C O N N E CTI O N SC O N N E CTI O N SUNITING SCIENCE AND PRACTICE

IN THIS ISS U E Landmark ISPOR Asia Pacific Conference Opens Door to I S P O RFuture in Asia-Pa c i f i c Daniel Klim, Director, Meetings and Communications

1 Landmark Asia Pacific Conference OpensDoor to Prosperous ISPOR Future in Far East

2 Letter From the Editor

4 Use Of Iterative Search Strategies ToIncrease PubMed Yield ForPharmacoeconomic Research

6 Best Practices: Evaluating Modeling Researchat ISPOR Using BMJ and ISPOR Guidelines

9 Evaluating Retrospective Study DesignPosters Presented at The ISPOR 7th AnnualInternational Meeting

12 Fireside Chat — Vision 2010:A Road Mapfor ISPOR

13 Survey of Acceptable Variations in Cost-effectiveness Ratios:A Brief Overview

13 Web Connections

14 ISPOR Student Corner

15 News Briefs from Around the World

16 Using Pharmacoeconomics and Outcomes Research Innovatively

20 ISPOR 9th Annual International MeetingInformation

22 ISPOR 6th Annual European CongressInformation

22 ISPOR6th Annual European CongressR e g i s t r ation Fo r m

REGISTER NOWISPOR Sixth Annual European Congress

9-11 November 2003 Barcelona, Spain

OCTOBER 15, 2003 VOL. 9, NO. 5 ■ IN T E R N ATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH

For the first time in the eight-year existenceof the organization, ISPOR expanded outsideof Europe and North America to hold ani n t e rnational conference in Kobe, Japan.

Over 250 people gathered at theInternational Conference Center Kobe inKobe, Japan to attend ISPOR’s First AsiaPacific Conference earlier this month toexchange ideas and gather information aboutp h a rmacoeconomics and outcomes assess-ment from surrounding countries such asChina, Taiwan, Korea, and Australia.

Sean Sullivan PhD, University of Wa s h i n g t o n ,Seattle, WA, USA and 2003-2004 ISPORPresident, stated that the ISPOR First AsiaPacific Conference would be remembered “asa water-shed event for ISPOR.”

Monday, September 1, 2003J a p a n ’s first ISPOR conference began withS h o rt Courses followed by the opening of theContributed Poster Presentations featuringover 90 posters and a pre - c o n f e rence sympo-sium “Clinical and Social Burden of COPD”,s p o n s o red by Pfizer and Nippon Boehringer-Ingelheim. Shuzo Nishimura PhD, KyotoU n i v e r s i t y, Kyoto, Japan, Masakazu IchinoseMD, PhD, Wakayama Medical University,Wakayama, Japan, and Ng Tze Pin MD, PhD,National University of Singapore, Singapore ,spoke about the current problems and futured i rection of chronic obstructive pulmonarydisease, both clinically and economically.

Tuesday, September 2, 2003On Tuesday over 250 people gathered for theo fficial welcome from the ISPOR Asia PacificC o n f e rence co-chairs, Isao Kamae MD, PhD,Kobe University, Kobe, Japan, Naoki IkegamiMD, MA, Keio University, Tokyo, Japan, andShuzo Nishimura PhD, Kyoto University,Kyoto, Japan during the First Plenary Session,“Role of Pharmacoeconomics and OutcomesR e s e a rch in Health Care Decisions”. Dr.Ryoji Takahara, Dire c t o r-General of theM i n i s t ry of Health, Labour and We l f a re ofJapan, Tokyo, Japan, presented issues on thehealth care re f o rm in Japan. Sean SullivanPhD, 2003-2004 ISPOR President, then dis-cussed the role of pharamacoeconomic guide-lines in drug selection health care decisions.D r. Sullivan explained how guidelines fo rp h a rmacoeconomic evaluations are playing ani n c reasingly important role in re s o u rce alloca-tion decisions for a select few countries.

ISP R

continued on page 3

ISPOR First Asia-Pacific Conference Program Co-Chair Isao Kamae MD, DrPH (left) and ISPORPresident Sean Sullivan PhD (right)

Standing room only at the First Plenary Session

I t ’s all a matter of perspective.

Health economics is often painted with a brush so bro a dthat some believe a statement about cost effectiveness isgeneric. Yet when it comes to money out of one’s ownpocket the statement is riddled with bullets of doubts.This lack of understanding impedes the advance of thescience of health economics.

H E A LTH CARE COSTS, QUALITY, AND OUTCOMES: ISPOR BOOK OFT E R M S© defines health economics as “a discipline that analyses the economic aspectsof health and health care and that usually focuses on the costs (inputs) and the conse-quences (outcomes) of health care interventions using methods and theories from economics and medicine.”

Health economists are a diverse group of professionals, including clinicians from variouspractice settings and expertise, economists, statisticians, actuary, health service re s e a rc h ,public health, epidemiology, social psychology or other related fields from pharm a c e u t i-cal industry, academia, health care, insurance, government or consultants. I haven’tt h o roughly re s e a rched all the disciplines re s e a rching health economics, so I pro b a b l ymissed quite a few.

The perspective of health economics varies, and some simply segregate into five cate-gories: pro v i d e r, institution, patient, third - p a rty payer or society. Within each categoryt h e re are numerous subgroups. For example, third - p a rty payer can further be bro k e ndown to insurance companies, managed care, government, self-insured companies, andhealth maintenance organizations. Again, these subcategories may be broken downeven furt h e r. For example, US government includes Medicaid, Medicare, Ve t e r a n sAdministration, and government employees. It doesn’t end here. Within this subgro u pt h e re are numerous other versions to consider.

Health economics is like a kaleidoscope with an endless number of patterns of colors,changing each time a user looks through it. No matter how many perspectives youchoose to re s e a rch your hypothesis, the end user may say “but this is not my patient pop-ulation”.

With all the diff e rent backgrounds within health economics designing the studies, themyriad number of perspectives to consider, and the lack understanding by the users ofhealth economics, suspicion, and conjecture will continue to flourish as to methods andmotives of the re s e a rch.

S i n c e re l y,

Steven E. Marx PharmD MS, E d i t o r- i n - C h i e f

Letter From the Editor

Copyright © 2003 International Society of Pharmacoeconomics and Outcomes Research (ISPOR)All rights reserved under International and Pan-American Copyright Conventions. Published in the United States of America by the International Society for Pharmacoeconomics and Outcomes Research.

No part of this publication may be used or reproduced in any manner whatsoever or by any means – graphic, electronic, ormechanical, including photocopying, taping, or information storage and retrieval systems without express written permission ofthe International Society for Pharmacoeconomics and Outcomes Research.

ISPOR and ISPOR C O N N E C T I O N S are trademarks of the International Society for Pharmacoeconomics and Outcomes Research.Inquiries should be addressed to: International Society for Pharmacoeconomics and Outcomes Research, 3100 Princeton Pike, Building 3, Suite E, Lawrenceville, NJ 08648 USA

2 October 15,2003 ISPORCONNECTIONS

ISPOR 2003-2004 Board of DirectorsPRESIDENT – Sean Sullivan PhD, University ofWashington, sdsull@u.washington.edu

PAST PRESIDENT –Peter Da vey MD, FRC P, Un i ve r-s i t y of Dundee and MEMO, peter@memo.dundee.ac.uk

PRESIDENT-ELECT – Lieven Annemans PhD,HEDM, University of Ghent, lieven.annemans@hedm.be

DIRECTORS – Kerstin (Chris) Bingefors PhD,Uppsala University, chris.bingefors@farmaci.uu.se;D.S. (Pete) Fullerton RPh, PhD, University ofWashington, peteful@msn.com; Mark Nuijten MD,MBA, MEDTAP International, nuijten@medtap.nl;Randel E. Richner BSN, MPH, Boston ScientificCorporation, richnerr@bsci.com; Marcus D. WilsonPharmD, Health Core, Inc., mwilson@hcore.com

TREASURER – Jean Paul Gagnon PhD, AventisPharmaceuticals, jean.gagnon@aventis.com

EXECUTIVE DIRECTOR – Marilyn Dix Smith RPh,PhD, ISPOR, mdsmith@ispor.org

ISPOR CONNECTIONS Editor & Editorial BoardE D I TO R – St e ve n E. Ma rx PharmD, MS, Ab b o t tLaboratories, isporc o n n e c t i o n s @ i s p o r.org

E D I TORIAL BOA R D – Chih-Hung Chang PhD,Northwestern University; Bonnie M. Korenblat DonatoPhD, Bristol Myers Squib; Luis Prieto PhD, Lilly SA;Michael Wonder BSc, BPharm, Nova rtis Ph a r m a c e u t i c a l sAustralia; Peter Wong RPH, MS, MBA, PhD, GoodSamaritan Hospital

ISPOR CONNECTIONS Publishing, Subscription,and Advertising Office:I S P O RCO N N E C T I O N S(ISSN 1538-5108) (USPS019121) is published bi-monthly by the In t e r n a t i o n a lSociety for Pharmacoeconomics and Ou t c o m e sRe s e a rch, 3100 Princeton Pike, Building 3, Suite E,L a w renceville, NJ 08648 USA. Phone: 609-219-0773 Fax: 609-219-0774 Website: w w w. i s p o r. o r gManaging Editor: Stephen L. Priori, email: spriori@ispor.org Ad ve rtising Manager: Nadia G. Naaman, email: nnaaman@ispor. o r g

Di rect adve rtising, photocopy permission, and re p r i n trequests, to Managing Ed i t o r. Periodicals Postage paid atTrenton, New Je r s e y.

Annual membership dues include $30 for regular mem-bers and $15 for student members for a 1-year subscrip-tion to ISPOR CO N N E C T I O N S.POSTMASTER: Send address changes to I S P O RCO N N E C T I O N S ,3100 Princeton Pike, Building 3,Suite E, Lawrenceville, NJ 08648 USA.

ISPORCONNECTIONS October 15, 2003 3

Rounding out the First Plenary Session, for-mer U.S. Senator David Dure n b e rger fro mMinnesota presented to the audience a policy-m a k e r’s perspective on the importance ofhealth care quality and outcomes re s e a rc h .D u re n b e rg e r, who heads up the MedicalTechnology Leadership Forum as Pre s i d e n t ,identified the common challenges that alldeveloped nations face in managing theirhealth care systems.

Following the First Plenary Session, work-shops addressed issues on clinical studies,p h a rmacoeconomics, quality of life, andhealth policy.

The Conference featured two special sessions.The first session, “The Japanese Health CareSystem: Structure, Dynamics, Lessons” wasp resented by Naoki Ikegami MD, MA,P ro f e s s o r, School of Medicine at KeioUniversity, Tokyo, Japan. Dr. Ikegami dis-cussed the Japanese health care system and itsstructure, dynamics and lessons learned.

The second special session, “Datasources forP h a rmacoepidemiology and Pharm a c o-economics Studies in Asia Pacific” chaired byK i i c h i ro Tsutani MD, PhD, Pro f e s s o r,University of Tokyo, Tokyo, Japan, addre s s e ddata sources for pharmacoepidemiolgy andp h a rmacoeconomics studies in Asia Pacificregion. The Special Session, co-sponsored bythe Japanese Society of Pharm a c o-e p i d e m i o l o g y, ISPOR, and the Intern a t i o n a lSociety for Pharm a c o e p i d e m i o l o g y, re v i e w e dthe current status of data sources, identifiedp roblems and looked at future plans for phar-macoeconomic development in the Asia-Pacific re g i o n .

Peter Davey MA, Dire c t o r, M-TA G ,C h a t s w o od, Australia, spoke about the curre n tt rends in Australia while Shanlian Hu PhD,P ro f e s s o r, Fudan University in Shanghai,Shanghai, China lectured about China’s cur-

rent status. Byung Joo Park MD, PhD,P ro f e s s o r, Seoul National University, Seoul,K o rea, spoke on data sources in Korea, andTa k u ro Shimbo MD, DMs, AssociateP ro f e s s o r, Kyoto University, Kyoto, Japan,talked about data sources in Japan. The specialsession concluded with Yen-Huei (Tony) Ta rnPhD, Associate Pro f e s s o r, National DefenseMedical Center, Taiwan, speaking in Ta i w a n ’sdata sources. As Dr. Ta rn concluded, he alsonoted that Taiwan had started the Ta i w a nSociety for Pharmacoeconomics andOutcomes Research (TA S P OR) in August2002. Curre n t l y, TA S P OR has 149 members.

Concluding the afternoon session was a satel-lite symposium, “Kobe Medical DevelopmentProject in the 21st Century”. The symposiumf e a t u red Peter Neumann ScD, AssociateProfessor, Harvard School of Public Health,Cambridge, MA, and J. Jaime Caro MD,Scientific Director, Caro Research, Concord,MA, USA. Dr. Neumann discussed the needfor technology assessment in health carewhile Dr. Caro talked about business develop-ment and technology assessment.

Following the satellite symposium was a char-t e red cruise around the bay. The eveningevent provided tastes of traditional Japaneseand Chinese cuisine as well as traditionalJapanese music and dance, Gagaku, and a tra-ditional Japanese tea cere m o n y.

Wednesday, September 3,2003Wednesday morning began with poster view-ing followed by the second of the plenary ses-sions, “International Comparison of HealthC a re Reimbursement Systems and Use ofP h a rmacoeconomics in the ReimbursementP rocess”, in which there was a displayed ani n t e rnational comparison of health care re i m-bursement systems and the use of pharm a-coeconomics in the reimbursement pro c e s s .Six plenary speakers re p resented six diff e re n tc o u n t ry health care reimbursement systems.

Makoto Shiragami PhD, Pro f e s s o r, NihonUniversity in Chiba, Chiba, Japan, openedand discussed the health care re i m b u r s e m e n tsystems and the use of pharmacoeconomics inJapan, followed by Zhiqiang Guan MD, Headof the Health Insurance Research Depart m e n tat the National Institute of Social Insurance,M i n i s t ry of Labor and Social Security, Beijing,C h i n a .

Bong-Min Yang PhD, Pro f e s s o r, SeoulNational University, Seoul, Korea pre s e n t e dthe Korean reimbursement system and thenShu Chuen Li, MBA, PhD, AssistantP ro f e s s o r, National University of Singapore ,S i n g a p o re, discussed the health care re i m-bursement systems and pharamacoeconomicsin Singapore .

continued from cover...

From left, Kiichiro Tstutani (Japan) (moderat o r ) ,Peter Dav ey (Australia), and Shanlian Hu (China),at the Datasources Special Session

ISPOR staff and First Asia-Pacific Conference volunteers

From left: Byung Joo Park (Korea), Takuro Shimbo( J apan) and Yen Huei Tarn (Taiwan) answer questionsduring the Datasources Special Session

4 October 15,2003 ISPORCONNECTIONS

The two concluding speakers in the second plenary session wereN a t h o rn Chaiyak u n a p ruk PharmD, PhD, Instru c t o r, N a re s u a nU n i v e r s i t y, Bangkok, Thailand and Dr. Ta rn, to once again re p re s e n tTa i w a n ’s reimbursement system.

After the Closing Poster Session, attendees perticipated in the finalworkshop session discussing topics on clinical studies, pharm a c o e c o-nomics, quality of life, and health policy studies.

Isao Kamae closed the ISPOR First Asia Pacific Conference by sayingthat the meeting was a “great success” and that he was looking forw a rdto more ISPOR gatherings in the Asia Pacific region very soon. ■

For more information on the ISPOR First Asia Pacific Conference inKobe, Japan, log onto the ISPOR website at www.ispor.org.

Sound evidence for clinical decision-makingi n c reasingly includes patient-re p o rted out-comes such as quality of life, andeconomic/societal outcomes such as coste ffectiveness. The vast and expanding arr a yof choices for pharmacologic treatment, andi n c reasing debate about value and cost hasp ropelled evidence-based approaches toquantify the value of drug treatment into cen-ter stage. Systematic reviews of well-designedstudies are at the top of the hierarchy of bestevidence [1], and electronic literature searc h-es are invariably a key component. TheNational Library of Medicine’s PubMed inter-face, of which fully indexed MEDLINE cita-tions are the primary component, is thel a rgest and most widely accessible database ofpublished biomedical re s e a rch literature .H o w e v e r, even clinically oriented searches ofPubMed/MEDLINE may not capture a larg es h a re of relevant articles, due to suboptimaluse of search capability by end users [2,3].F rom our experience conducting multiple sys-tematic reviews, we hypothesized that infor-mation pertaining to pharmacoeconomic andpatient-oriented outcomes was even more dif-

ficult to accurately locate on PubMed, anddevised a plan to improve search yields usingan iterative process, and tracking the value ofthe added search terms.

ObjectiveOur goal was twofold: to evaluate the adequa-cy of PubMed searching to capture re l e v a n ta rticles, and to design a method to makes e a rch yields more comprehensive. Fiveb road subject areas were identified as a test,each one re p resenting a common, chro n i ccondition for which there was an active andongoing debate re g a rding the value of phar-maceutical treatment(s): asthma, depre s s i o n ,diabetes, gastrointestinal (GI) disord e r s(including gastroesophageal reflux and pepticulcer), and migraine. How adequate isPubMed searching for locating relevant art i-cles on these topics, and how can searc hyields be made more compre h e n s i v e ?

Iterative Search MethodologyWe conducted a systematic review in fivec h ronic disease settings, including develop-ment of prospectively defined criteria for

study inclusion. Outcomes of interest werethose relevant to the value of pharm a c e u t i c a lt reatment (economic, societal, and/or patientbenefit), including quality of life and quality-adjusted life years, cost-benefit or cost-eff e c-tiveness of treatment, changes in prod u c t i v i-t y, absenteeism, or work function. Eligiblestudies were of prospective or re t ro s p e c t i v edesign, either interventional or observ a t i o n a l(including economic models using data fro mpublished literature, clinical studies, or claimsdatabases). Studies had to assess a pharm a c o-logic treatment and had to re p o rt at least oneoutcome of interest for at least 10 adultpatients in one of the 5 conditions of intere s t :asthma, depression, diabetes, GI disorders, ormigraine. No burdens of illness studies (with-out re p o rting of value of pharmacologic tre a t-ment) were eligible for this re v i e w.

An initial PubMed search was constru c t e dwith MeSH (Medical Subject Heading) term sindicating each of the 3 domains of intere s t :d rug treatment (“drug therapy” subheading);outcomes (“Economics, pharm a c e u t i c a l ” ,“Costs and Cost Analysis,” and “Quality of

Use Of Iterative Search Strategies To Increase PubMed Yield For Pharmacoeconomic ResearchDiana Fr a m e, M E M , M e t a Works Inc. , M e d f o r d , M A , U S A ; Sidney Klawansky, M D, P h D, H a rvard School of Public Health, B o s t o n , M A , U S A

D r. Isao Kamne (center) and his gr o u p

From left, former US Senator David Durenberger, ISPOR President Dr. Sean Sullivanand Health Bureau Director-General of Japan's Ministry of Health, L abour & We l f a r e ,D r. Ryoji Ta k a h a r a

ISPORCONNECTIONS October 15,2003 5

life” MeSH terms); and conditions (MeSHt e rms for each of the 5 settings). The goal wasa broad, comprehensive search, which wouldbe screened further to identify relevant art i-cles. In other words, the emphasis was on sen-s i t i v i t y, not specificity, though we did make ane ff o rt to maintain the total “top-of-funnel”number within reasonable bounds to limit thes c reening eff o rt (no more than 5,000-6,000).The years searched were 1995-2000, ands e a rches were limited to English language andHuman subjects.

Next, we reviewed indexing terms present inkey articles found independently of the initials e a rch (including searches on key authors andj o u rnals), using an iterative process. BothMeSH terms and keywords were identified atthis stage, and terms that led to identificationof new, relevant citations without excessivei n c rease in the total search yield wereretained. The MeSH tree stru c t u re wasaccounted for by investigating higher- l e v e lt e rms for relevance of added yield, and if theh i g h e r-level term (exploded) was added,l o w e r-level terms were taken out of the searc hunless their use was desired as keywords. ThePubMed search was also refined to logicallyaccount for terms, which indicated multipleconcepts (e.g. the MeSH term “anti-depre s-sive agents” was included as an “OR” option inboth the depression topic string and the dru gtherapy string for the depression search; like-wise the term “economics, pharm a c e u t i c a l ”counted for both the outcomes string and thed rug therapy string).

Supplemental electronic (Current Contents,Cochrane Library, University of York NHSC e n t re) and manual bibliography searches wereused to create a listing of accepted studies forcomparison to the PubMed-only search results.

Search YieldsCitations totaling 3677 were downloaded ands c reened from all sources, resulting in 135accepted papers across the five settings (asth-ma-20, depression-40, diabetes-16, GI disor-ders-41, migraine-18). The method of itera-tive development of search terms incre a s e dthe percentage of studies found on PubMed to90% of the final total (122/135, range 80-100% by setting) compared to only 69%(93/135, range 44%-83% by setting) with ini-tial terms (Figure 1). The first term to be iden-tified on a casual review of the MeSH diction-a ry, the MeSH term “economics, pharm a c e u t i-cal”—a reasonable and intuitive choice for anoccasional user of PubMed to make—whenc rossed with disease setting terms would byitself have captured only a small minority ofrelevant articles (22/135, 16% overall).

PubMed indexing appears to vary by clinicalsetting and journal subject, with somewhatweaker results for pharm a c o e c o n o m i c / m a n-aged care journals (78%) than disease-specific(94%) or general medical (98%) journ a l s .Supplemental searches are there f o re even morei m p o rtant for socioeconomic and patient-out-comes re s e a rch. Duplication of articles acro s sdatabases was more common than it appeare di n i t i a l l y, owing to variation in the way cita-tions were indexed in the diff e rent databases

and in manual re f e rence list checks. Non-matching journal abbreviations, study gro u pauthors, and incorrect publication year werethe most common reasons identical papersw e re not immediately identified as duplicates.

Lessons LearnedC a reful iterative development of search term sshould be a component of all systematics e a rches in PubMed, and exploration of theMeSH term hierarchy is advised even forcasual searches. PubMed has recently added(since this review) an improved MeSH bro w s-er interface which greatly facilitates thelookup of terms containing relevant concepts;still, locating a single perfectly relevant MeSHt e rm does not mean other equally re l e v a n tt e rms do not exist elsewhere in the MeSHt ree. Keyword searching for recent (unhin-d e red) citations and supplemental electro n i cand manual searching remain necessary toobtain a comprehensive study set.

The accept rate in this re v i e w, once full papersw e re retrieved for screening, was only 3.6%a c ross all five disease settings due to our goal ofa comprehensive search. Maximizing sensitiv-ity of searches (% articles captured) can oftencome at the cost of sensitivity (% capture da rticles which are relevant) [4]. We accepteda low specificity in order to identify the larg e s ts h a re of potentially relevant articles; webelieve this approach to be necessary for sys-tematic review purposes, but for other purpos-es users may wish to perf o rm a more targ e t e ds e a rch. The process of iterative searching onMeSH terms and keywords would still be a keyi n g redient in refining a targeted search, withthe application of diff e rent decision rules toe n s u re that only the terms with the highesti n c remental yield of relevant articles wereretained. ■

REFERENCES1 Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users’guides to the medical literature: XXV: evidence-based medicine: principles for applying the users’guides to patient care. JAMA 2000;284:1290-6.

2 Hersh WR, Hickam DH. How well do physiciansuse electronic information retrieval systems? A frame-work for investigation and systematic review. JAMA1998;21:1347-52.

3 Gault LV. Variations in Medical Subject Heading(MeSH) mapping: From the natural language ofpatron terms to the controlled vocabulary of mappedlists. J Med Libr Assoc 2002;90:173-80.

4 Haynes RB, Wilczynski N, McKibbon KA, et al.Developing optimal search strategies for detectingclinically sound studies in MEDLINE. J Am MedInform Assoc 1994;1:447-58

F i g . 1 Percent of studies captured in PubMed searches

Asthma Depression Diabetes GI Disordres Migraine

6 October 15,2003 ISPORCONNECTIONS

INTRODUCTION The number of economic modeling studies forevaluation of health care services hasi n c reased exponentially in the past decade.H o w e v e r, the quality of re s e a rch in this fieldvaries, ranging from poor to excellent, makingit difficult for policy-makers, administrators,and health care practitioners to determine thevalidity of pharmacoeconomic study re s u l t s .Several studies have noted that economicevaluations of health care services and inter-ventions in the literature frequently fail toa d h e re to the basic analytic and re p o rt i n gprinciples noted in commonly accepted evalu-ation criteria [1-4]. The failure to use stan-d a rdized re p o rting severely constrains evalua-tion of the methods of economic studies. Ino rder to address this issue, several guidelineshave been developed to encourage standard-ized methods and re p o rting. These guidelinesconsist of criteria to guide re s e a rch as well asre p o rting of re s e a rch findings in this field. Inaddition, these guidelines also assist in studyevaluation in order to determine whetherg o od re s e a rch practice standard are met bypublished modeling studies.

Both the British Medical Journal (1996) andthe ISPOR Working Panel on Good Researc hPractice in Modeling Studies (2003) haveestablished guidelines. These guidelines pro-vide re s e a rchers with excellent guidance inthe design and execution of modeling studies,and it is important to consider whetherre s e a rchers are using them to improve thequality of re s e a rch submitted to ISPOR annu-al meetings.

OBJECTIVE The purpose of our re s e a rch is to evaluatewhether the modeling posters presented at the2002 ISPOR 7th Annual Intern a t i o n a lMeeting met the standards of good re s e a rc hpractice criteria established by the BritishMedical Journal (BMJ) and ISPOR. We alsodescribe the criteria most likely to be satisfiedby the posters.

WHICH GUIDELINES TOCHOOSE? A literature search using MEDLINE for anypublished guidelines was conducted prior toinitiating the study. There were a total of 19guidelines, checklists, and re c o m m e n d a t i o n sfor health economic studies. All were written

in the English language, published after 1990,and developed for cost-minimization (CMA),c o s t - e ffectiveness (CEA), or cost-utility(CUA) analysis. The guideline established bythe British Medical Journal was chosenbecause it is available in a clear checklist ofcriteria, provides reasonable detail, and is suf-ficiently comprehensive in scope. In addition,the ISPOR criteria were not published at thetime they were used to evaluate the posters.T h e re f o re, the guidelines by the BritishMedical Journal were used as comparatorguidelines that have been published.

At the beginning of our study, the ISPORguideline was not yet published. However, aworking draft generated by the ISPOR HealthScience Committee of the Task Force onG o od Research Practices in Modeling Studieswas accessible on the ISPOR website. Thedraft was not in a checklist form, but it pro-vided an important frame of re f e rence forre s e a rch presented at the ISPOR meeting. We

extracted essential elements of the panel’s re c-ommendations and created our own checklistbased on the draft.

METHODS Posters presented at the meeting were collect-ed onsite (N = 40) or from those posted to theI S P OR website (N = 93). Of the total 337posters presented, 133 posters (39%) wereevaluated. The posters were initially catego-rized into prospective (N = 11), re t ro s p e c t i v e(N = 42), modeling (N = 26), health re l a t e dquality of life (HrQoL; N = 29), or other stud-ies (N = 25). Nine (9) out of 26 mod e l i n gposters were excluded because they focusedexclusively on the denominator or numeratorof a cost-effectiveness analysis.

The remaining 17 posters were evaluated byBMJ and ISPOR guidelines for modeling stud-ies in 3 major sections (Table 1): a) Studydesign (7 items for BMJ; 3 for ISPOR); b)Data validity (14 items for BMJ; 13 for

I S P OR); c) Analysis and interpretation (14items for BMJ; 23 for ISPOR).

In each section, the posters were placed inq u a rtiles through the application of the check-lists by two of the authors (VDP and JS). Asenior author (MBN) reconciled inconsisten-cies between the ratings of the two principalraters. Thus, the posters were grouped intofour categories depending on the extent towhich they satisfied: a) greater than or equal to75% of the specific criteria; b) greater than orequal to 50% to less than 75%; c) greater thanor equal to 25% to less than 50%; and d) lessthan 25% of the criteria in both guidelines.

RESULTSOverall, the 17 posters met 52% (18/35) of theBMJ criteria and 46 % (18/39) of the ISPORcriteria (Fig 1). Posters were slightly more like-ly to satisfy the BMJ, rather than ISPOR crite-ria for data validity as well as for analysis andi n t e r p retation sections (Fig. 2). The majority

of the posters satisfied 75% or greater of thecriteria in the study design section of both theI S P OR and BMJ guidelines. However, most ofthem only satisfied between 50% and 75% ofthe criteria in the data validity and analysisand interpretation sections of both guidelines(Fig. 2).

Nine out of 17 posters (53%) met more than75% of the study design criteria within theBMJ guideline. For the data validity section ofBMJ, 11 posters (65%) satisfied less than 50%of the criteria. Only 3 posters satisfied morethan 75% and 4 posters satisfied less than 25%of the criteria in the analysis & interpre t a t i o nsection of BMJ guideline (Fig. 2).

For the ISPOR guideline, only 9 (out of 17)posters satisfied more than 75% of the studydesign criteria. None of the posters satisfied75% of the ISPOR data validity criteria, andonly 3 posters satisfied between 50-75% of the data validity criteria. A total of 9 (53%)

Best Practices: Evaluating Modeling Research at ISPOR Using BMJ and ISPOR GuidelinesJuliana Setyawan, P h a rm D, MS (candidate), Vaishali Pa t e l , P h a rm D, MS (candidate), and Michael B. N i c h o l , P h D, University of SouthernC a l i f o rn i a , School of Pharm a c y, Department of Pharmaceutical Economics and Po l i c y, Los A n g e l e s, C A , U S A ; Gerald Borok, P h D,Astra Zeneca, Los A n g e l e s, C A , USA

The number of economic modeling studies for evaluation of health care services hasincreased exponentially in the past decade. H o w e v e r, the quality of research in thisfield varies, r a n ging from poor to excellent, making it difficult for policy-makers, a d m i n-i s t r at o r s , and health care practitioners to determine the validity of pharmacoeconomicstudy results.

ISPORCONNECTIONS October 15,2003 7

1.Is the viewpoint of the analysis clearly stated? (p.11; Structure # 1)

2.Is the model structure relevant to the decision making perspective of the economic evaluation? (p.11;Structure # 1)

3.Are the key steps taken in developing the model carefully documented & recorded? (p.14; Data modeling # 2)

1.The research question is stated

2.The economic importance of the research question is stated

3.The viewpoint(s) of the analysis are clearly stated and justified

4. The rationale for choosing the alternative programmes or i n t e rventions compared is stat e d

5.The alternatives being compared are clearly described

6.The form of economic evaluation used is stated

7. The choice of form of economic evaluation is justified in relation to the questions addressed

4.Are the model inputs and outputs relevant to the decision making perspective? (p.11; Structure # 1)

5.Is systematic review of the literature on key model input conducted? (p.13; Data Identification # 2)

6.Are all the available data pertaining to the study question utilized? If not,is the explanation for excluding certain data given? (p.13; Data Identification # 5 & 6)

7.Is the modeled populations disaggregated according to strata that have different event probabilities,quality oflife,and costs? (p.12; Structure # 12)

8.Is the supporting evidence obtained from studies that examine the effect of risk factors or intervention in apopulation stratified by base risk? (p.14; Data Modeling # 1e)

9.Is measurement of population characteristics throughout the model mutually consistent? (p.14; DataIncorporation # 1)

10.Is expert opinion elicited? Is the elicitation disclosed in details? (p.13; Data Identification # 7)

11.Are validated HrQoL instruments used in the process of combining domain-specific utilities into a multi-attribute utility function? (p.14 Data Modeling # 1f)

12.Is the method for transforming health status values ( i.e.,rating scales or health-states classifications) intoquality of life weights clearly elucidated? (p.14; Data Modeling # 1g)

13.Are the methods for transforming charges to cost reported? (p.14; Data Modeling # 1h)

14.Is measurement of unit costs throughout the model mutually consistent? (p.14; Data incorporation # 1)

15.Are baseline probabilities of survival and other endpoints from population-based sources in order to incorpo-rate estimates of treatment effectiveness appropriately estimated? (The most appropriate approach is to esti-mate OR or RR) (p.13; Data Modeling # 1a).

16.Is the method for transforming interval probabilities from clinical trial to transition or event probabilities in themodel clearly elucidated? (p.13; Data Modeling # 1b)

1 7 . Is measurement of time interval (time horizon) throughout the model mutually consistent? (p.14; Data Incorporation # 1)

1 8 . Is the time length of the model long enough to measure difference between outcomes? (p. 12; Structure # 13)

1 9 . Are the model assumption clearly stated? (p.14; Data Modeling # 2)

2 0 . Are the model assumption supported by literature? (p. 14; Data Modeling # 2)

2 1 . Are the model assumptions based on coherent theory of the disease being modeled? (p. 11; Structure # 2&3)

2 2 . Are the outcomes based on model assumption? (p. 16; External & Predictive Va l i d ation # 1)

2 3 . Are explanation provided if a model’s outputs differ appreciably from published / publicly available results based onother models? (p. 15; Between-model Va l i d ation # 2)

2 4 . Are the discrepancies in the model’s outputs due to differences in model structures? (p. 15; Between-modelVa l i d ation # 2)

2 5 .Are the discrepancies in the model’s outputs due to differences in input values? (p. 15; Between-model Va l i d ation # 2)

2 6 . Does the model structure reflect the essential features of the disease? (p.12; Structure # 11)

2 7 . Is the model described in detail so that it can be replicated? (p. 11; Model evaluat i o n )

2 8 . Is there evidence regarding the causal linkages between the variables chosen in the model? Are these evidencedocumented? (p. 11; Structure # 2)

2 9 . Is the structure of the model as simple as possible while still capturing the essentials of the disease process andi n t e rvention? (p. 12; Structure # 9)

3 0 . Is sensitivity analysis conducted? (p.12; Structure # 9)

3 1 . Is there evidence that the model has been tested for internal validity? (p. 15; Internal Va l i d ation # 1)

3 2 . Is the data adjusted for inflation? (p. 14; Data Modeling # 1i)

3 3 . Is the method for discounting costs & health effects to present value described? (p.14; Data Modeling # 1j)

3 4 . Are the base-case estimates of all inputs parameters defined in the sensitivity analysis? (p.13; DataIdentification # 3)

3 5 . Is the value range for the parameters to be included in the sensitivity analysis specified? ? (p. 13; Dat aI d e n t i f i c ation # 3)

3 6 . Is sensitivity analysis using alternative model structures ( i.e., a l t e r n ative surrogate markers or intermediate variables) performed? (p. 11; Structure #3)

3 7 . Is heterogeneity within the modeled population considered in constructing the model? (p. 12; Structure #12)

3 8 . Are limitations of the evidence supporting the chosen model structures acknowledged? (p. 11; Structure # 3)

3 9 . Is the conclusion clearly framed based on the assumptions and conditional upon the parameters’ input estimates? (p. 1 0 )

Study Design

Data Validity

Study Analysis & Interpretation

Major Sections British Medical Journal(5) ISPOR Task Force on Good Research Practices – Modeling Studies* (6)

(*):Each of the criteria extracted from ISPOR Task

Force on Good Research Practices – Modeling Studies

is accompanied by the page number where each item

can be found in the referenced article.

8.The source(s) of effectiveness estimates used are stated

9.Details of the design and results of effectiveness study aregiven (if based on a single study)

10.Details of the method of synthesis or meta-analysis of estimates are given (if based on an overview of a number ofeffectiveness studies)

11.The primary outcome measure(s) for the economic evaluation are clearly stated

12.Methods to value health states and other benefits are stated

13.Details of the subjects from whom valuations were obtainedare given

14.Productivity changes (if included) are reported separately

15.The relevance of productivity changes to the study questionis discussed

16.Quantities of resources are reported separately from theirunit costs

17.Methods for the estimation of quantities and unit costs aredescribed

18.Currency and price data are recorded

19.Details of currency of price adjustments for inflation or currency conversion are given

20.Details of any model used are given

21.The choice of model used and the key parameters on whichit is based are justified

22. Time horizon of costs and benefits is stated

23.The discount rate(s) is stated

24.The choice of rate(s) is justified

25. An explanation is given if costs or benefits are not discounted

26.Details of statistical tests and confidence intervals are givenfor stochastic data

27.The approach to sensitivity analysis is given

28.The choice of variables for sensitivity analysis is justified

29.The ranges over which the variables are varied are stated

30.Relevant alternatives are compared

31.Incremental analysis is reported

32.Major outcomes are presented in a disaggregated as well asaggregated form

33.The answer to the study question is given

34.Conclusions follow from the data reported

35.Conclusions are accompanied by the appropriate caveats

8 October 15,2003 ISPOR CONNECTIONS

F i g . 1 Overall Average Proportion of BMJ and ISPOR CriteriaSatisfied by Modeling Posters Presented at the 2002 7thAnnual International Meeting

F i g . 2 BMJ-rated vs. ISPOR-rated Po s t e r s

posters satisfied between 25 – 50% of the cri-teria in the analysis & interpretation sectionof the ISPOR guideline (Fig. 2).

Several of the criteria in the ISPOR guidelinew e re never met by any of the posters. The cri-teria were: 1) whether validated HrQoLi n s t rument were used in the process of com-bining domain-specific utilities; 2) whetherm e t h ods of transforming health states intoquality of life weights re p o rted; 3) whetherm e t h ods for transforming probabilities fro mclinical trials to event probabilities corre s p o n-ding to the time interval in the model wereemployed; and 4) whether the method fort r a n s f o rming charges to cost was stated.

Within the BMJ guideline, the criteria thatw e re never satisfied by any of the posters, werethe following: 1) whether details of them e t h od of meta-analysis summarizing the esti-mates obtained from overview of the literaturew e re re p o rted; 2) whether methods to valuehealth states and other benefits were re p o rt e d ;3) whether explanations were given if cost andbenefit were not discounted.

DISCUSSIONThe results of our study demonstrated the factthat most of the posters perf o rmed well instudy design section for both guidelines, butmany failed to meet significant portions of thedata validity, analysis, and interpretation sec-tions. There are a number of plausible re a s o n sfor the low perf o rmance in these posters, suchas: 1) the guidelines are too strict and compre-

hensive; 2) low awareness of the availability ofg o od re s e a rch practices standards; or 3) theabstracts review committee at ISPOR did notstrictly adhere to its established guideline ofg o od re s e a rch practice. In any event, it is clearthat a number of re s e a rchers who pre s e n t e dm odeling re s e a rch abstracts at the 7th AnnualI S P OR meeting did not pay close attention toI S P OR criteria in their submitted posters.

It should be noted that a brief content analy-sis was conducted on both guidelines. Criteriasuch as comprehensiveness, interpre t a b i l i t y,c l a r i t y, and applicability of each element ofthe guidelines were used in the evaluation.The ISPOR guideline focused more ondetailed mathematical methodologies forbuilding an economic model, which makessome of its content to be less practical andm o re difficult to satisfy. The BMJ guideline onthe other hand, focused less on the details yetstill covered all the important key criteria thatw e re also mentioned in the ISPOR guideline.Overall, BMJ and ISPOR guidelines appeare dto be very comprehensive and comparable.The comprehensiveness of these guidelines

may be too demanding for poster pre s e n t a t i o n sgiven the limited space available to re p o rtre s e a rch design, methods, and results. Thismay partially explain the observed studyresults that most posters only satisfied a re l a-tively small pro p o rtion (~50%) of the estab-lished criteria in both guidelines.

The overall observation that the postersa p p e a red to be slightly more likely to satisfythe BMJ rather than ISPOR criteria may bedue to the fact that the BMJ criteria are easierto understand and thus better applied.Although BMJ and ISPOR guidelines addre s ssimilar study characteristics and are generallyconsistent in their approach, we found thatthe BMJ criteria were much easier to interpre tand were available in a checklist form, whichmakes them more user-friendly and easier toapply than the criteria established by theI S P OR working group. The ISPOR guidelinewas not available as checklist, and it was mored i fficult to interpret and apply many elementsof the guideline. The ISPOR guidancea p p e a red to be highly focused on technicalissues, and was there f o re somewhat less com-p rehensive and adaptable to a checklista p p roach.

Several limitations of this study should betaken into consideration when one attemptsto further interpret the observed results. First,the nature of the present sample is quite limit-ed. Since it re p resents a convenience sampleof posters that were either available as copiesor were posted to the website, it may be biased.

The results of our study demonstrat e dthe fact that most of the posters per-formed well in study design section fo rboth guidelines, but many failed to meetsignificant portions of the data validity,a n a ly s i s , and interpretation sections.

0.6 —

0.5 —

0.4 —

0.3 —

0.2 —

0.1 —

0BMJ ISPOR

Guidelines for Evaluation

12

10

8

6

4

2

0

Guidelines for Evaluation

75% 50 to <75% 25% to <50% <25%

BMJ (N) ISPOR(N)

Study Design

BMJ (N) ISPOR(N)

Data Validity

BMJ (N) ISPOR(N)

A n a l y s i s & I n t e r p re t a t i on

M A J O R S E C T I O N S

9 9

6

20 0

6

9

20

3

78

9

0 0

3 34 4

10

5

3

0

ISPORCONNECTIONS October 15,2003 9

IntroductionThe number of posters presented at theI S P OR Annual International Meetings hasi n c reased in the past two years from 330 atthe seventh conference, to 456 at the eighthc o n f e rence [1-3]. It is likely that as theI S P OR active membership increases over thenext few years, so will the number of abstractssubmitted and posters presented. This makesit critical to evaluate the quality of postersp resented, using the published ISPOR orother published guidelines. A systematicreview such as this one can be very useful foridentifying specific areas that the posters per-f o rm positively on, as well as those areas thatneed improvement in the future .

Most of the posters presented at ISPOR canbe categorized, based on their study design, asp rospective, re t rospective, quality of life, orm odeling. Four diff e rent task forces org a n i z e dby ISPOR have either completed guidelinesin each one of these major study design are a s ,

or are in the process of doing so. The guide-lines for the re t rospective database re s e a rc hand the modeling re s e a rch have been com-pleted and published recently [4, 5].

We evaluated both the re t rospective and them odeling study design posters, presented atthe ISPOR Seventh Annual Intern a t i o n a lC o n f e rence. This article highlights the re s u l t sof our evaluation of the re t rospective studydesign posters.

We hope that both the presenters and thereviewers will find these evaluations usefulwhen submitting or reviewing posters for thef u t u re ISPOR confere n c e s .

ObjectiveEvaluate the quality of re t rospective studydesign posters presented at the ISPORSeventh Annual Conference using the crite-ria published by the ISPOR task force on re t-rospective databases.

MethodsA thorough search of published literature wasconducted using Medline to find any check-lists that are specific for evaluating the quali-ty of re t rospective studies. Only five pub-lished guidelines were identified, none ofwhich focused specifically on the evaluationof re t rospective study design [6-10]. All fiveof these guidelines were meant for evaluatingthe quality of economic and/or cost-eff e c t i v e-ness studies in general. The checklist devel-oped by the ISPOR task force on re t ro s p e c-tive databases, which was only available inthe form of a working document at the timeof this study, was deemed to be the most re l e-vant one for the purpose of this evaluation. Afinal version of this document, which has thesame content but diff e rent formatting com-p a red to the working document, was pub-lished soon after the completion of thisreview [4].

Evaluating Retrospective Study Design Posters Presented at the ISPOR 7th Annual InternationalMeeting, May 19-22, 2002, Arlington, VA, USAVaishali D. Patel PharmD, Juliana Setyawan MS, PharmD, Research Fellow in the Dept. of Pharmaceutical Economics and Policy,University of Southern California School of Pharmacy, Los Angeles, CA, USA, Gerald M. Borok PhD, MPH, Director of HealthEconomics and Outcomes Research, AstraZeneca, Los, Angels, CA, USA, and Michael B. Nichol PhD, Associate Professor and Chairfor the Dept. of Pharmaceutical Economics and Policy, University of Southern California School of Pharmacy, Los Angels, CA, USA

Second, the higher likelihood for the postersto satisfy BMJ rather than ISPOR criteria mayoccur due to chance, because of the small sizeof the study sample as well as the limited num-ber of evaluators in this study. In addition, dueto problems with interpretation for bothguidelines, as well as the experience level ofthe re s e a rcher may affect the evaluation of there s e a rch. There f o re, the appropriateness ofthese two guidelines for evaluative purposesremains subject to interpretation.

In order to improve future re s e a rch in this fieldat ISPOR, extra eff o rt should be focused on: 1)simplifying the guideline to the most essential,yet basic, components of an economic study;2) testing the established guideline on a larg e rsample of submitted modeling re s e a rch atI S P OR; 3) increasing awareness of the guide-lines’ availability at ISPOR; 4) encouragingI S P OR members to pay closer attention toI S P OR criteria for future submitted abstracts;and 5) establishing guidance to the abstract

selection committee to apply the establishedguideline of good re s e a rch practice in thereview process.

In conclusion, the number of posters re v i e w e dand the number of evaluators limit this study.Reviewed posters revealed satisfactory per-f o rmance in the study design elements of theI S P OR and BMJ guidelines, but could bei m p roved in data validity and analysis.G e n e r a l l y, the posters perf o rmed better whenrated using the BMJ rather than the ISPORguideline. Additional work by the ISPORG o od Research Practices Panel on Mod e l i n gStudies should focus on increasing awareness aswell as improving the applicability and inter-p retability of the good practices guideline. ■

REFERENCES1. Sanchez LA. Evaluating the Quality of PublishedPharmacoeconomic Evaluations. Hosp Pharm1995;30:146-52.

2. Udvarhelyi S, Colditz GA, Ray A, Epstein AM.Cost-Effectiveness and Cost-Benefit Analyses in the Medical Literature. Ann Intern Med1992;116:238-44.

3. Jefferson T, Demicheli V, Vale L. Quality ofSystematic Reviews of Economic Evaluations inHealth Care. JAMA 2002;287:2809-12.

4. Weinstein MC, O’Brien B, Hornberger J, et al.Principle of Good Practice for Decision AnalyticModeling in Health-Care Evaluation: Report of theISPOR Task Force on Good Research Practices –Modeling Studies. Value Health 2003; 6:9-17.

5. Drummond MF, Jefferson TO. Guidelines forAuthors and Peer Reviewers of EconomicSubmissions to the BMJ. BMJ. 1996;313:275-83.

6. Rennie D, Luft HS, Pharmacoeconomic Analyses:Making Them Transparent, Making Them Credible.JAMA 2000;283:2158-60.

10 October 15, 2003 ISPORCONNECTIONS

T h e re were 330 posters that were presented atthe ISPOR 7th Annual Intern a t i o n a lMeeting. Out of this we had access to 133(40%) from either the on site collection orthe ISPOR website. These 133 posters werecategorized into 1 of 5 categories: Pro s p e c t i v e ,R e t rospective, Modeling, Quality of Life orO t h e r. A total of 41 re t rospective studydesign posters were identified through thisp rocess, and all were evaluated.

The ISPOR Checklist for Retro s p e c t i v eDatabase Studies' was used. The originalchecklist contained 10 criteria, out of whichfour that had two or more explicit compo-nents were relabeled to have subsections.This yielded a re f o rmatted checklist with 15criteria, which were used to evaluate and scorethe perf o rmance of the re t rospective studydesign posters. Three diff e rent reviewers eval-uated posters, and compared their ratings, toassess compliance with the criteria. All of there t rospective posters available were evaluatedas a group to find the highest, lowest, andmedian scores. We also identified the criteriamost likely and least likely to be satisfied.

ResultsThe median score for the 41 re t ro s p e c t i v estudy design posters evaluated was 4 out ofpossible 15 points, which was obtained by 12posters. The highest score was 11 points,achieved by 1 poster. The lowest score was 1

point, achieved by 4 posters.

As can be seen from figure 2, several criteriaw e re likely to be met by the posters, while anumber of other criteria showed a great dealof variability. The following section on ‘posi-tive perf o rmance areas’ highlights the criteriathat were satisfied by majority of the posters,and a short description of each criterion. Thesection on ‘problem areas for future consider-ation’ highlights the criteria that were leastlikely to be met by the posters.

Positive Performance AreasThe majority of posters (86%) provided suff i-cient detail about the content and the re l e-vance of their data set (criterion 1). Thisincluded describing the type of database theyused, the population demographics, and thef o rm u l a ry coverage of a drug when evera p p ropriate. Most of the posters (84%) clear-ly defined the inclusion and exclusion criteriathey used to derive the final study sample (criterion 4a). About 44% of the postersre p o rted the confounding variables used ascovariates (criterion 7).

Problem areas for futureconsiderationOnly 12% of posters discussed validity or re l i-ability of their data set (criterion 2). Themajority of the posters did not describe thef requency of missing or out of range data, the

f requency of claim duplicates, or a compari-son of the results to the published literature .Even the posters that did describe the validi-ty or reliability measures provided insuff i c i e n tdetail to evaluate them. Thus, it was very dif-ficult to judge the quality of the data set usedin most cases.

While the majority of the posters describedtheir study design in depth, only 33% ofposters discussed the limitations of their cho-sen study design (criterion 3b). Less than 5%of posters provided a rationale for the inclu-sion or exclusion criteria used to derive thefinal study sample from the original popula-tion (criterion 4b). Likewise, fewer than 5%of the posters described the impact of theseselection criteria on sample re p re s e n t a t i v e-ness (criterion 4c). Only 47% of the postersincluded justification for selection criteriaand/or variable definitions (criterion 5a).This included listing and justifying the use ofc e rtain ICD-9 codes, CPT-4 codes, or dru gnames to identify patients.

Of the posters re p o rting statistical signifi-cance, only 26% discussed the practical oreconomic significance of their results (criteri-on 9). Only 19% of posters provided a soundt h e o retical basis (criterion 10a) for theirresults. Even fewer authors (7%) pre s e n t e dan alternative explanation for their findings(criterion 10b).

Figure 1: Modified version of the checklist developed by the ISPOR task force on retrospective databases

Topic QuestionDatabase Relevance Has the database content and study population been described in sufficient detail to determine the rationale for using the data-

base to answer the research question and to assess how the findings can be interpreted in the context of other organizations?Database Quality Have the reliability and validity of the data been described,including any data quality checks and handling of missing data?

Research Design a) Has a rationale for selecting the particular research design been provided? b) Have the potential limitations of that designbeen acknowledged?

Sample Selection a) Have the inclusion and exclusion criteria used to derive the final sample from the initial population been described?b) Has the rationale for their use been described? c) Has the impact of these criteria on sample representativeness discussed?

Variable Definitions a) Has a rationale and/or supporting literature for the selection criteria and variable definitions been provided?b) Is sensitivityanalyses performed for definitions or criteria that are controversial,uncertain,or novel?

Resource Valuation For studies that examine costs,has a method and rationale for valuing resources (costs,charges, payments,fee schedules) beendescribed and is it consistent with the study perspective?

Confounding If the goal of the study is to examine treatment effects,have the authors adequately controlled for confounding variables throughuse of a comparison group and I) multivariate statistical techniques or ii) stratification of the sample by different levels of theconfounding variables to compare outcomes?

Statistical Analysis Have the appropriate statistical techniques been used,taking into account the particular nuances of utilization and cost data,such as skewness and correlations within and among population subgroups?

Practical Significance Has the practical significance of the findings been explained by discussing the statistical versus clinical or economic significanceof the results and the variance explained/goodness of fit of the statistical models?

Theoretical Basis a) Has a theory for the findings been provided? b) Have alternative explanations for the observed findings been discussed?

ISPOR CONNECTIONS October 15, 2003 11

Discussion and LimitationsOne of the major limitations of this study isthat due to lack of access, we were only ableto evaluate a portion of the re t ro s p e c t i v estudy design posters. Another limitation isthat the ISPOR check list is not a validatedi n s t rument for evaluating the quality of re t ro-spective re s e a rch. It is also not a weightedi n s t rument, thus it considers each criterion tobe of equal importance, which may not be thecase. Some of the criteria on the ISPORchecklist are subject to interpretation by thelimited number of reviewers. For example,t h e re was a significant amount of discre p a n c ybetween the raters for criteria 3a, 5a, 8, and 9.This was thought to because majority of theposters contained some, but not nearly

enough information to fully satisfy each oneof these criterion. This is understandablegiven the space limitation authors have for ap o s t e r. But, this made it difficult to determ i n eif that particular criterion should be re c o rd e das ‘met’ or ‘not met’.

It should be noted that some criteria on thischecklist were judged ‘not appropriate’ (NA)for majority of the posters re v i e w e d .Criterion 5b, pertaining to sensitivity analy-sis, was not appropriate for 60% of the posters

because either they were descriptive studiesor were limited in the uncertainty that couldbe determined for specific outcomes.Criterion 6, regarding methods for valuingresources, was not appropriate for 42% of theposters because they did not incorporate acost component. Criterion 7, regarding con-trolling for confounders, was not appropriatefor 37% of the posters because either theywere descriptive studies or did not look attreatment effect.

I S P OR does not currently re q u i re the authorsto follow a strict set of guidelines such as thisone when preparing posters for ISPOR con-f e rences. This evaluation shows that this lackof guidance may have led to a significant

amount of content and quality diff e re n c e sbetween posters. It is possible that thischecklist is too extensive and is not very spe-cific to evaluating posters. However, follow-ing a checklist such as this, or one that isdeveloped specifically for posters, can pro v i d epotential presenters with valuable guidancewhen preparing their ISPOR posters.

ConclusionThe posters in this convenience sampleranked low on the expanded ISPOR checklist

with the median score of 4 points. It wouldbe useful for researchers to review the ISPORchecklist prior to the poster presentations toa s s u re consistent and evaluable re s e a rc hpractices. ■

REFERENCES1. Contributed Poster Presentations: Session I.Value Health 2003;6:198-290.Contributed PosterPresentations: Session II. Value Health 2003;6:291-381.

3. Contributed Poster Presentations. Value Health2002;5:138-279.

4. Motheral B, Brooks J, Clark M, et al. A checklistfor retrospective database studies-report of theISPOR task force on retrospective databases. ValueHealth 2003;6:90-7.

5. Garrison LP. The ISPOR Good PracticeModeling Principles A Sensible Approach: BeTransparent, Be Reasonable. Value in Health2003;6:6-8.

6. Drummond MF, Jefferson TO. Guidelines forauthors and peer reviewers of economic submissionto the BMJ. BMJ 1996;313:275–83.

7. Sculpher M, Fenwick E, Claxton K. Assessingquality in decision analytic cost-effectiveness mod-els. Pharmacoeconomics 2002;17:461-77.

8. Sanchez LA. Applied pharmacoeconomics:Evaluation and use of pharmacoeconomic data fromthe literature. Am J Health Syst Pharm1999;56:1630-8.

9. Torrance GW, Blaker D, Detsky A, et al.Canadian guidelines for economic evaluation ofpharmaceuticals. Pharmacoeconomics 1996;9:535-59.

10. Glennie JL, Torrance GW, Baladi JF, et al. Therevised canadian guidelines for economic evaluationof pharmaceuticals. Pharmacoeconomics1999;15:459-68.

O r i gi n a l ly the Belgian health insurance was only destined to employees, but step-by -step the right to health care has been broadened to other social gr o u p s , so thatalmost the entire Belgian population is insured now. The entitled to health insurancemust join one of the five sickness funds or the public fund.

Figure 2: Scoring of Retrospective Study Design Posters Using the Modified ISPOR Retrospective Checklist

Call for Reviewers ISPOR is seeking abstractreviewers for our upcoming9th Annual Intern a t i o n a lMeeting (reveiw period:J a n u a ry 12-22, 2004) and our7th Annual Euro p e a nC o n g ress (review period: June 21-July 1, 2004).

If you are interested in beinga reviewer or would likem o re information, pleaseemail reviewer@ispor.orgby Friday, November 14, 2003.

12 October 15,2003 ISPORCONNECTIONS

Fireside Chat — Vision 2010: A Road Map for ISPORSean D. Sullivan PhD, University of Washington, Seattle, WA, USA; 2003-2004 ISPOR President

Membership driven organizations like ISPOR rely on the creativity ande n e rgy of members to initiate activities, committees, and pro g r a m s .I S P OR offers a healthy mix of scientific and applied committees andspecial interest groups (SIGs) within which members can work togeth-er on common themes. To be timely and relevant, the committees andSIGs need new ideas and new people. Consider signing up for one ofthe myriad opportunities to become more involved in your society. Go

to www. i s p o r. o rg and click on the Member Information tab to view theLeadership Dire c t o ry and list of committees, work groups, and SIGs.Make contact with committee and SIG chairs and leaders and tell themyou want to participate. I assure you that they will welcome you.

In order to chart a long-range course for ISPOR, the Board of Dire c t o r sand I have appointed the Vision 2010 Committee, comprised of mem-bers and past officers. The committee has been meeting regularly andgathering input from all parts of the society. The Vision 2010Committee will hold a forum at the 6th Annual European Congress in

B a rcelona. Recently, co-chairs Marc Berger andG e rry Oster set-up a member input mechanism sothat you could provide comments directly to thecommittee. The 10 minute survey can be foundat www. i s p o r. o rg / s u rveys/vision2010.asp on the ISPOR web site. Theresponse from members to date has been overwhelming, but the com-mittee would like more .

F i n a l l y, you will all be pleased to learn that the ISPOR First Asia-PacificC o n f e rence was a huge success. Attendance exceeded 250 delegatesand the weather cooperated. Attendees came from 15 countries. Wel e a rned that there are ISPOR Chapters developing in Japan, Kore a ,Taiwan, Thailand, and Singapore. I would like to extend my thanks onbehalf of the Board of Directors to Isao Kamae and the organizing com-mittee for a memorable meeting.

As always, should you like to contact me about ISPOR matters, pleasesend an e-mail message to sdsull@u.washington.edu. ■

The Vision 2010 committee has been meeting regularly and gathering input from all parts of the society. R e c e n t ly, c o - c h a i r sMarc Berger and Gerry Oster set-up a member input mechanism so that you could provide comments directly to the committee.The ten-minute surv ey can be found at www. i s p o r. o r g / s u rv eys/vision2010.asp on the ISPOR web site. The response frommembers to date has been overwhelming, but the committee would like more.

Visit the ISPOR Website at www.ispor.orgThe ISPOR website has never been better. Drop-down menus provide easy navigation throughout the site.It is clear, precise and current.Following are some of its helpful features:

> ISPOR FUTURE MEETINGS: In the Future Meetings section (under Meetings), abstract submission deadlines and earlyregistration deadlines are displayed through 2005(http://www.ispor.org/meetings/future/index.htm)

> MEMBER-TO-MEMBER COMMUNICATIONS: In the MembersArea section (under Member Email Address),ISPOR memberscan request the email address of another ISPOR member(http://www.ispor.org/lookup.asp)

> CONTRIBUTED PODIUM AND POSTER PRESENTAT I O N S :Presentations at ISPOR Annual International Meetings orEuropean Congresses can be posted at the ISPOR website(Example: Go to http://www.ispor.org/meetings/cannes1101/index_new.html, go to Contributed PosterPresentations - Session 1,scroll down to PIN 15 and activate thehyperlink on presentation title)

> UPCOMING FEATURES: Online surveys to benchmark pharmacoeconomics and outcomes research activities; onlineISPOR Meeting / European Congress Evaluations for your easyaccess and convenience

At ISPOR we strive to give our valued ISPOR members faster andimproved services to meet all their growing needs. Thousands of people a day are finding www. i s p o r.org a valuable site to visit.We invite you to add it to your own list of favorite s i t e s .

ISPORCONNECTIONS October 15,2003 13

During the past several years, much at t e n t i o nhas been focused on determining the statisti-cal significance of cost-effectiveness ratios(CERs); however, little is known about whatwe, as a group of experts, would judge to be asubstantial diff e rence between CERs thatoriginate from diff e rent studies. In otherw o rds, we do not know “how big is too big” ad i ff e rence between the CERs pre s e n t e dtogether in league tables or used to discuss thecomparability of study results in the discus-sion section of journal articles. Recently,some members of the International Societyfor Pharmacoeconomics and OutcomesR e s e a rch (ISPOR) participated in a survey toassess the magnitude of variation that wouldbe considered substantial to practice or policy.

At the suggestion of the ISPOR, we sent thes u rvey to 132 members who had voluntarilychosen to participate in the newly form e dManaged Care / P h a rmacy Benefit Manage-ment Special Interest Group (SIG). Thisg roup had a consistently high response rate torequests from the organization, and theirrecently collected email addresses were

assumed to be up to date. The emailedrequest for survey participation was sent to allSIG members as of June 2002 and to a num-ber of ISPOR members who were also mem-bers of the American Association of Collegesof Pharmacy (AACP). We received 61usable responses from ISPOR members. Anadditional five members responded that theywould either need additional information toanswer the questions or that they were notc o m f o rtable with the use of quality-adjustedlife years (QALYs).

Each survey question began with a scenario oftwo re s e a rch teams using the same clinicaldata set that, because of diff e rent appro a c h e sto assigning costs, produced diff e rent incre-mental CERs. We assumed that there mightbe some diff e rence between the CERs thatre s e a rchers consider to be “close enough” or

negligible. Survey participants were asked toindicate the point at which they would judgethe diff e rence between two CERs to be sub-stantial enough to warrant an in-depth exam-ination of the methods underlying both stud-ies. This was taken to be the magnitude ofvariation that would be considered substan-tial in practice or policy considerations.

Because this decision may vary with the mag-nitude of the baseline CER, the surv e yincluded 3 discrete ranges of CERs based ont h resholds commonly cited in the literature :less than $20,000/QALY, between $20,000and $50,000/QALY, and above $50,000/Q A LY. The table below shows the variationc o n s i d e red substantial by survey re s p o n d e n t s .The statistical methods and a more thoro u g ht reatment of the results have been submittedto Value in Health. ■

Cost-effectiveness Mean Variation Considered Substantial Ratio Range in Practice or Policy ConsiderationsLess than $20,000/QALY $3,660/QALY$20,000-50,000/QALY $5,170/QALYGreater than $50,000/QALY $9,665/QALY

Survey of Acceptable Variations in Cost-effectiveness Ratios: A Brief Overview Elinor C.G. Chumney, PhD, Assistant Professor, Medical University of South Carolina, Charleston, SC, USA; Andrea K. Biddle, PhD,Associate Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Kit N. Simpson, DrPH, Professor, MedicalUniversity of South Carolina, Charleston, SC, USA

The ISPOR Avedis Donabedian OutcomesResearch Lifetime Achievement AwardNominations Due By December 1, 2003Do you want to understand the proce-

dure by which medicines are priced inAustralia? Or are you trying to find aprice of a certain compound on theSchedule of Pharmaceutical Benefits?

This information can be found at:http://www.health.gov.au/pbs/pharm/index.html. The site also leads you toinformation regarding thePharmaceutical Benefits PricingAuthority as well as detailed informa-tion regarding the preparation of pric-ing submissions.

Do you know of any websites thatyou would like to share with theISPOR community? If so, contactBonnie M. Korenblat Donato PhD, at bonnie.donato@bms.com.

Web Connections■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Criteria The Award is open to any person who through his or her life’s endeavors has demonstrat e da significant and lasting contribution towards better health outcomes in a population or sub-populat i o n ,as defined by the Lifetime Achievement Awards Committee. The Award is targeted towards demonstrat e dvalue delivered in health outcomes, r ather than purely academic achievement. T h e r e f o r e , nominees willbe expected to have demonstrated tangible and persistent contributions that led towards improvedhealth outcomes in an identifiable group of individuals. A c a d e m i c i a n s ,i n d u s t ry professionals, e c o n o-m i s t s , researchers and others who meet these criteria are eligible, i n cluding ISPOR members.S e l f - n o m i n ations are discourag e d . Deceased persons are not eligible for the A w a r d . H ow e v e r, s h o u l dthe recipient die prior to receiving the A w a r d , it may be presented posthumously.

Nomination No m i n ations may be made by any ISPOR member. Members may nominate morethan one person (nominee does not have to be an ISPOR Member); however a completed ap p l i c ation musta c c o m p a ny each nominat i o n . All nominations must include a brief essay indicating the reason for yourn o m i n at i o n . Supporting documentation must be provided including publication citations and any othernotable achievements of the nominee in the area of outcomes research. Please submit nominations toI S P O R ,A t t n :A D L A , 3100 Princeton Pike, Bldg 3, Suite E, L aw r e n c e v i l l e , NJ 08648, U S A . or online ath t t p : / / w w w. i s p o r. o r g / / aw a r d s / d o n a b e d i a n _ . h t m l

C O N TA C TBryan Luce PhD, MBA,2003-04 ChairISPOR AVEDIS DONABEDIAN OUTCOMES RESEARCH

LIFETIME ACHIEVEMENT AWARD TASK FORCE

awards@ispor.org

Stephen Priori, Facilitator ISPOR AVEDIS DONABEDIAN OUTCOMES RESEARCH

LIFETIME ACHIEVEMENT AWARD TASK FORCE

spriori@ispor.org

14 October 15, 2003 ISPOR CONNECTIONS

In the last couple of years, students’ involvement and attendance atthe Annual European Congress has tremendously increased. More andm o re students are now being encouraged to attend and participate atsuch International Congress meetings. Last year, about 80 studentsattended the Fifth Annual European Congress that was held inR o t t e rdam, Netherlands in November of 2002, nearly a thre e - f o l di n c rease from the year 2001. For the forthcoming Sixth AnnualE u ropean Congress that is scheduled to commence from 9-11thNovember 2003, at the Princesa Sofia Intercontinental, Barc e l o n a ,Spain, a turnout of more than 100 students is expected. Activities thata re planned for students each year at the Anuual Meetings or Euro p e a nC o n g resses are a Student Welcome Reception, an Ice-bre a k e r, as wellas an ISPOR Student Leadership Retreat. This year, the ISPORStudent Leadership Retreat was very successful in instituting and plan-ning important student’s events, which also facilitated in shaping the

f u t u re of the student body in the organization. At the fort h c o m i n gE u ropean Congress, the Student Network Advisor Zeba M. Khan,PhD, and Student Network Chair, Ritesh Kumar MS, will lead theStudent Welcome Reception. There will be an open discussion wherestudents will be informed about how to start a student chapter at theirrespective universities. The major focus of current year’s ISPORStudent Council is to increase awareness and promote re p re s e n t a t i o nby students within Europe. In addition, Dr. Khan and Ritcsh Kumarwill also participate in the ISPOR Leadership Retreat to be held priorto the Congess.

For the Sixth Annual European Congress, 38 abstracts submitted bystudents were accepted for presentations. The following awards willalso be given: > ISPOR Best Student Contributed Poster Pre s e n t a t i o n> ISPOR Best Student Contributed Podium Pre s e n t a t i o n

ISPOR Student Corner Prepared by Ritesh Kumar MS, University of Michigan, Ann Arbor, MI, USA

Following is the list of all the students’ contributed presentations accepted for the ISPOR 6th Annual European Congress:

Outcomes of an intervention to improve hospital antibiotic prescribing:interrupted time series analysis with segmented regression Faranak AnsariAssociation between skin tattoos and hepatitis b of 1/2000 privates at Adisorn Fort hospital,Thailand Titinun AuamnoyThe association of recommended surgical site infection guidelines and other factors with hospital length of stay (LOS) in patients undergoing different clean or clean-contaminated procedures. Patrick Olivier BonnetCost effectiveness of pharmacological treatment versus care as usual for panic disorder and/or depression driven chest pain:preliminary results of unblinded data DEM BrunenbergPiribedil improves quality of life in patients with Parkinson’s disease in Russia Elena S.ChikinaA method for identification of frontier practice in diabetes care Michael Cronquist

ChristensenChildren with ADHD (attention-deficit/hyperactivity disorder):health care use and social burden on the family Annemieke D E RidderCost-effectiveness analysis of different drug therapies for osteoporosis Biljana DzajkovskaConsumption of antibiotics in Europe:results of the ESAC retrospective data collection. Matus FerechA systematic review of cost-effectiveness of statins in cardiovascular risk management Oscar FrancoThe maturity model of NEMCC for a continuous improvement of the organization Mami FurukuboIs the MLHF questionnaire valid for international multicentric studies? Olatz GarinPrescription drug samples - does this marketing strategy counteract policies for quality use of medicines? Kent E M GrovesCost-effectiveness analysis of Piribedil in patients with Parkinson’s disease in Russia Alla B.GuechtA systematic review and meta-analysis of studies comparing readmission rates and mortality in patients with heart failure Femida Gwadry-SridharEvaluation of medical diagnoses for Texas Medicaid patients prescribed atypical antipsychotic medications Patricia M HarringtonThe time inconsistency of decisions in pharmacoeconomic sequential decision problems Micha Kosma JakubczykCost source and perspective in economic outcomes studies: focus on posters presented at the 7th annual international ISPOR meeting Sooyeon KwonDisability in stroke outcomes research: clinical meaning of the Barthel index,the functional independence measure and the modified Rankin scale Sooyeon KwonNew evidence on the relationship between health care utilization and medical care expenditure among decedents and elderly in Ta i w a n Ling-yu LiangEffect of co-pay increase on compliance:a natural experiment Brian MesserModeling the cost-effectiveness of the Varicella vaccine in Portugal Ruiz Portugal-FernandezThe impact of treatment management algorithms and evaluated time horizon on antiviral treatment costs in chronic hepatitis c Owe SiebertCost-effectiveness of fractional flow reserve testing to guide percutaneous coronary intervention in the drug-eluting Stint ERA:a decision analysis Owe SiebertA multi-outcome decision model for Parkinson’s disease Owe SiebertCausal inference in medical decision making Owe SiebertDecision-analytic modeling in Parkinson’s disease Owe SiebertTransforming the unified Parkinson’s disease rating scale into a utility scale Owe SiebertAdaptation of the RAQOL for Estonia Maria TamaraCost-effectiveness of Salmeterol and Fluticasone propionate combination:a review B D TanoHeliox in the treatment of Status Asthmaticus in the ICU:a cost-effectiveness analysis B D TanoAn investigation of generic drug utilisation and potential savings from generic substitution in the Irish healthcare setting Lesley TilsonCare of Pa r k i n s o n ’s disease patients in European countries. European cooperative network for research, d i agnosis and, t h e r apy of Pa r k i n s o n ’s disease (EUROPA) Sonja V. CampenhausenIs there a gain with the pain? Assessment of the relationship between self-reported adherence to self-monitoring of blood glucose (SMBG) and hba1c levels among type 2 diabetics Gábor VinczeType of diabetes and adherence to self-monitoring of blood glucose (SMBG) Gábor VinczeThe effects of genetic testing on the demand for life insurance Julia Catherine WittPharmacoeconomics in healthcare-decision making:a survey on china healthcare system Li YangCost-effectiveness of Salmeterol/Fluticasone propionate combination product 50/100 mcg twice daily and Budesonide 400 mcg twice daily in the treatment of adults with asthma in china Li Yang

ISPOR CONNECTIONS October 15, 2003 15

WESTERN EUROPEDenmark Based on recommendations from itsreimbursement committee, the Danish MedicinesAgency has updated the criteria for individualreimbursement of a number of major pharm a c e u-tical products, including those for Alzheimer’s dis-ease. (SCRIP2875:5)France Most French brand-name companies withp roducts in the new re f e rence price system arecutting their prices to the re f e rence level, andsales of these products could fall by around C = 1 0 0million, industry sources say. (SCRIP 2884:3) ■The French Council of State has re s t o red 65%reimbursement to a further 10 pharm a c e u t i c a lp roducts, annulling earlier health ministry deci-sions to cut their reimbursement rate to 34%.(SCRIP 2871:2)Germany The German pharmaceutical industryhas had to cops with a number of govern m e n t -imposed restrictions this year, but the recent pro-posal to bring in a 16% discount on medicinesp u rchased by the state is the worst so far, says there s e a rch based-industry association, the VFA .(SCRIP 2875:3) ■ G e rman OTC sales during thefirst quarter of this year amounted to C = 1.84 bil-lion, a 1% increase on the same period last year,a c c o rding to IMS Health data re p o rted by thei n d u s t ry association, the BAH. The number ofpacks sold increased by 3.5% to 248 million packs.(SCRIP 2871:5)Italy State spending on reimbursement pharm a-ceuticals in Italy was C = 5.63 billion in the firsthalf, a fall of 9.2% over the equivalent period in2002, and the downward trend in likely to con-tinue throughout the year. (SCRIP 2883:4) The Netherlands The Netherlands has becomethe first country worldwide to allow the sale ofcannabis on prescription in the country ’s 1650p h a rmacies for treating seriously ill people suff e r-ing from cancer, HIV/AIDS, multiple sclero s i s ,and To u re t t e ’s syndrome. (SCRIP 2882:4)Norway The Norwegian pharmaceutical marketg rew by 4% in value terms during the first sixmonths of this year, to NKr4.5 billion ($600 mil-lion). (SCRIP 2874:5) ■ The health insurancepolicy review committee of South Kore a ’sM i n i s t ry of Health and We l f a re has cut the re i m-bursement prices of 282 products from 83 manu-f a c t u res by an average of 5.4%, effective from July1st. (SCRIP 2874:17)Spain The Spanish health ministry has drafted ano rder that would lead to price cuts for more than2000 medicines, which the industry association,F a rmaindustria, says would have a part i c u l a r l ysmall and medium-sized ones. (SCRIP 2882:5)Sweden Sales of medicines under the national

h e a l t h c a re scheme in Sweden amounted toSKr1832 million ($218 million) in July, down by0.4% on the same period last year. (SCRIP2881:3) ■ The introduction of generic substitu-tion in Sweden last October sparked a downwardspiral of price reductions, which has led to almost3,800 products having their prices re d u c e d ,a c c o rding to the Swedish Pharmaceutical BenefitsB o a rd. (SCRIP 2877:3) ■ Medicine sales inSweden, including those under the national re i m-bursement scheme, patient co-payments and thecounties’ expenditures, grew by 3.4% to SKr1973million last year, according to state-owned phar-macy organization, Apoteket. (SCRIP 2872:6) ■The annualized equivalent of SKr500 million($39 million) was saved by Sweden on drug costsduring the first six months of generic substitutionsays a new re p o rt. The re p o rt examines the eff e c t sof the Swedish medicines re f o rms brought in lastO c t o b e r, which featured the introduction ofgeneric substitution. (SCRIP 2872:2)UK England spent L=6,847 million on NHS pre-scriptions for 2002, an increase of 11.9% (or 8.5%in real terms) compared with 2001, according tothe latest statistics released by the Department ofHealth. (SCRIP 2873:4)

EASTERN/CENTRAL EUROPEC r o at i a The Croatian Agency for HealthInsurance aims to cut medicine prices by 10-15%following consultation with pharmaceutical man-u f a c t u res and distributors. It has already had twonegotiating rounds to date, but these have failedto reach a consensus. (SCRIP 2872:6)Estonia Last year sales of prescribed and OTCmedicines in Estonia grew by 13.7% to Eek1.5 bil-lion ($101 million) at the wholesaler prices com-p a red with the previous year. (SCRIP 2884:3)Hungary The Hungarian government has posteduntil September 1st as the induction of a schemecutting ex-manufacturing and wholesale prices forreimbursed pharmaceuticals by 20%. (SCRIP2879:3) ■ The Hungarian government has decid-ed to cut ex-manufacturer and wholesale prices forreimbursed medicines by 20% from August 16th,2003. The change will not apply to manufacture sthat agree to pay the National Health InsuranceFund (OEP) a pro p o rtion of any overspending onreimbursement above predefined level. (SCRIP2 8 7 6 : 5 )Kazakhstan The Kazakhstani pharm a c e u t i c a lmarket grew by 26.3% to $111.3 million in thefirst six months of 2003 compared with the samep e r i od last year. (SCRIP 2886:18)M o l d o v a P h a rmaceutical sales in Moldovai n c reased by 22.6% to $19.6 million in 2003,

a c c o rding to the Ukrainian market re s e a rc ha g e n c y, Business Credit, which monitors theUkrainian and Moldovian markets. (SCRIP2879:6) Russia The Russian pharmaceutical retail andmanufacturing group, Pharmacy Chain 36.6, hasannounced an 18% sales increase to $118.7 mil-lion in 2002 over the previous year, with hospitalsales up 2.5-fold. (SCRIP 2875:7)Slovakia The cumulative debt of the Slovakhealth insurance funds to pharmacies for medi-cines has exceeded SK6 billion ($152.3 million)and is growing, with some payments overdue bym o re than 180 days, while by law they must besettled within 30 days. (SCRIP 2878:4)

THE AMERICASC a n a d a Sales of pharmaceuticals in Canadai n c reased by 13.9% to Can$13.1 billion (9.4 bil-lion) last year, while sales of patented medicinesrose by 17.3% to Can $8.8 billion, according tothe 2002 annual re p o rt by the Patented MedicinePrices Review Board. (SCRIP 2878:17)US The US FDA’s strategic action plan wasreleased on August 20th, outlines some new waysthe agency could lower costs, both to itself and toi n d u s t ry, and also get more drugs to market oreq u i c k l y. (SCRIPT 2879:16) ■ House and Senatenegotiators working on a Medicare drug bill havetentatively reached agreement on a key issuerelating to authorization of a drug discount cardfor seniors. (SCRIP 2875:15) ■ The US House ofR e p resentatives has 243-186 to allow wholesalers,p h a rmacists and individuals to import pre s c r i p-tion drugs from Canada, Europe and other indus-trialized countries–specifically without first need-ing an assurance from the US Secre t a ry of Healthand Human Services (HHS) that the drugs wouldbe safe and would save money. ■ B e f o re theAugust recess, the US House of Representatives isexpected to vote on a bill that would allowi m p o rts of prescription drugs from other econom-ically advanced countries by US wholesalers,p h a rmacists and individuals. (SCRIP 2869:14)

AUSTRALASIAA u s t r a l i a The Australian government spentAus$4585 million ($3038 million) on pre s c r i p-tion medicines under its Pharmaceutical BenefitsScheme (PBS) for the year ending June 30th, upby 9.2% compared with the previous year.(SCRIP 2886:18)New Zealand Some New Zealand pharmacies inp rescription medicines and home delivery serv i c-es to recover the loss of income from the intro-duction of bulk dispensing, according to a re p o rtin the Dominion Post. (SCRIP 2877:17) ■

News Briefs from Around the WorldPrepared by Stephen L. Priori, Director, ISPOR Publications

16 October 15, 2003 ISPORCONNECTIONS

Disease Related ResearchArthritis/Skeletal• Bae SC, Kim SJ, Sung MK. Inadequate antioxidant

nutrient intake and altered plasma antioxidant sta-tus of rheumatoid arthritis patients. J Am CollNutr 2003;22:311-5.

• Brunner HI, Giannini EH. Health-related qualityof life in children with rheumatic diseases. CurrOpin Rheumatol 2003;15:602-12.

• Lee KK, You JH, Ho JT, Suen BY, Yung MY, LauWH, Lee VW, Sung JY, Chan FK. Economicanalysis of celecoxib versus diclofenac plus omepra-zole for the treatment of arthritis in patients at riskof ulcer disease. Aliment Pharmacol Ther2003;15:217-22.

• Ofman JJ, Maclean CH, Straus WL, Morton SC,Berger ML, Roth EA, Shekelle PG. Meta-analysisof dyspepsia and nonsteroidal antiinflammatorydrugs. Arthritis Rheum 2003;15:508-18.

• Reddan DN, Szczech LA, Tuttle RH, Shaw LK,Jones RH, Schwab SJ, Smith MS, Califf RM, MarkDB, Owen WF Jr. Chronic kidney disease, mortali-ty, and treatment strategies among patients withclinically significant coronary artery disease. J AmSoc Nephrol 2003;14:2373-80.

• Russak SM, Croft JD Jr, Furst DE, Hohlbauch A,Liang MH, Moreland L, Ofman JJ, Paulus H,Simon LS, Weisman M, Tugwell P; Evidence-BasedMedicine Working Groups in Rheumatology. Theuse of rheumatoid arthritis health-related quality oflife patient questionnaires in clinical practice: les-sons learned. Arthritis Rheum 2003;15:574-84.

Cardiovascular Disease• Caro J, Huybrechts KF, Klittich WS, Jackson JD,

McGuire A; CORE Study Group. Allocating fundsfor cardiovascular disease prevention in light of theNCEP ATP III guidelines. Am J Manag Care2003;9:477-89.

• de Lissovoy G, Stier DM, Ciesla G, Munger M,Burger AJ. Economic implications of nesiritide ver -sus dobutamine in the treatment of patients withacutely decompensated congestive heart failure.Am J Cardiol 2003;92:631-3.

• Heaton A, Martin S, Brelje T. The economic effectof hypoglycemia in a health plan. Manag CareInterface 2003;16:23-7.

• Johnston JA, Cluxton RJ Jr, Heaton PC, Guo JJ,Moomaw CJ, Eckman MH. Predictors of warfarinuse among Ohio medicaid patients with new-onsetnonvalvular atrial fibrillation. Arch Intern Med2003;163:1705-10.

• Lynd LD, O'Brien BJ. Cost-effectiveness of theimplantable cardioverter defibrillator: J CardiovascElectrophysiol 2003;14(Suppl 9):S99-103.

• Nichol G, Valenzuela T, Roe D, Clark L, Huszti E,Wells GA. Cost effectiveness of defibrillation bytargeted responders in public settings. Circulation.2003;108:697-703.

• Varney SJ, Guest JF. The annual cost of bloodtransfusions in the UK. Transfus Med.2003;13:205-18.

Dermatology• Bae SC, Lee KW. Identification of a novel

DRB1*04 allele: DRB1*0445. Tissue Antigens2003;62:270-2.

• Gupta AK, Batra R, Bluhm R, Faergemann J.Pityriasis versicolor. Dermatol Clin 2003;21:413-29, v-vi.

• Gupta AK, Bluhm R, Cooper EA, Summerbell RC,Batra R. Seborrheic dermatitis. Dermatol Clin2003;21:401-12.

• Gupta AK, Chaudhry M, Elewski B. Tinea cor-poris, tinea cruris, tinea nigra, and piedra.Dermatol Clin 2003;21:395-400.

• Gupta AK, Chow M, Daniel CR, Aly R.Treatments of tinea pedis. Dermatol Clin2003;21:431-62.

• Gupta AK, Cooper EA, Ginter G. Efficacy andsafety of itraconazole use in children. DermatolClin 2003;21:521-35.

• Gupta AK, Cooper EA, Lynde CW. The efficacyand safety of terbinafine in children. DermatolClin 2003;21:511-20.

• Gupta AK, Cooper EA, Montero-Gei F. The use offluconazole to treat superficial fungal infections inchildren. Dermatol Clin 2003;21:537-42.

• Gupta AK, Ryder JE, Baran R. The use of topicaltherapies to treat onychomycosis. Dermatol Clin2003;21:481-9.

• Gupta AK, Ryder JE. How to improve cure ratesfor the management of onychomycosis. DermatolClin 2003;21:499-505.

• Gupta AK, Ryder JE. The use of oral antifungalagents to treat onychomycosis. Dermatol Clin2003;21:469-79.

• Gupta AK, Tomas E. New antifungal agents.Dermatol Clin 2003;21:565-76.

• McKenna SP, Cook SA, Whalley D, Doward LC,Richards HL, Griffiths CE, Van Assche D.Development of the PSORIQoL, a psoriasis-specif-ic measure of quality of life designed for use inclinical practice and trials. Br J Dermatol2003;149:323-31.

• Pettey AA, Balkrishnan R, Rapp SR, Fleischer AB,Feldman SR. Patients with palmoplantar psoriasishave more physical disability and discomfort thanpatients with other forms of psoriasis: implicationsfor clinical practice. J Am Acad Dermatol2003;49:271-5.

Endocrinology, Metabolism,& Diabetes• Zhang P, Engelgau MM, Valdez R, Benjamin SM,

Cadwell B, Venkat Narayan KM. Costs of screen-ing for pre-diabetes among US adults: a compari-son of different screening strategies. Diabetes Care2003;26:2536-42.

Gastro-Intestinal• Bernstein CN, Blanchard JF, Metge C, Yogendran

M. The association between corticosteroid use anddevelopment of fractures among IBD patients in apopulation-based database. Am J Gastroenterol2003;98:1797-801.

Using Pharmacoeconomics and Outcomes Research InnovativelyRecently Published Work by ISPOR members

This column includes books,

a r t i c l e s , and abstracts recently

published by ISPOR members. To

ensure that your published work in

pharmacoeconomic or outcomes

research is reported here, p l e a s e

keep your contact info r m ation up

to date with the Society.

A ny questions, c o m m e n t s , or

submissions concerning this

review can be directed to Stephen

Priori at spriori@ispor. o r g .

ISPORCONNECTIONS October 15,2003 17

Geriatrics• Kamal-Bahl SJ, Doshi JA, Stuart BC, Briesacher

BA. Propoxyphene use by community-dwellingand institutionalized elderly medicare beneficiar -ies. J Am Geriatr Soc 2003;51:1099-104.

• Murray MD, Callahan CM. Improving medica-tion use for older adults: an integrated researchagenda. Ann Intern Med 2003;139:425-9.

Gynochology• Oglesby AK, Minshall ME, Shen W, Xie S,

Silverman SL. The impact of incident vertebraland non-vertebral fragility fractures on health-related quality of life in established post-menopausal osteoporosis: results from the teri-paratide randomized, placebo-controlled trial inpostmenopausal women. J Rheumatol2003;30:1579-83.

Infectious Disease• Chan PK, Li CK, Chik KW, Shing MM, Lee V,

Ng KC, Lam CW, Cheung JL, Cheng AF.Genetic variation of glycoproteins B and H ofhuman herpesvirus 7 in Hong Kong. J Med Virol2003;71:429-33.

• Gupta AK, Ahmad I, Porretta M, SummerbellRC. Arthroconidial formation in trichophytonraubitschekii. Mycoses 2003;46:304-10.

• Paladino JA, Sunderlin JL, For rest A, SchentagJJ. Characterization of the onset and conse-quences of pneumonia due to fluoroquinolone-susceptible or -resistant Pseudomonas aeruginosa.J Antimicrob Chemother 2003;52:457-63.

• Pechevis M, Khoshnood B, Buteau L, Durand I,Piquard Y, Lafuma A. Cost-effectiveness of hepa-titis A vaccine in prevention of secondary hepati-tis A infection. Vaccine 2003;8:3556-64.

• Schiffman RM, Walt JG, Jacobsen G, Doyle JJ,Lebovics G, Sumner W. Utility assessment amongpatients with dry eye disease. Ophthalmology2003;110:1412-9.

• Shahriar J, Delate T, Hays RD, Coons SJ.Commentary on using the SF-36 or MOS-HIV instudies of persons with HIV disease. Health QualLife Outcomes 2003;1:25.

Kidney• Brophy DF, Ripley EB, Holdford DA.

Pharmacoeconomic considerations in the healthsystem management of anaemia in patients withchronic kidney disease and end stage renal dis-ease. Expert Opin Pharmacother 2003;4:1461-69.

Neurology & Mental Health• Blumenthal JA, Lett HS, Babyak MA, White W,

Smith PK, Mark DB, Jones R, Mathew JP,Newman MF; NORG Investigators. Depression asa risk factor for mortality after coronary arterybypass surgery. Lancet 2003;362:604-9.

• Feldman H, Levy AR, Hsiung GY, Peters KR,Donald A, Black SE, Bouchard RW, GauthierSG, Guzman DA, Hogan DB, Kertesz A,Rockwood K; ACCORD Study Group. ACanadian cohort study of cognitive impairmentand related dementias (ACCORD): study meth-ods and baseline results. Neuroepidemiology2003;22:265-74.

• Ganguly R, Miller LS, Martin BC. Futureemployability, a new approach to cost-effective-

ness analysis of antipsychotic therapy. SchizophrRes 2003;63:111-9.

• Herings RM, Erkens JA. Increased suicideattempt rate among patients interrupting use ofatypical antipsychotics. Pharmacoepidemiol DrugSaf 2003;12:423-4.

• Milne RD, Nicholson T, Corballis MC. Lexicalaccess and phonological decoding in adult dyslex-ic subtypes. Neuropsychology 2003;17:362-8.

• Rosen MI, Beauvais JE, Rigsby MO, Salahi JT,Ryan CE, Cramer JA. Neuropsychological corre-lates of suboptimal adherence to metformin. JBehav Med 2003;26:349-60.

• Shumway M, Saunders T, Shern D, Pines E,Downs A, Burbine T, Beller J. Preferences forschizophrenia treatment outcomes among publicpolicy makers, consumers, families, and providers.Psychiatr Serv 2003;54:1124-8.

• Stanley KM, Amabile CM, Simpson KN,Couillard D, Norcross ED, Worrall CL. Impact ofan alcohol withdrawal syndrome practice guide-line on surgical patient outcomes.Pharmacotherapy 2003;23:843-54.

• Ward A, Caro JJ, Getsios D, Ishak K, O'Brien J,Bullock R; AHEAD Study Group. Assessment ofhealth economics in Alzheimer's disease(AHEAD): treatment with galantamine in theUK. Int J Geriatr Psychiatry 2003;18:740-7.

Oncology• Berger A, Dukes E, Smith M, Hagiwara M,

Seifeldin R, Oster G. Use of oral and transdermalopioids among patients with metastatic cancerduring the last year of life. J Pain SymptomManage 2003;26:723-30.

• Brown J, Broaddus R, Koeller M, Burke TW,Gershenson DM, Bodurka DC. Sarcomatoid car-cinoma of the cervix. Gynecol Oncol 2003;90:23-8.

• Chu WC, Lee V, Howard RG, Roebuck DJ, ChikKW, Li CK. Imaging findings of paediatric oncol-ogy patients presenting with acute neurologicalsymptoms. Clin Radiol 2003;58:589-603.

• Cooperberg MR, Lubeck DP, Penson DF, MehtaSS, Carroll PR, Kane CJ. Sociodemographic andclinical risk characteristics of patients withprostate cancer within the Veterans Affairshealth care system: data from CaPSURE. J Urol2003;170:905-8.

• Goldie SJ, Grima D, Kohli M, Wright TC,Weinstein M, Franco E. A comprehensive naturalhistory model of HPV infection and cervical can-cer to estimate the clinical impact of a prophylac-tic HPV-16/18 vaccine. Int J Cancer2003;106:896-904.

• Kim TE, Murren JR. Lapatinib ditosylate(GlaxoSmithKline). IDrugs 2003;6:886-93.

• Patrick DL, Ferketich SL, Frame PS, Harris JJ,Hendricks CB, Levin B, Link MP, Lustig C,McLaughlin J, Ried LD, Turrisi AT 3rd, UnutzerJ, Vernon SW; National Institutes of HealthState-of-the-Science Panel. National Institutes ofHealth State-of-the-Science ConferenceStatement: Symptom Management in Cancer:Pain, Depression, and Fatigue, July 15-17, 2002. JNatl Cancer Inst 2003;95:1110-7.

• Qin W, Hu J, Guo M, Xu J, Li J, Yao G, Zhou X,

Jiang H, Zhang P, Shen L, Wan D, Gu J. BNIPL-2, a novel homologue of BNIP-2, interacts withBcl-2 and Cdc42GAP in apoptosis. BiochemBiophys Res Commun 2003;22:379-85.

• Sabel MS, Schott AF, Kleer CG, Merajver S,Cimmino VM, Diehl KM, Hayes DF, Chang AE,Pierce LJ. Sentinel node biopsy prior to neoadju-vant chemotherapy. Am J Surg 2003;186:102-5.

Pediatrics• Tennyson DH. Hospital-affiliated pediatric urgent

care clinics: a necessary extension for emergencydepartments? Health Care Manag (Frederick)2003;22:190-202.

Radiology• Speight JL, Silva SJ, Lubeck DP. Long-term lon-

gitudinal assessment of changes in sexual func-tion and bother in patients treated with externalbeam radiotherapy or brachytherapy, with andwithout neoadjuvant hormone therapy: data fromcaPSURE. Int J Radiat Oncol Biol Phys2003;57(2 Suppl):S222-3.

Surgery• Cordera F, Long KH, Nagorney DM, McMurtry

EK, Schleck C, Ilstrup D, Donohue JH. Openversus laparoscopic splenectomy for idiopathicthrombocytopenic purpura: clinical and econom-ic analysis. Surgery 2003;134:45-52.

• Lee VY, Kwok AK. Multiport - i l l u m i n a t i o n - s y s t e m -assisted phacoemulsification in eyes with dense vit-reous hemorrhage during combined cataract andv i t reous surg e ry. J Cataract Refract Surg2 0 0 3 ; 2 9 : 1 2 5 2 - 5.

Topics of General InterestHealth Services• Belay ED, Holman RC, Maddox RA, Foster DA,

Schonberger LB. Kawasaki syndrome hospitaliza-tions and associated costs in the United States.Public Health Rep 2003;118:464-9.

• Brandon WR, Chambers R. Reducing emergencydepartment visits among high-using patients. JFam Pract 2003;52:637-40.

• Chaiyakunapruk N, Veenstra DL, Lipsky BA,Sullivan SD, Saint S. Vascular catheter site care:the clinical and economic benefits of chlorhexi-dine gluconate compared with povidone iodine.Clin Infect Dis 2003;37:764-71.

• Dannenberg AL, Jackson RJ, Frumkin H,Schieber RA, Pratt M, Kochtitzky C, Tilson HH.The impact of community design and land-usechoices on public health: a scientific researchagenda. Am J Public Health 2003;93:1500-8.

• Diehr P, Patrick DL. Trajectories of health forolder adults over time: accounting fully for death.Ann Intern Med 2003;139(5 Pt 2):416-20.

• Drummond M, Brown R, Fendrick AM, FullertonP, Neumann P, Taylor R, Barbieri M; ISPOR TaskForce. Use of pharmacoeconomics information--report of the ISPOR task force on use of pharma-coeconomic/health economic information inhealth care decision- making. Value Health2003;6:407-16.

• Etemad LR, Hay JW. Cost-effectiveness analysisof pharmaceutical care in a medicare drug benefitprogram. Value Health 2003;6:425-35.

18 October 15, 2003 ISPORCONNECTIONS

• Feldman SR, Garton R, Averett W, BalkrishnanR, Vallee J. Strategy to manage the treatment ofsevere psoriasis: considerations of efficacy, safetyand cost. Expert Opin Pharmacother2003;4:1525-33.

• Glick HA, Orzol SM, Tooley JF, Polsky D,Mauskopf JO. Design and analysis of unit costestimation studies: How many hospital diagnoses?How many countries? Health Econ 2003;12:517-27.

• Kamal KM, Madhavan SS, Maine LL. Pharmacyand immunization services: pharmacists' partici-pation and impact. J Am Pharm Assoc (WashDC) 2003;43:470-82.

• Mackenzie ER, Taylor L, Bloom BS, Hufford DJ,Johnson JC. Ethnic minority use of complemen-tary and alternative medicine (CAM): a nationalprobability survey of CAM utilizers. Altern TherHealth Med 2003;9:50-6.

• Mark TL, Kranzler HR, Song X. UnderstandingUS addiction physicians' low rate of naltrexoneprescription. Drug Alcohol Depend 2003;71:219-28.

• McCombs JS, Shi L, Croghan TW, Stimmel GL.Access to drug therapy and substitution betweenalternative antidepressants following an expan-sion of the California medicaid formulary. HealthPolicy 2003;65:301-11.

• Parkerton PH, Wagner EH, Smith DG, StraleyHL. Effect of part-time practice on patient out-comes. J Gen Intern Med 2003;8:717-24.

• Riedler GF, Haycox AR, Duggan AK, Dakin HA.Cost-effectiveness of solvent/detergent-treatedfresh-frozen plasma. Vox Sang. 2003;85:88-95.

• Smala AM, Spottke EA, Machat O, Siebert U,Meyer D, Kohne-Volland R, Reuther M,DuChane J, Oertel WH, Berger KB, Dodel RC.Cabergoline versus levodopa monotherapy: adecision analysis. Mov Disord 2003;18:898-905.

• Vuchetich PJ, Garis RI, Jorgensen AM.Evaluation of cost savings to a state Medicaidprogram following a sertraline tablet-splittingprogram. J Am Pharm Assoc (Wash DC)2003;43:497-502.

Methodology• B rouwer WB, Rutten FF. The missing link: on the

line between C and E. Health Econ. 2003;12:6 2 9 - 3 6 .

• Coyle D. Who's better not best: appropriateprobabilistic uncertainty analysis. Int J TechnolAssess Health Care 2003;19:540-5.

• Coyne KS, Margolis MK, Gilchrist KA, GrandySP, Hiatt WR, Ratchford A, Revicki DA,Weintraub WS, Regensteiner JG. Evaluatingeffects of method of administration on walkingimpairment questionnaire. J Vasc Surg2003;38:296-304.

• Franic DM, Pathak DS. Assessment of respon-dent acceptability of preference measures: dis-criminatory power of graphic positioning scaleversus traditional scaling measures. Value Health2003;6:483-93.

• Hughes DA, Walley T. Predicting “real world”effectiveness by integrating adherence with phar-macodynamic modeling. Clin Pharmacol Ther2003;74:1-8.

• Patrick DL, Curtis JR, Engelberg RA, Nielsen E,McCown E. Measuring and improving the quali-ty of dying and death. Ann Intern Med2003;139:410-5.

In addition to this issues’ recently publishedworks, the following are works that havebeen published re c e n t l y :

• Singh G, Miller JD, Huse DM, Pettitt D,D'Agostino RB, Russell MW. The consequencesof increased systolic blood pressure in patientswith osteoarthritis and rheumatoid arthritis. J Rheumatol 2003;30:714-719.

• Singh G, Miller JD, Lee FH, Pettitt D, RussellMW. Prevalence of cardiovascular disease riskfactors among U.S. adults with self-reportedosteoarthritis: Data from the Third NationalHealth and Nutrition Examination Survey. Am JManag Care 2002; 8(15 Suppl):S383-91.

• Comp PC, Miller JD, Mayo KW, Wagner S,Russell MW. Outcomes of dalteparin use follow-ing total knee arthroplasty: a retrospectiveanalysis. Expert Rev Pharmacoecon OutcomesRes 2002;2:427-34. ■

ISPOR Ninth AnnualInternational Meeting

May 16-19, 2004Crystal Gateway Marriott

Arlington, VA

Abstract Submission Begins: October 1, 2003

Abstract Submission Deadline: January 12, 2004

Early Registration Deadline: April 20, 2004

ISPOR 7th Annual European Congress

24-26 October 2004CCH Congress Centrum Hamburg

Hamburg, Germany

Abstract Submission Begins: 1 March 2004

Abstract Submission Deadline: 21 June 2004

Early Registration Deadline: 28 September 2004

For information, submission instructions and more,

visit: www.ispor.org

ISPOR UPCOMING EVENTS

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ISPOR 9TH ANNUAL INTERNATIONAL MEETING M AY 15-19, 2004 | C RY S TAL GAT E WAY MARRIOTT, ARLINGTON, VA, USA

CALL FOR ABSTRACTS DEADLINE: JANUARY 12, 2004 | EARLY REGISTRATION DEADLINE: APR IL 20, 2004

S AT U R D AY, MAY 15TH

S U N D AY, MAY 16TH

M O N D AY, MAY 17TH

PROGRAM PLANNING COMMITTEE CHAIR: Bernie J. O’Brien PhD, Professor, Department of Clinical Epidemiology & Biostatistics, McMaster University, St. Joseph’s Hospital, Hamilton, Ontario, Canada

ISSUES PANEL & CONTRIBUTED WORKSHOP CO-CHAIRS: Andrew Briggs Dphil, Professor, Health Economics Research Centre, University of Oxford, Institute of Health Sciences Headington, Oxford and Mark Sculpher, MSc, PhD, Professor, University of York, Centre for Health Economics, Heslington York

CONTRIBUTED RESEARCH REVIEW COMMITTEE CHAIR: Adrian Levy PhD, Professor, Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia Vancouver, Canada

SHORT COURSE CO-CHAIRS: Lorne Basskin PharmD, President, Trinka Publications, Cooper City, FL, USA and J. Jaime Caro MD, Scientific Director, Caro Research, Concord, MA, USA

8:00AM-5:00PM PRE-MEETING SHORT COURSES

10:00PM-5:00PM ISPOR BOARD OF DIRECTORS MEETING

9:00PM-10:00PM STUDENT ICEBREAKER RECEPTION

8:00AM-8:30AM WELCOME & INTRODUCTIONBernie J.O’Brien PhD, Professor, Department of Clinical Epidemiology& Biostatistics, McMaster University, St. Joseph’s Hospital, Hamilton,Ontario, Canada

PRESIDENTIAL ADDRESSSean Sullivan PhD, 2003-2004 ISPOR President & Professor,University of Washington, Seattle, WA, USA

8:30AM-9:45AM FIRST PLENARY SESSIONMEDICARE DRUG BENEFIT & COST-EFFECTIVENESS: WHO PLAYS &

WHO PAYS

This plenary session will address US legislation concerning MedicareDrug Benefit Plan and the use of cost-effectiveness and outcomesresearch information in drug selection decisions. The role of the Agencyfor Health Care Research and Quality and the National Institutes ofHealth, as well as the Food and Drug Administration in providing andregulating this information will be discussed.

9:45AM-10:15AM EXHIBITS & CONTRIBUTED POSTER PRESEN-TATIONS VIEWING – SESSION I

10:15AM-11:15AM CONTRIBUTED PODIUM PRESENTATIONS –SESSION IP h a rmacoeconomics/health economic, quality-of-life, and outcomes

re s e a rch study results for the following diseases will be pre s e n t e d :CARDIOVASCULAR DISEASES CANCER

INFECTIOUS DISEASE RESPIRATORY DISORDERS

11:15AM-11:30AM BREAK

11:30PM-12:30PM ISSUES PANELS – SESSION I• Risk Sharing Deals In The Real World: Can We Afford Them AndDo They Work? • Cost Attribution In Economic Evaluation: What IsSignal And What Is Noise? • Contributed Issues Panels • Medical Device & Diagnostics Council Forum

12:30AM-2:00PM LUNCH, EXHIBITS & GRAND OPENING OFCONTRIBUTED POSTER PRESENTATIONS VIEWING – SESSION I

2:00PM-3:00PM CONTRIBUTED WORKSHOPS – SESSION I (8 WORKSHOPS IN 4 CATEGORIES)• Pharmacoeconomic/Health Economic Methodology Issues• Patient Registry Issues • Quality of Life/Patient Reported OutcomesMethodology Issues • Compliance Issues

3:00PM-3:15PM BREAK

9:00AM-5:00PM PRE-MEETING SHORT COURSES

21

ISPOR 9TH ANNUAL INTERNATIONAL MEETING M AY 15-19, 2004 | C RY S TAL GAT E WAY MARRIOTT, ARLINGTON, VA, USA

CALL FOR ABSTRACTS DEADLINE: JANUARY 12, 2004 | EARLY REG ISTRATION DEADLINE : APRI L 20, 2004

8:00AM-9:00AM CONTRIBUTED PODIUM PRESENTATIONS –SESSION II Research studies on the following topics will be discussed:HEALTH CARE REIMBURSEMENT HEALTH CARE COST IMPACT

MEDICAL DEVICES SCREENING

9:00AM-9:15AM BREAK

9:15AM-10:15AM ISSUES PANELS• Can We Bridge Too Far? Issues In Mapping Between Quality-Of-LifeInstruments And Utility • Stratified Cost-Effectiveness Analysis: TheRisks And Reward Of Looking At Sub-Groups • Contributed IssuesPanels • Contributed Issues Panels

10:15AM-11:00AM BREAK, EXHIBITS, CONTRIBUTED POSTERPRESENTATIONS VIEWING – SESSION II

11:00AM-11:30AM INCOMING PRESIDENTIAL ADDRESSLieven Annemans PhD, MSc, Mman, 2004-2005 ISPOR President andDirector, HEDM University of Ghent, Meise, Belgium

11:30AM-12:30PM SECOND PLENARY SESSIONNEW DIRECTIONS IN RISK SHARING AND POST MARKETING

ECONOMIC EVALUATION

• Risk Sharing Models: A Review of International Experience• Evaluating Cost-Effectiveness and Sharing Risk: The Case of MSDrugs • Disease Management and Risk Sharing in US Managed Care

12:30PM-1:30PM LUNCH, EXHIBITS, GRAND OPENING OF C O N-TRIBUTED POSTER PRESENTATIONS VIEWING – SESSION II

1:30PM-2:30PM CONTRIBUTED WORKSHOPS – SESSION III (UPTO 8 WORKSHOPS IN 4 CATEGORIES)• Retrospective Database Methodology Issues • Cost StudyMethodology Issues • Quality of Life/Patient Reported OutcomesMethodology Issues • Health Policy Health Systems Issues

2:30PM-2:45PM BREAK

2:45PM-3:45PM CONTRIBUTED WORKSHOPS – SESSION IV (UPTO 8 WORKSHOPS IN 4 CATEGORIES)• Modeling Methodology Issues • Clinical Outcomes MethodologyIssues • Quality of Life/Patient Reported Outcomes Methodology Issues• Health Policy Health Systems Issues

3:45PM-4:00PM BREAK

4:00PM-5:00PM ISPOR FORUMS• Quality of Life Forum • Managed Care_PBM Special Interest GroupForum • Risk Management Special Interest Group Forum

5:00PM-7:00PM EXHIBITORS’ WINE & CHEESE RECEPTION &CONTRIBUTED POSTER PRESENTATIONS VIEWING – SESSION II

T U E S D AY, MAY 18TH

3:15PM-4:15PM CONTRIBUTED WORKSHOPS – SESSION II (8WORKSHOPS IN 4 CATEGORIES)• Pharmacoeconomic/Health Economic Methodology Issues• Quality of Life/Patient Reported Outcomes Methodology Issues• Preference-based Study Issues• Health Policy Reimbursement Issues

4:15PM-4:30PM BREAK

4:30PM-5:30PM ISPOR FORUMS• Medical Device & Diagnostics Council Forum • Student Forum• Compliance Special Interest Group Forum

5:30PM-6:30PM ISPOR ANNUAL BUSINESS MEETING

6:00PM-8:00PM EXHIBITORS’ OPEN HOUSE RECEPTION & CONTRIBUTED POSTER PRESENTATION – SESSION I

W E D N E S D AY, MAY 18TH7:00AM-11:00AM CONTRIBUTED POSTER PRESENTATIONSVIEWING – SESSION II

8:00AM-9:00AM CONTRIBUTED PODIUM PRESENTATIONS –SESSION IIIResearch studies on the following topics will be presented:PRESCRIBING STUDIES ADHERENCE/COMPLIANCE

METHODS PRACTICE GUIDELINES

9:00AM-9:15AM BREAK

9:15AM-10:15AM CONTRIBUTED PODIUM PRESENTATIONS –SESSION IVP h a rmacoeconomics/health economic, quality-of-life, and outcomes

re s e a rch study results for the following diseases will be pre s e n t e d :MENTAL HEALTH ARTHRITIS

DIABETES NEUROLOGICAL DISORDERS/MIGRAINE

10:15AM-10:45AM EXHIBITS, CONTRIBUTED POSTER PRESEN-TATIONS VIEWING – SESSION II

10:45AM-11:00AM ISPOR CONTRIBUTED RESEARCH AWARDSPRESENTATION

11:00AM-12:30PM THIRD PLENARY SESSIONTHE $64,000 QUESTION: WHAT ARE WE WILLING TO PAY FOR A QALY?

• New OMB guidance on QALYs • Should we monetize QALYs?• Research agenda for WTP and QALYs

22 October 15,2003 ISPOR CONNECTIONS

ISPOR 6th Annual European Congress 9 -11 November 2003, B a r c e l o n a , Spain

The Professional Recruitment Assistance Program Center (PRAP)provides participants with a CONFIDENTIAL, and PROFESSIONALservice that pairs individuals seeking positions with employers whohave available positions. It includes:

■ Listings of available positions ■ Listings of qualified candidates ■ A mailbox system for applicants and employers

Exhibit Hours

S U N DAY, 9 NOVEMBER12.00-13.00 Break15.00-15.30 Break16.30-17.00 Break18.00-20.00 Exhibitors’ Open House Reception

M O N DAY, 10 NOVEMBER10.30-11.00 Break12.00-13.30 Lunch14.30-15.00 Break16.00-16.30 Break18.00-20.00 Exhibitors’ Wine & Cheese Reception

T U E S DAY, 11 NOVEMBER10.30-11.00 Break12.00-13.30 Lunch14.00-14.30 Break15.30-16.00 Break

Contact Information > http://www. i s p o r. o r g

Sponsorship Opportunities> h t t p : / / w w w. i s p o r. o r g / c o n g r e s s e s /

s p a i n 1 1 0 3 / s p o n s o r. h t m l

For high visibility, be an official sponsor of one ormore events at the Sixth Annual European Congress.All sponsors will receive a complimentary congressregistration, and will be recognized on all signage for the sponsored events.

■ COFFEE BREAKS: Sunday, 9 November; Monday, 10 November; Tuesday, 11 November

■ LUNCH: Monday, 10 November; Tuesday, 11 November

■ EXHIBITORS’ OPEN HOUSE RECEPTION: Sunday, 9 November

■ EXHIBITORS’ WINE & CHEESE RECEPTION: Monday, 10 November

■ REGISTRATION TOTES including your name and logo

■ PLASTIC BOTTLES including your name and logo

Exhibitor Information> http://www. i s p o r. o r g / c o n g r e s s e s / s p a i n 1 1 0 3 / ex h i n f o . h t m

This Exhibit Program will provide you with an opportunity to present yourproducts and services to a global representation of the top outcomesresearchers and healthcare decision-makers from a variety of work environments including the pharmaceutical and biotechnology industries,clinical practice, government agencies,academia and managed care.

ISPOR Professional Recruitment Assistance Program> http://www. i s p o r. o r g / p r a p. h t m

www.ispor.org or contact Nadia Naaman, Director, Marketing and Member Services

ISPOR, 3100 Princeton Pike, Bldg 3, Suite E, Lawrenceville, NJ 08648 USA

Tel:+609-219-0773 ext.11 or nnaaman@ispor.org

Hotel Information

Hotel Juan Carlos I

phone +34 93 364 40 40fax +34 93 364 40 13

Hotel Hilton

phone +34 93 495 77 77fax +34 93 495 77 70

Hotel Melia

phone +34 93 410 60 60fax +34 93 410 77 44

F E ECA N D I DATES: (ISPOR members or Congress registrants) FREE of chargeE M P L OYERS: $1000 USD for the first position and $500 USD for eachadditional position advertised by the same employer.Fee will include:■ 1/4 page announcement in the final program

(if received before 8 September 2003)■ Private rooms for interviewing■ Company listing on ISPOR Web Site

Early Registration Deadline: 6 OCTOBER 2003

ISPOR CONNECTIONS October 15,2003 23

ISPOR 6th Annual European Congress 9 -11 November 2003, B a r c e l o n a , Spain

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S AT U R DAY 8 NOVEMBER: 9.00-17.00 Each course 8 hrs (check one)■ Pharmacoeconomics for the Health Care Decision-Maker

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Before 6 October 2003 $350 325 C= $175 163 C=

After 6 October 2003 $400 372 C= $200 186 C=

S U N DAY 9 NOVEMBER: 8.00-12.00 Each course 4 hrs (check one)■ Cost Estimation and Assessing Financial Impact (Cost-Consequence,

Cost-of-Illness) and Budgetary Impact of Decision Making

■ Evidence-Based Healthcare Reimbursement Systems in Europe– NICE and Beyond

■ Va l u e / Valuation in Measuring Outcomes (Pre f e rence-based Te c h n i q u e s )

■ Advanced Pharmacoeconomic Modeling

■ Meta-Analysis and Systematic Literature Review - Introduction

■ Analysis & Interpretation of Quality of Life & Patient ReportedOutcomes

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Before 6 October 2003 $150 140 C= $75 70 C=

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Payment must be made in US dollars or Euro C = . Payment may be made by check or travelers check.VISA,MasterCard,or American Express will be charged in US dollars.Signature,account number, and expiration date must be included.Non-US checks written in US$ must be written on banks with a US counterpart.Phone charges will NOT be accepted.Ifpayment is being made by your company, please make sure your name is indicated on the check stub or correspondence.If ISPORcannot verify your current membership,you will becharged the non-member registration rate.

*When you register as a non-member, you receive ISPOR membership and a one-year, on-line subscription to Value In Health-The Journal of the International Society forPharmacoeconomics and Outcomes Research.

**One Day registration does not include ISPOR membership benefits and cannot be combined. Cancellation fee before 6 October is US $100.No refunds given after 6 October 2003.

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