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High Price Drugs

I Spozio Züst, H R Räz, F Burkhalter
Nephrotic syndrome is common in immunoglobulin light-chain (AL) amyloidosis and successful therapy may pose a challenge. We report the case of a 63-year-old patient with severe nephrotic syndrome due to primary renal AL-amyloidosis with well-preserved renal function at first presentation. Therapy with high dose steroids, loop diuretics, and ACE-inhibitors did not affect his proteinuria and he was seriously disabled because of symptomatic orthostatic hypotension and anasarca. With the patient's informed consent, medical nephrectomy was tried with nonsteroidal-anti-inflammatory drugs (NSAIDs), cyclosporine, and aminoglycosides, with significant deterioration of his renal function, but without relevant effect on his proteinuria...
2019: Case Reports in Nephrology
Eric A Jones, Benjamin P Linas, Ve Truong, James F Burgess, Karen E Lasser
PURPOSE: Safety-net health systems, which serve a disproportionate share of patients at high risk for hepatitis C virus (HCV) infection, may use revenue generated by the federal drug discount pricing program, known as 340B, to support multidisciplinary care. Budgetary impacts of repealing the drug-pricing program are unknown. Our objective was to conduct a budgetary impact analysis of a multidisciplinary primary care-based HCV treatment program, with and without 340B support. METHODS: We conducted a budgetary impact analysis from the perspective of a large safety-net medical center in Boston, Massachusetts...
2019: PloS One
Kate Traynor
No abstract text is available yet for this article.
March 14, 2019: American Journal of Health-system Pharmacy: AJHP
Ioannis Gallos, Helen Williams, Malcolm Price, Karen Pickering, Abi Merriel, Aurelio Tobias, David Lissauer, Harry Gee, Özge Tunçalp, Gillian Gyte, Vidhya Moorthy, Tracy Roberts, Jonathan Deeks, Justus Hofmeyr, Metin Gülmezoglu, Arri Coomarasamy
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide. Prophylactic uterotonic drugs can reduce blood loss and are routinely recommended. There are several uterotonic drugs for preventing PPH, but it is still debatable which drug or combination of drugs is the most effective. OBJECTIVES: To identify the most effective and cost-effective uterotonic drug(s) to prevent PPH, and generate a ranking according to their effectiveness and side-effect profile...
February 2019: Health Technology Assessment: HTA
Josep Darbà, Meritxell Ascanio
BACKGROUND: Traditional drug payment schemes in Catalonia are generally based on the negotiation of fixed prices; however, disadvantages arise in the case of innovative therapies. Risk sharing agreements distribute potential health and economic uncertainties and high prices on access across the interested parts. OBJECTIVES: To identify, characterize and analyze current publicly available agreement reports signed by the Catalan Health Service and different pharmaceutical companies evaluating the current market access scene for new drugs in Catalonia...
March 1, 2019: Expert Review of Pharmacoeconomics & Outcomes Research
Tijmen H Booij, Leo S Price, Erik H J Danen
The introduction of more relevant cell models in early preclinical drug discovery, combined with high-content imaging and automated analysis, is expected to increase the quality of compounds progressing to preclinical stages in the drug development pipeline. In this review we discuss the current switch to more relevant 3D cell culture models and associated challenges for high-throughput screening and high-content analysis. We propose that overcoming these challenges will enable front-loading the drug discovery pipeline with better biology, extracting the most from that biology, and, in general, improving translation between in vitro and in vivo models...
February 28, 2019: SLAS Discovery
Tinevimbo Shiri, Angela Loyse, Lawrence Mwenge, Tao Chen, Shabir Lakhi, Duncan Chanda, Peter Mwaba, Síle F Molloy, Robert Heyderman, Cecilia Kanyama, Mina C Hosseinipour, Charles Kouanfack, Elvis Temfack, Sayoki Mfinanga, Sokoine Kivuyo, Adrienne K Chan, Joseph N Jarvis, Olivier Lortholary, Shabbar Jaffar, Louis W Niessen, Thomas S Harrison
BACKGROUND: Mortality from cryptococcal meningitis remains very high in Africa. In the ACTA trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2-week amphotericin-based regimens. However, many African settings treat with FLU monotherapy and the cost effectiveness of adding 5FC to FLU is uncertain. METHODS: Effectiveness and costs of FLU+5FC were taken from ACTA, which included costing analysis at the Zambian site. Effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA...
February 28, 2019: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ben Goldacre, Carl Reynolds, Anna Powell-Smith, Alex J Walker, Tom A Yates, Richard Croker, Liam Smeeth
OBJECTIVES: Approximately one in eight practices in primary care in England are 'dispensing practices' with an in-house dispensary providing medication directly to patients. These practices can generate additional income by negotiating lower prices on higher cost drugs, while being reimbursed at a standard rate. They, therefore, have a potential financial conflict of interest around prescribing choices. We aimed to determine whether dispensing practices are more likely to prescribe high-cost options for four commonly prescribed classes of drug where there is no evidence of superiority for high-cost options...
February 5, 2019: BMJ Open
Alpha A Lee, Qingyi Yang, Asser Bassyouni, Christopher R Butler, Xinjun Hou, Stephen Jenkinson, David A Price
Predicting ligand biological activity is a key challenge in drug discovery. Ligand-based statistical approaches are often hampered by noise due to undersampling: The number of molecules known to be active or inactive is vastly less than the number of possible chemical features that might determine binding. We derive a statistical framework inspired by random matrix theory and combine the framework with high-quality negative data to discover important chemical differences between active and inactive molecules by disentangling undersampling noise...
February 26, 2019: Proceedings of the National Academy of Sciences of the United States of America
R Horowski, P-A Löschmann
The pioneering work of Arvid Carlsson has laid the foundation for a number of innovative therapies for severe central nervous system (CNS) diseases. He was awarded the Nobel Price for the discovery of the crucial role of dopamine (DA) as a neurotransmitter in the CNS, thereby forming the basis for the symptomatic therapy of Parkinson's disease (PD) with L-DOPA and subsequently dopaminergic drugs. Parenteral apomorphine has a short lasting effect in PD, bromocriptine can be administered orally and has a long-lasting effects but is poorly tolerated...
February 25, 2019: Journal of Neural Transmission
Jaume Puig-Junoy, Natàlia Pascual-Argente, Lluc Puig-Codina, Laura Planellas, Míriam Solozabal
High prices of second-generation direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C virus (HCV) patients led to reimbursement decisions based on cost per quality-adjusted life year (QALY). Areas covered: We performed a systematic review of cost-utility analyses (CUA) comparing interventions with second-generation DAA therapies with no treatment, and with previous therapies for chronic HCV patients until July 2017. A total of 36 studies were included: 30 studies from the perspective of the healthcare payer, 3 from the societal perspective, and 3 did not report the perspective...
December 2018: Expert Review of Gastroenterology & Hepatology
Alyssa A Schatz, Katy Winckworth Prejsnar, James McCanney, Meghan Gutierrez, Stefanie Joho, Joseph Alvarnas, Robert W Carlson
In recent years, oncology has seen a rapid increase in the introduction of high-cost innovative therapies while scrutiny around drug pricing has simultaneously amplified. Significant policy shifts impacting health coverage and benefit design are also being implemented, including narrow network health plans, uncertainty around the Affordable Care Act insurance exchanges, and threats to preexisting condition protections. Shifting health coverage policy combined with high drug prices and outdated reimbursement systems may create barriers to patient access to innovation and high-quality cancer care...
February 2019: Journal of the National Comprehensive Cancer Network: JNCCN
David A M C van de Vijver, Ann-Kathrin Richter, Charles A B Boucher, Barbara Gunsenheimer-Bartmeyer, Christian Kollan, Brooke E Nichols, Christoph D Spinner, Jürgen Wasem, Knud Schewe, Anja Neumann
BackgroundPre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.AimOur objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.MethodsWe calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM...
February 2019: Euro Surveillance: European Communicable Disease Bulletin
Adithya Balasubramanian, Nannan Thirumavalavan, Ashwin Srivatsav, Justin Yu, Larry I Lipshultz, Alexander W Pastuszak
INTRODUCTION: Testosterone-boosting supplements (T-Boosters) are prominently featured on, with numerous dedicated pages and claims that they "naturally" increase testosterone levels. AIM: To evaluate the highest rated and frequently reviewed T-Boosters on to facilitate patient counseling regarding marketing myths, T-Booster formulations, and evidence for efficacy and safety. METHODS: The Amazon marketplace was queried using the key words "testosterone" + "booster," with default search settings and ranking items based on relevance...
February 2019: Journal of Sexual Medicine
Patrice Trouiller
The main problems of the system governing the development and dissemination of innovative medicines are known. Despite relatively low manufacturing costs, patented drugs are unduly expensive, and neglected diseases attract little pharmaceutical research. Both problems are compounded by patients who, discouraged by high prices, lack of access to competent medical services and low quality medicines, do not complete their treatment.
July 20, 2018: Journal International de Bioéthique et D'éthique des Sciences
Elizabeth Thithi Ndichu, Kelechi Ohiri, Oluwafemi Sekoni, Olasunmbo Makinde, Kevin Schulman
BACKGROUND: As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables. METHODS: We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria...
2019: PloS One
C Vargas, C Balmaceda, F Rodríguez, R Rojas, A Giglio, M A Espinoza
BACKGROUD: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. METHODS: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs and efficacy estimates were obtained from an indirect treatment comparison...
February 13, 2019: Expert Review of Pharmacoeconomics & Outcomes Research
Mrutyunjaya Parida, Kyle A Nilson, Ming Li, Christopher B Ball, Harrison A Fuchs, Christine K Lawson, Donal S Luse, Jeffery L Meier, David H Price
The large genome of human cytomegalovirus (HCMV) is transcribed by RNA polymerase II (Pol II). However, it is not known how closely this betaherpesvirus follows host transcriptional paradigms. We applied PRO-Seq and PRO-Cap methods to profile and quantify transcription initiation and productive elongation across the host and virus genomes in late infection. A major similarity between host transcription and viral transcription is that treatment of cells with the P-TEFb inhibitor flavopiridol preempts virtually all productive elongation, which otherwise covers most of the HCMV genome...
February 12, 2019: MBio
Mickael Hiligsmann, Setareh A Williams, Lorraine A Fitzpatrick, Stuart S Silverman, Richard Weiss, Jean-Yves Reginster
OBJECTIVES: There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared with teriparatide (TPTD) followed by ALN (TPTD/ALN). METHODS: A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective...
January 10, 2019: Seminars in Arthritis and Rheumatism
Daniel M Hartung, Kirbee A Johnston, Adriane Irwin, Sheila Markwardt, Dennis N Bourdette
The high cost of multiple sclerosis (MS) disease-modifying therapies can negatively affect access for patients through increased payer restrictions and higher out-of-pocket spending. Our objective was to describe changes in pharmacy benefit coverage and cost-sharing amounts for MS disease-modifying therapies in the Medicare Part D program, using enrollment-weighted Prescription Drug Plan Formulary files for the period 2007-16. Among therapies available throughout the study period, the rate of prior authorization use increased from 61-66 percent of plans to 84-90 percent...
February 2019: Health Affairs
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