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Assessing the Use of Retrospective Databases in Conducting Economic Evaluations of Drugs

The Case of Asthma

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Abstract

When evaluating drug substances, the traditional clinical study setting does not allow scope for observing real-life behaviour since all alternative actions are determined beforehand. However, a study based on prospective or retrospective databases containing real-life data can examine how patients and physicians behave in a real-world setting and can investigate the relationship between the introduction of a drug and the amount of healthcare used in actual practice.

We reviewed the quality and potential policy application of published retrospective database studies in which an economic evaluation of the use of drugs in asthma was conducted. A search in literature databases found 16 such studies, which were reviewed and evaluated according to a published checklist. No article fulfilled all the criteria for a ‘good’ economic evaluation. The results of many of the evaluations may be informative, but not transparent enough to deliver policy conclusions. This may limit the use of the currently published retrospective database studies as a base for policy decision, compared with randomised controlled trials, despite the additional value of these database analyses when wellconducted. A greater transparency when presenting material and results is therefore called for, to increase the usefulness of database studies.

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References

  1. Culyer AJ, Newhouse JP. The state and scope of health economics. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Vol. 1A. Amsterdam: North-Holland, 2000: 1–7

    Chapter  Google Scholar 

  2. Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997

    Google Scholar 

  3. Varian HR. Microeconomic analysis. 3rd ed. New York: WW Norton & Co, 1992

    Google Scholar 

  4. Barton S. Which clinical evidence provide the best evidence? BMJ 2001; 321: 255–6

    Article  Google Scholar 

  5. Benson K, Hartz AJ. A comparison of observational studies and randomised controlled trials. N Engl J Med 2000; 342: 1878–86

    Article  PubMed  CAS  Google Scholar 

  6. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000; 342: 1887–92

    Article  PubMed  CAS  Google Scholar 

  7. Sullivan SD, Lyles A, Luce B, et al. AMPC guidance for submission of clinical and economic evaluation data to support formulary listing in US health plans and pharmacy benefits management organizations. J Manag Care Pharm 2001; 7: 272–82

    Google Scholar 

  8. Guidance for manufacturers and sponsors. Technology appraisals process series no 5. London: National Institute for Clinical Excellence, 2001

    Google Scholar 

  9. Canadian Coordinating Office for Health Technology Assessment (CCOillA). Guidelines for economic evaluation ofpharmaceuticals: 2nd ed. Ottawa, Canada, 1997 Nov

    Google Scholar 

  10. Klingman D, Bielory L, Wang Y, et al. Asthma outcomes changes associated with use of the leukotriene-receptor antagonist zafirlukast. Manag Care Interface 2001; 14 (2): 62–6

    PubMed  CAS  Google Scholar 

  11. Price DB, Ben-Joseph RH, Zhang Q. Changes in asthma drug therapy costs for patients receiving chronic montelukast therapy in the UK. Respir Med 2001; 95: 83–9

    Article  PubMed  CAS  Google Scholar 

  12. Tierce JC, Meller W, Berlow B, et al. Assessing the cost of albuterol inhalers in the Michigan and California Medicaid programs: a total cost-of-care approach. Clin Ther 1989; 11: 53–61

    PubMed  CAS  Google Scholar 

  13. Bukstein DA, Henk HJ, Luskin AT. A comparison of asthmarelated expenditures for patients started on montelukast versus fluticasone propionate as monotherapy. Clin Ther 2001; 23: 1589–600

    Article  PubMed  CAS  Google Scholar 

  14. Holzer SS, Engelhart L, Crown WH, et al. Asthma treatment costs using inhaled corticosteroids. Am J Manag Care 1997; 3: 891–7

    PubMed  CAS  Google Scholar 

  15. Langley PC. The technology of metered-dose inhalers and treatment costs in asthma: a retrospective study of breath actuation versus traditional press-and-breathe inhalers. Clin Ther 1999; 21: 236–52

    Article  PubMed  CAS  Google Scholar 

  16. O’Connor RD, O’Donnell JC, Pinto LA, et al. Two-year retrospective economic evaluation of three dual-controller therapies used in the treatment of asthma. Chest 2002; 121: 1028–35

    Article  PubMed  Google Scholar 

  17. Ollendorf DA, Pozniak AS, Bowers BW, et al. An economic analysis of alternative step-up therapies in asthma patients receiving inhaled corticosteroids. P&T 2002; 27: 147–53

    Google Scholar 

  18. Pathak DS, Davis EA, Stanford RH. Economic impact of asthma therapy with fluticasone propionate, montelukast, or zafirlukast in a managed care population. Pharmacotherapy 2002; 22: 166–74

    Article  PubMed  CAS  Google Scholar 

  19. Stempel DA. Pharmacoeconomic impact of inhaled corticosteroids. Am J Manag Care 2000; 6: S382–7

    Google Scholar 

  20. Stempel DA, Mauskopf J, McLaughlin T, et al. Comparison of asthma costs in patients starting fluticasone propionate compared to patients starting montelukast. Respir Med 2001; 95: 227–34

    Article  PubMed  CAS  Google Scholar 

  21. Stempel DA, McLaughlin T, Griffis DL, et al. Cost analysis of the use of inhaled corticosteroids in the treatment of asthma: a I-year follow-up. Respir Med 2001; 95: 992–8

    Article  PubMed  CAS  Google Scholar 

  22. Stempel DA, Meyer JW, Stanford RH, et al. One-year claims analysis comparing inhaled fluticasone propionate with zafirlukast for the treatment of asthma. J Allergy Clin Immunol 2001; 107: 94–8

    Article  PubMed  CAS  Google Scholar 

  23. Stempel DA, O’Donnell JC, Meyer JW. Inhaled corticosteroids plus salrreterol or montelukast: effects on resource utilization and costs. J Allergy Clin Imminol 2002; 109: 433–9

    Article  CAS  Google Scholar 

  24. Wang SW, Liu X, Weiner DJ, et al. Comparison of prevalence, cost, and outcomes of a combination of salrreterol and fluticasone therapy to common asthma treatments. Am J Manag Care 2001; 7: 913–22

    PubMed  CAS  Google Scholar 

  25. Hay J. Health care costs and outcomes: how should we evaluate real world data? Value Health 1999; 2: 417–9

    Article  PubMed  CAS  Google Scholar 

  26. Armstrong EP, Malone MC. Pluticasone is associated with lower asthma-related costs than leukotriene modifiers in a realworld analysis. Pharmacotherapy 2002; 22 (9): 1117–23

    Article  PubMed  CAS  Google Scholar 

  27. Melfi CA. Using databases for studying and comparing health care costs and resource use. Pharmacoepidemiol Drug Saf 2001; 10: 399–402

    Article  PubMed  CAS  Google Scholar 

  28. Motheral BR, Fairman KA. The use of claims databases for outcomes research: rationale, challenges, and strategies. Clin Ther 1997; 19: 346–66

    Article  PubMed  CAS  Google Scholar 

  29. Jones AM. Health econometrics. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Vol 1A. Amsterdam: North-Holland, 2000: 265–344

    Chapter  Google Scholar 

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Acknowledgements

This article was funded by AstraZeneca R&D Lund.

The author would like to thank Emma Andreásson, AstraZeneca R&D, Lund, for her considerable contribution in the writing of this manuscript, and Dr F. Andersson, AstraZeneca R&D Lund, for his critical remarks on the manuscript.

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Correspondence to Fredrik Berggren.

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Berggren, F. Assessing the Use of Retrospective Databases in Conducting Economic Evaluations of Drugs. PharmacoEconomics 22, 771–791 (2004). https://doi.org/10.2165/00019053-200422120-00002

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