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Tužil J, Mlčoch T, Jirčíková J, Závada J, Nekvindová L, Svoboda M, Uher M, Křístková Z, Vencovský J, Pavelka K, Doležal T. Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry. Expert Opin Biol Ther 2019; 20:183-192. [PMID: 31736377 DOI: 10.1080/14712598.2020.1694900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Lucie Nekvindová
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Faculty of Medicine of the Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Zlatuše Křístková
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Jiří Vencovský
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Zrubka Z, Rencz F, Závada J, Golicki D, Rupel VP, Simon J, Brodszky V, Baji P, Petrova G, Rotar A, Gulácsi L, Péntek M. EQ-5D studies in musculoskeletal and connective tissue diseases in eight Central and Eastern European countries: a systematic literature review and meta-analysis. Rheumatol Int 2017; 37:1957-1977. [PMID: 28849432 DOI: 10.1007/s00296-017-3800-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/17/2017] [Indexed: 02/05/2023]
Abstract
EQ-5D is becoming the preferred instrument to measure health-state utilities involved in health technology assessment. The objective of this study is to assess the state of EQ-5D research in musculoskeletal disorders in 8 Central and Eastern European countries and to provide a meta-analysis of EQ-5D index scores. Original research articles published in any language between Jan 2000 and Sept 2016 were included, if they reported any EQ-5D outcome from at least two musculoskeletal patients from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, or Slovenia. Risk of bias was assessed with the Cochrane Collaboration's tool. Twenty-nine articles (5992 patients) were included on rheumatoid arthritis (n = 7), osteoporosis (n = 5), chronic pain (n = 5), osteoarthritis (n = 4), ankylosing spondylitis (n = 2), psoriatic arthritis (n = 2), total hip replacement (n = 2), and scleroderma (n = 2). Low back pain was under-represented, while studies in neck pain, systemic lupus erythematosus, gout, and childhood disorders were lacking. EQ-5D index scores were reported in 24 studies, while the version of the instrument and the value-set was not specified in 41% and 46% of the articles, respectively. Meta-analysis was performed on 24 disease states involving 6876 observation points. Intervention effect was reported in 22 subgroups, out of which risk of bias was low in 41%. This review provides recommendations to improve reporting standards of EQ-5D results and highlights potential areas for future research. Coordinated research in conditions with greatest public health impact as well as a development of a regional value-set could provide locally relevant health-state utilities that are transferable among countries within the region.
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Affiliation(s)
- Zsombor Zrubka
- Doctoral School of Business and Management, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
- Sandoz Hungária Kft, Bartók Béla u. 43-47, 1134, Budapest, Hungary
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Jakub Závada
- Institute of Rheumatology, Na Slupi 4, Prague, 128 00, Czech Republic
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul. Banacha 1b, 02-097, Warsaw, Poland
| | | | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1 1090, Vienna, Austria
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Alexandru Rotar
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary.
- Department of Rheumatology, Flór Ferenc County Hospital, Semmelweis tér 1, 2143, Kistarcsa, Hungary.
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Mlcoch T, Sedova L, Stolfa J, Urbanova M, Suchy D, Smrzova A, Jircikova J, Pavelka K, Dolezal T. Mapping the relationship between clinical and quality-of-life outcomes in patients with ankylosing spondylitis. Expert Rev Pharmacoecon Outcomes Res 2016; 17:203-211. [PMID: 27291258 DOI: 10.1080/14737167.2016.1200468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To map health-related quality of life (Qol) with clinical parameters BASFI and ASDAS-CRP measure, and other covariates. METHODS Our prospective multicenter non-interventional observation study of ankylosing spondylitis (AS) collected data about QoL and clinical outcomes on the initial and four subsequent visits. We employed simple linear regression analysis of a cross-sectional dataset, and fixed effect, random effect and pooled linear regression of a longitudinal dataset. RESULTS We showed that BASFI and ASDAS-CRP are very strong, robust predictors of EQ-5D utilities in all regression specifications together with sex (female), invalidity, and activity impairment. Additionally, the longitudinal regression analysis showed that a fixed effect model may be a viable alternative to the most commonly used random effect model or pooled linear regression due to the nature of our dataset. CONCLUSION This is one of the first studies using a fixed effect model in longitudinal patient-level data, although, this method has been widely used in economics.
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Affiliation(s)
- Tomas Mlcoch
- a Institute of Health Economics and Technology Assessment , Prague , Czech Republic
| | - Liliana Sedova
- b Institute of Rheumatology , Prague , Czech Republic.,c Clinic of Rheumatology, 1st Faculty of Medicine , Charles University in Prague , Prague , Czech Republic
| | - Jiri Stolfa
- b Institute of Rheumatology , Prague , Czech Republic
| | | | - David Suchy
- d Department of Clinical Pharmacology, Rheumatology , University Hospital Plzen , Plzen , Czech Republic
| | - Andrea Smrzova
- e Third Internal Clinic , University Hospital Olomouc , Olomouc , Czech Republic
| | - Jitka Jircikova
- a Institute of Health Economics and Technology Assessment , Prague , Czech Republic
| | - Karel Pavelka
- b Institute of Rheumatology , Prague , Czech Republic
| | - Tomas Dolezal
- a Institute of Health Economics and Technology Assessment , Prague , Czech Republic
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Tsifetaki N, Migkos MP, Papagoras C, Voulgari PV, Athanasakis K, Drosos AA. Counting Costs under Severe Financial Constraints: A Cost-of-Illness Analysis of Spondyloarthropathies in a Tertiary Hospital in Greece. J Rheumatol 2015; 42:963-7. [DOI: 10.3899/jrheum.141277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the total annual direct cost of patients with spondyloarthritis (SpA) in Greece.Methods.Retrospective study with 156 patients diagnosed and followed up in the rheumatology clinic of the University Hospital of Ioannina. Sixty-four had ankylosing spondylitis (AS) and 92 had psoriatic arthritis (PsA). Health resource use for each patient was elicited through a retrospective chart review that documented the use of monitoring visits, medications, laboratory/diagnostic tests, and inpatient stays for the previous year from the date that the review took place. Costs were calculated from a third-party payer perspective and are reported in 2014 euros.Results.The mean ± SD annual direct cost for the patients with SpA reached €8680 ± 6627. For the patients with PsA and AS, the cost was estimated to be €8097 ± 6802 and €9531 ± 6322, respectively. The major cost was medication, which represented 88.9%, 88.2%, and 89.3% of the mean total direct cost for SpA, AS, and PsA, respectively. The annual amount of the scheduled tests for all patients corresponded to 7.5%, and for those performed on an emergency basis, 1.1%. Further, the cost for scheduled and emergency hospitalization, as well as the cost of scheduled visits to an outpatient clinic, corresponded to 2.5% of the mean total annual direct cost for the patients with SpA.Conclusion.SpA carries substantial financial cost, especially in the era of new treatment options. Adequate access and treatment for patients with SpA remains a necessity, even in times of fiscal constraint. Thus, the recommendations of the international scientific organizations should be considered when administering high-cost drugs such as biological treatments.
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Malinowski KP, Kawalec P. The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2015; 15:285-300. [DOI: 10.1586/14737167.2015.1001370] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Péntek M, Poór G, Wiland P, Olejárová M, Brzosko M, Codreanu C, Brodszky N, Gulácsi L. Biological therapy in inflammatory rheumatic diseases: issues in Central and Eastern European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15 Suppl 1:S35-S43. [PMID: 24832834 DOI: 10.1007/s10198-014-0592-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
Biological drugs revolutionized the treatment of inflammatory rheumatic diseases. Access to treatment presents substantial variability across Europe. The economic level of a particular country as well as administrative restrictions have been proved as determining factors of biological drug uptake. The objective of this paper was to provide an overview of biological treatment in six selected Central and Eastern European (CEE) countries, namely in the Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia. The literature is summarized with regard to the epidemiology, disease burden and use of biological agents in rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Moreover, an estimate is provided on the prevalence and number of patients with biological treatment based on international and local sources. In view of the limited availability of information and uncertainty in data, there is an urgent need for development of systematic and comprehensive data collection in inflammatory rheumatic diseases in CEE countries.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., Budapest, 1093, Hungary,
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