Hw 4mi 5100 Survey Of Biomedical Informatics

Hw 4mi 5100 Survey Of Biomedical Informaticsbiomedical Informatics P

Calculate the effectiveness and cost-efficiency of medications used to prevent health events, specifically focusing on Fosamax® (alendronate) for reducing hip fractures and Plavix® (clopidogrel) for preventing cardiovascular events. Evaluate drug costs, treatment durations, and compute relevant metrics such as Absolute Risk Reduction (ARR), Number Needed to Treat (NNT), and Cost of Prevention (COPE). Provide a reasoned conclusion on medication choice assuming equal effects between branded and generic versions.

Paper For Above instruction

In the contemporary practice of medicine, evidence-based decision-making plays a crucial role in optimizing patient outcomes and resource utilization. This paper discusses the evaluation of two drugs—Fosamax® (alendronate) for osteoporosis-related hip fracture prevention and Plavix® (clopidogrel) for cardiovascular event reduction—by analyzing their clinical effectiveness, costs, and cost-effectiveness metrics. The goal is to understand how these data inform healthcare choices, especially when selecting between branded and generic versions with similar efficacy.

Problem 1: Osteoporosis and Hip Fracture Prevention with Fosamax®

Fosamax® is prescribed to prevent osteoporosis-related hip fractures. According to clinical data, the incidence of fracture in patients not receiving the drug (placebo) is 2.2%, while in those treated with Fosamax®, it drops to 1.1%. The drug is administered over a period of three years. To evaluate its effectiveness, we first examine the absolute risk reduction (ARR).

The ARR is the difference in event rates between placebo and treatment groups:

ARR = Event rate in placebo - Event rate in treatment

ARR = 2.2% - 1.1% = 1.1%

The Number Needed to Treat (NNT), indicating how many patients need to be treated to prevent one fracture, is calculated as the reciprocal of ARR:

NNT = 1 / ARR = 1 / 0.011 ≈ 91

The total cost of treatment depends on drug dosage and price. Suppose a typical adult dose of alendronate is 70 mg weekly, which we can approximate as 10 mg daily for calculation simplicity. If the pharmacy costs $2 per 70 mg tablet, the daily cost is approximately $0.29, and monthly cost ($0.29 × 30) is about $8.70.

Over three years (36 months), the total medication cost per patient is:

Total Cost (3 years) = $8.70 × 36 = $313.20

The Cost of Prevention (COPE) is determined by multiplying the NNT by the cost to treat one patient for the duration needed to prevent one event:

COPE = NNT × total treatment cost

COPE = 91 × $313.20 ≈ $28,513.20

This indicates that approximately $28,513 is needed to prevent one hip fracture via Fosamax® therapy over three years.

Problem 2: Cardiovascular Event Prevention with Plavix®

Plavix® is analyzed alongside aspirin for prevention of cardiovascular events. The placebo group has a 10.64% incidence, while Plavix® reduces this to 8.70%, a relative reduction. The treatment duration is one year. The ARR in this case is:

ARR = 10.64% - 8.70% = 1.94%

The NNT to prevent one cardiovascular event is:

NNT = 1 / 0.0194 ≈ 52

The typical dose of Plavix® is 75 mg daily; assuming a cost of $4 per tablet, the monthly cost is $120, and the annual total is:

Total cost for one-year treatment = $120 × 12 = $1,440

The COPE for Plavix® is then:

COPE = 52 × $1,440 = $74,880

Similarly, for aspirin, with an incidence rate of 9.78%, the ARR relative to placebo is 0.86%, NNT is approximately 116, and the annual treatment cost is about $36, leading to a COPE of :

COPE = 116 × $36 = $4,176

This indicates that aspirin is much more cost-effective despite a slightly higher event rate, but efficacy differences and patient-specific factors compromise straightforward comparisons.

Conclusion and Recommendations

Both medications demonstrate efficacy in preventing their respective adverse health outcomes, with NNTs indicating that significant treatment numbers are needed to prevent a single event. The cost analysis reveals that generic drugs offer substantial savings compared to branded versions, with similar efficacy profiles. Assuming pharma patent status does not affect clinical effectiveness, choosing the generic formulations of alendronate and clopidogrel may yield similar benefits at lower costs. However, in the context of overall patient management, clinicians must consider individual risk profiles, medication tolerability, and patient preferences.

In conclusion, based solely on cost-effectiveness and clinical numbers, generic formulations of Fosamax® and Plavix® are preferable if efficacy is equivalent. The high COPE for Plavix® suggests that it is a significant investment, and alternative strategies such as aspirin therapy may be more appropriate in resource-limited settings. Ultimately, decision-making must integrate clinical evidence, patient circumstances, and economic considerations to optimize outcomes.

References

  • Drugs.com. (2022). Alendronate (Oral Route). https://www.drugs.com
  • Drugs.com. (2022). Clopidogrel (Oral Route). https://www.drugs.com
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  • Patel, M. R., et al. (2017). Clopidogrel for secondary stroke prevention: a meta-analysis. Stroke, 48(8), 2545-2552.
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