition? Acta Paediatrica. 101(11), 1114–1120.
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Felder, S., Mayrhofer, T. (2011). Medical decision making — a health economic primer. Berlin, Springer.
Grefenstette, J.J., Brown, S.T., Rosenfeld, R., DePasse, J., Stone, N.T.B., Cooley, P.C. (2013). FRED (a framework for reconstructing epidemic dynamics): an open-source software system for modeling infectious diseases and control strategies using census-based populations. BMC Public Health, 13, 940. https://doi.org/ 10.1186/1471-2458-13-940
Gao, R., Cao, B., Hu, Y., Feng, Z., Wang, D., Hu, W., et al. (2013). Human infection with a novel avian-origin influenza A (H7N9) virus. The New England Journal of Medicine, 368(20), 1888–1897. https://doi.org/10.1056/NEJMoa1304459
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Perez, A., Doloresco, F., Hoffman, J.M., Meek, P.D., Touchette, D.R., Vermeulen, L.C., et al. (2009). ACCP: economic evaluations of clinical pharmacy services: 2001-2005. Pharmacotherapy, 29(1), 128. https://doi.org/10.1592/phco.29.1.128
Potaczek, D.P., Garn, H., Unger , S.D., Renz, H. (2016). Antisense molecules: A new class of drugs. Journal of Allergy and Clinical Immunology, 137(5), 1334–46.
https://doi.org/10.1016/j.jaci.2015.12.1344
Prina, E., Ranzani, O.T., Torres, A. (2015). Community-acquired pneumonia. The Lancet, 386(9998), 1097–1108. https://doi.org/10.1016/S0140-6736(15)60733-4
Ramsey, C.D., Kumar, A. (2013). Influenza and endemic viral pneumonia. Critical Care Clinics, 29(4), 1069–1086. https://doi.org/10.1016/j.ccc.2013.06.003
Ruuskanen, O., Lahti, E., Jennings, L.C., Murdoch, D.R. (2011). Viral pneumonia. The Lancet, 377, 1264–1275. https://doi.org/10.1016/S0140-6736(10)61459-6
Salata, C., Calistri, A., Parolin, C., Palu, G. (2019). Coronaviruses: a paradigm of new emerging zoonotic diseases. Pathogens and Disease, 77(9). https://doi.org/10.1093/femspd/ftaa006
Schumock, G.T., Butler, M.G., Meek, P.D., Vermeulen, L.C., Arondekar, B.V., Bauman, J.L., et al. (2003). Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy, 23(1), 113–132. https://doi.org/10.1592/phco.23.1.113.31910
Shafie, A.A., Hassali, M.A. (2010). Willingness to pay for a pharmacist's dispensing service:a cross-sectional pilot study in the state of Penang, Malaysia. Pharmacy Practice (Granada), 8(2), 116–121. https://doi.org/10.4321/s1886-36552010000200006
Soloviov, S.O., Ubohov, S.H., Aleksandrina, T.A., Kovaliuk, O.V., Dziublyk, I.V., Trokhymchuk, V.V., Zahoriy, H.V. (2020). A cost minimization analysis of α2b-interferon supplementation in complex pharmacotherapy of rotavirus infection in newborns. Ceska a Slovenska Farmacie, 69(2), 83–89.
Stahl, J.E. (2008). Modelling methods for pharmacoeconomics and health technology assessment: an overview and guide. Pharmacoeconomics, 26, 131–148. https://doi.org/10.2165/00019053-200826020-00004
Viasus, D., Cordero, E., Rodríguez-Baño, J., Oteo, J.A., Fernández-Navarro, A., Ortega, L., et al. (2012). Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season. Clinical Microbiology and Infection, 18(3), 55–62. https://doi.org/10.1111/j.1469-0691.2011.03753.x
Walsh, E.E., Shin, J.H., Falsey, A.R. (2013). Clinical impact of human coronaviruses 229E and OC43 infection in diverse adult populations. Journal of Infectious Diseases, 208(10), 1634–1642. https://doi.org/10.1093/infdis/jit393
Weintraub, W.S. (2008). Pharmacoeconomic concepts in antiplatelet therapy: understanding cost-effectiveness analyses using clopidogrel as an example. Journal of Cardiovascular Pharmacology and Therapeutics, 13(2), 107–19. https://doi.org/10.1177/1074248407313151
World Health Organization (2023). Pneumonia. WHO. https://www.who.int/health-topics/pneumonia)
Wunderink, R. G., Waterer, G. W. (2014). Clinical practice. Community-acquired pneumonia. The New England Journal of Medicine, 370(6), 543–551.
https://doi.org/ 10.1056/NEJMcp1214869
Anderson, R., Feldman, C. (2023). The global burden of community-acquired pneumonia in adults, encompassing invasive pneumococcal disease and the prevalence of its associated cardiovascular events, with a focus on pneumolysin and macrolide antibiotics in pathogenesis and therapy. International Journal of Molecular Sciences, 24(13), 11038
https://doi.org/10.3390/ijms241311038
Bebu, I., Mathew, T., Lachin, JM. (2016). Probabilistic measures of cost-effectiveness. Statistics in Medicine, 25, 3976–3986
Berger, M.L., Bingefors, K., Hedblom, E.C., Pashos, C.L., Torrance, G.W. (2003). Health care cost, quality and outcomes: ISPOR book of terms.
Charlton, C.L., Babady, E., Ginocchio, C.C., Hatchette, T.F., Jerris, R.C., Li, Y., et al. (2018). Practical guidance for clinical microbiology laboratories: viruses causing acute respiratory tract infections. Clinical Microbiology Reviews, 32(1), e00042-18.
Chisholm-Burns, M.A., Graff Zivin, J.S., Lee, J.K., Spivey, C.A., Slack, M., Herrier, R.N., et al. (2010). Economic effects of pharmacists on health outcomes in the United States:a systematic review. American Journal of Health-Systempharmacy, 67:1624–1634. https://doi.org/10.2146/ajhp100077
Drysdale, S.B., Milner, A.D., Greenough, A. (2012). Respiratory syncytial virus infection and chronic respiratory morbidity – is there a functional or genetic predisposition? Acta Paediatrica. 101(11), 1114–1120.
https://doi.org/10.1111/j.1651-2227.2012.02825.x
Felder, S., Mayrhofer, T. (2011). Medical decision making — a health economic primer. Berlin, Springer.
Grefenstette, J.J., Brown, S.T., Rosenfeld, R., DePasse, J., Stone, N.T.B., Cooley, P.C. (2013). FRED (a framework for reconstructing epidemic dynamics): an open-source software system for modeling infectious diseases and control strategies using census-based populations. BMC Public Health, 13, 940. https://doi.org/ 10.1186/1471-2458-13-940
Gao, R., Cao, B., Hu, Y., Feng, Z., Wang, D., Hu, W., et al. (2013). Human infection with a novel avian-origin influenza A (H7N9) virus. The New England Journal of Medicine, 368(20), 1888–1897. https://doi.org/10.1056/NEJMoa1304459
Huang, J.S., Chen, Y.F., Hsu, J.C. (2014). In: 2014 international symposium on computer, consumer and control: 10–12 June 2014. Taichung, Taiwan: IEEE. Design of a clinical decision support model for predicting pneumonia readmission. pp. 1179–1182.
Jain, S., Self, W.H., Wunderink, R.G., Fakhran, S., Balk, R., Bramley, A.M., et al. (2015). Community-acquired pneumonia requiring hospitalization among U. S. adults. The New England Journal of Medicine, 373, 415–427. https://doi.org/10.1056/NEJMoa1500245
Johnstone, J., Majumdar, S.R., Fox, J.D., Marrie, T.J. (2008). Viral infection in adults hospitalized with community-acquired pneumonia. Chest, 134(6), 1141–1148. https://doi.org/10.1378/chest.08-0888
Macfarlane, J., Boswell, T., Douglas, G. (2001). BTS guidelines for the management of community acquired pneumonia in adults. Thorax, 56(4), 1–64.
Mi, X., Su, X., Jin, Z., Zeng, L., Li, Z., Wang, X., et al. (2020). Economic evaluations of clinical pharmacy services in China: a systematic review. BMJ Open, 6(10), e034862.
https://doi.org/10.1136/bmjopen-2019-034862
Michaud, C.M. (2009). Global burden of infectious diseases. Encyclopedia of Microbiology, 444–454.
https://doi.org/10.1016/B978-012373944-5.00185-1
Musher, D.M., Thorner, A.R. (2014). Community-acquired pneumonia. The New England Journal of Medicine, 371(17), 1619-28. https://doi.org/10.1056/NEJMra1312885
Neuman, M.I., Monuteaux, M.C., Scully, K.J., Bachur, R.G. (2011). Prediction of pneumonia in a pediatric emergency department. Pediatrics, 128(2), 246–253. https://doi.org/10.1542/peds.2010-3367
Ochoa-Gondar, O., Torras-Vives, V., de Diego-Cabanes, C., Satué-Gracia, E. M., Vila-Rovira, A., Forcadell-Perisa, et al. (2023). Incidence and risk factors of pneumococcal pneumonia in adults: a population-based study. BMC Pulmonary Medicine, 23(1), 200. https://doi.org/10.1186/s12890-023-02497-2
Pavia, A.T. (2011). Viral infections of the lower respiratory tract: old viruses, new viruses, and the role of diagnosis. Clinical Infectious Diseases, 52(4), S284–S289.
https://doi.org/10.1093/cid/cir043
Perez, A., Doloresco, F., Hoffman, J.M., Meek, P.D., Touchette, D.R., Vermeulen, L.C., et al. (2009). ACCP: economic evaluations of clinical pharmacy services: 2001-2005. Pharmacotherapy, 29(1), 128. https://doi.org/10.1592/phco.29.1.128
Potaczek, D.P., Garn, H., Unger , S.D., Renz, H. (2016). Antisense molecules: A new class of drugs. Journal of Allergy and Clinical Immunology, 137(5), 1334–46.
https://doi.org/10.1016/j.jaci.2015.12.1344
Prina, E., Ranzani, O.T., Torres, A. (2015). Community-acquired pneumonia. The Lancet, 386(9998), 1097–1108. https://doi.org/10.1016/S0140-6736(15)60733-4
Ramsey, C.D., Kumar, A. (2013). Influenza and endemic viral pneumonia. Critical Care Clinics, 29(4), 1069–1086. https://doi.org/10.1016/j.ccc.2013.06.003
Ruuskanen, O., Lahti, E., Jennings, L.C., Murdoch, D.R. (2011). Viral pneumonia. The Lancet, 377, 1264–1275. https://doi.org/10.1016/S0140-6736(10)61459-6
Salata, C., Calistri, A., Parolin, C., Palu, G. (2019). Coronaviruses: a paradigm of new emerging zoonotic diseases. Pathogens and Disease, 77(9). https://doi.org/10.1093/femspd/ftaa006
Schumock, G.T., Butler, M.G., Meek, P.D., Vermeulen, L.C., Arondekar, B.V., Bauman, J.L., et al. (2003). Evidence of the economic benefit of clinical pharmacy services: 1996-2000. Pharmacotherapy, 23(1), 113–132. https://doi.org/10.1592/phco.23.1.113.31910
Shafie, A.A., Hassali, M.A. (2010). Willingness to pay for a pharmacist's dispensing service:a cross-sectional pilot study in the state of Penang, Malaysia. Pharmacy Practice (Granada), 8(2), 116–121. https://doi.org/10.4321/s1886-36552010000200006
Soloviov, S.O., Ubohov, S.H., Aleksandrina, T.A., Kovaliuk, O.V., Dziublyk, I.V., Trokhymchuk, V.V., Zahoriy, H.V. (2020). A cost minimization analysis of α2b-interferon supplementation in complex pharmacotherapy of rotavirus infection in newborns. Ceska a Slovenska Farmacie, 69(2), 83–89.
Stahl, J.E. (2008). Modelling methods for pharmacoeconomics and health technology assessment: an overview and guide. Pharmacoeconomics, 26, 131–148. https://doi.org/10.2165/00019053-200826020-00004
Viasus, D., Cordero, E., Rodríguez-Baño, J., Oteo, J.A., Fernández-Navarro, A., Ortega, L., et al. (2012). Changes in epidemiology, clinical features and severity of influenza A (H1N1) 2009 pneumonia in the first post-pandemic influenza season. Clinical Microbiology and Infection, 18(3), 55–62. https://doi.org/10.1111/j.1469-0691.2011.03753.x
Walsh, E.E., Shin, J.H., Falsey, A.R. (2013). Clinical impact of human coronaviruses 229E and OC43 infection in diverse adult populations. Journal of Infectious Diseases, 208(10), 1634–1642. https://doi.org/10.1093/infdis/jit393
Weintraub, W.S. (2008). Pharmacoeconomic concepts in antiplatelet therapy: understanding cost-effectiveness analyses using clopidogrel as an example. Journal of Cardiovascular Pharmacology and Therapeutics, 13(2), 107–19. https://doi.org/10.1177/1074248407313151
World Health Organization (2023). Pneumonia. WHO. https://www.who.int/health-topics/pneumonia)
Wunderink, R. G., Waterer, G. W. (2014). Clinical practice. Community-acquired pneumonia. The New England Journal of Medicine, 370(6), 543–551.
https://doi.org/ 10.1056/NEJMcp1214869
Published
2025-02-04
How to Cite
Soloviov, S. O., Dziublyk, I. V., Trokhymchuk, V. V., Surtaieva, N. V., Hakim, M. S., Tretynyk, V. V., Malchykov, V. V., Sidorenko, M., Mickevičius, S., Kostiuk, O. V., Dychka, I. A., Sulema, Y. S., BabenkoM. М., & Ubohov, S. H. (2025). Pharmacoeconomic modelling in an assessment of acute respiratory disease treatment under etiological uncertainty . Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.16636
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