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Martínez‐Ripoll JM, García‐Domingo M, de la Fuente Robles YM. Epidermolysis Bullosa in Spain: A Qualitative Analysis of Its Social Impact on Families With Diagnosed Minors. Health Expect 2024; 27:e14128. [PMID: 38943541 PMCID: PMC11214136 DOI: 10.1111/hex.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) comprises a group of rare types of genodermatoses characterized by extreme mucocutaneous fragility, leading to blistering and/or erosions, even with minimal trauma. Continuous care through wound management is an integral part of daily life for the families and individuals affected. The aim of this study was to assess the social reality and impacts on families of having minor members diagnosed with EB in Spain. METHODS A qualitative methodology was employed, utilizing four focus groups entailing participation by 24 parents (19 mothers and five fathers) of minors diagnosed with EB in Spain. RESULTS Negative impacts on the family nucleus were evident in four priority areas of analysis: sociorelational, economic-labour, physical and psychoemotional, with significant differences observed based on the severity of the symptoms. CONCLUSION Impacts on the family nucleus are noticeable from birth, influencing all other daily life routines and complicating family planning and organization. There is an imperative need to enhance the availability of sociohealth resources and to adopt an interdisciplinary approach to address their biopsychosocial needs. PATIENT OR PUBLIC CONTRIBUTION The active participation of relatives of minors diagnosed with Epidermolysis Bullosa (EB) is invaluable to sociohealth professionals, legislators and researchers. A team member conducts their professional activities at DEBRA España (national patient association dedicated to enhancing the quality of life for individuals with EB and their families), actively engaging in all study phases.
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Salamon G, Field-Werners U, Strobl S, Hübl V, Diem A. Facing the complex challenges of people with epidermolysis bullosa in Austria: a mixed methods study on burdens and helpful practices. Orphanet J Rare Dis 2024; 19:211. [PMID: 38773622 PMCID: PMC11110252 DOI: 10.1186/s13023-024-03163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/30/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND With approximately 500 people affected in Austria, epidermolysis bullosa (EB) is a rare genetic skin disease reducing the quality of life of those affected and their relatives. The intensive efforts of the patient organisation DEBRA Austria during the last decades have led to a unique situation of those affected and their relatives, with increased support and broader knowledge about the disease in the general population. The aim of the study is to evaluate the current situation of patients and their relatives living in Austria, with a focus on burdens and helpful practices. RESULTS The mixed-methods study consisted of two parts: a qualitative interview study to identify psychosocial aspects of EB in those affected and their relatives, and a subsequent online survey to further assess those aspects in a larger sample, resulting in a total of n=78 Austrian participants. The impact of EB on the quality of life of EB patients and their relatives in Austria is related to the current health status, psychological burden, mobility, visibility, financial situation as well as job prospects. Personal and social resources and external support have a significant influence on the individual situation. CONCLUSIONS The outcome is mapped to concrete implications regarding targeted support for EB patients and their relatives on an individual level and their needs in regard to the Austrian health care system.
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Affiliation(s)
- Gudrun Salamon
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria.
| | - Ursula Field-Werners
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Sophie Strobl
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Vinzenz Hübl
- Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020, Vienna, Austria
| | - Anja Diem
- EB House Austria, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
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Alheggi A, Alfahhad A, Bukhari A, Bodemer C. Exploring the Impact of Epidermolysis Bullosa on Parents and Caregivers: A Cross-Cultural Validation of the Epidermolysis Bullosa Burden of Disease Questionnaire. Clin Cosmet Investig Dermatol 2024; 17:1027-1032. [PMID: 38737942 PMCID: PMC11086395 DOI: 10.2147/ccid.s459429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Purpose Epidermolysis bullosa (EB) is a heterogeneous group of genetically inherited skin and mucosal fragility disorders. EB may have a profound impact on parental physical and psychosocial health. This study was designed to evaluate the disease burden in parents of patients with EB and identify out-of-pocket (OOP) expenditures for EB care in Saudi Arabia. Patients and Methods Thirty-eight caregivers of patients with EB were recruited from the Saudi EB registry to participate. All participants completed the EB Burden of Disease (EB-BoD) questionnaire. Data were collected between May 2020 and December 2020. The sample included 10 patients with EB simplex (EBS), 10 with junctional EB (JEB), 14 with dystrophic EB (DEB), and 4 with an unknown type. Results Mothers were the primary caregivers in 89.5% of cases. The mean EB-BoD score was 53 ± 21.5. The family-life and child's life dimensions had the higher burden. The mean EB-BoD score observed in patients with DEB was 62.4±16.8 versus 45.7 ± 19.42 for EBS. The EB-BoD score was correlated with the patient's family income. Most caregivers (97.4%) reported OOP expenditure, with a mean monthly OOP expenditure of $575.5± $701.1. OOP expenses increased with the severity of the condition. Conclusion This study highlights the need for support services for parents caring for patients with EB.
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Affiliation(s)
- Ashjan Alheggi
- Department of Dermatology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Aseel Alfahhad
- Department of Dermatology, College of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abrar Bukhari
- Department of Dermatology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Christine Bodemer
- Department of Dermatology, Expert Centre for Genodermatoses (MAGEC) Necker-Enfants Malades Hospital, University Paris Centre, Paris, France
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Hachem ME, Diociaiuti A, Zambruno G, Samela T, Ferretti F, Carnevale C, Linertová R, Bodemer C, Murrell DF, Abeni D. "Quality of Life in Epidermolysis Bullosa" and "Epidermolysis Bullosa Burden of Disease": Italian translation, cultural adaptation, and pilot testing of two disease-specific questionnaires. Ital J Pediatr 2024; 50:76. [PMID: 38637879 PMCID: PMC11027388 DOI: 10.1186/s13052-024-01657-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of skin fragility disorders characterized by blister formation following minor trauma. Four major types are distinguished based on the level of cleavage within the skin. Most EB forms present severely disabling cutaneous and systemic signs and symptoms. Management relies on daily time-consuming and distressing topical medications, and symptomatic treatment of systemic findings. Disease manifestations, symptoms, and daily care strongly affect patient and caregiver quality of life (QoL). To date, there are two validated EB-specific questionnaires, the "Quality of Life in Epidermolysis Bullosa" (QOLEB) and the "Epidermolysis Bullosa Burden of Disease" (EB-BoD) for the evaluation of patient and family disease burden, respectively. The aim of our study was to develop an Italian translation of the two questionnaires and to pilot-test them. METHODS The guidelines for translation and cross-cultural adaptation of health-related QoL measures were followed. Initially, two separate translations were generated for each questionnaire, and subsequently reconciled by an expert committee. This was followed by a back-translation process. The original texts and all translations underwent revision by the expert committee, resulting in definitive versions. The final versions were then tested in a pilot study involving cognitive debriefing in a group of 17 families, representative of all EB major types. RESULTS The translation and reconciliation process led to minor changes to obtain semantic/idiomatic/cultural equivalence of the Italian versions with the original ones and to reconcile the questions with the answer options. The cognitive debriefing process showed a good understanding and did not require text modifications. CONCLUSIONS The Italian versions of the QOLEB and EB-BoD provide valuable tools in everyday clinical practice of reference centers, and they allow the participation in multicenter international real-life observational studies as well as in controlled clinical trials. They enable the identification of disease-specific psychological and socioeconomic challenges for EB patients and their families, guiding targeted interventions to ensure appropriate and timely care.
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Affiliation(s)
- May El Hachem
- Dermatology Unit and Genodermatosis Research Unit, Translational Paediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Research Unit, Translational Paediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Giovanna Zambruno
- Dermatology Unit and Genodermatosis Research Unit, Translational Paediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Tonia Samela
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
- Clinical Psychology Unit, IDI-IRCCS, Rome, Italy
| | - Francesca Ferretti
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia Carnevale
- Dermatology Unit and Genodermatosis Research Unit, Translational Paediatrics and Clinical Genetics Research Division, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Renata Linertová
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
| | - Christine Bodemer
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Filière Maladies Rares Dermatologiques (FIMARAD), ERN-Skin, Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP5), Paris, France
| | - Dédée F Murrell
- Department of Dermatology, St George Hospital & University of New South Wales, Sydney, Australia
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Tabor A, LeQuang JAK, Pergolizzi J. Epidermolysis Bullosa: Practical Clinical Tips From the Field. Cureus 2024; 16:e53774. [PMID: 38465068 PMCID: PMC10921121 DOI: 10.7759/cureus.53774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
Epidermolysis bullosa (EB) is a rare genetic condition characterized by fragile skin caused by impaired adhesion between the dermis and epidermis. EB is present at or near birth. There is no cure and treatments are supportive. Children with EB are at elevated risk of squamous cell cancer. Under ideal circumstances, EB patients benefit from interdisciplinary care teams who can offer state-of-the-art treatments. In reality and particularly in less-developed nations, care can be limited. In all cases, families dealing with a member with EB face great challenges in caregiving, much of which is managed at home, and incur great financial expenses for dressings, equipment, transportation, and out-of-pocket expenses. While research groups are working to find a cure for EB, clinicians working with EB patients around the world have found practical and relatively inexpensive tips to make life easier for people with EB. NoBabyBlisters.org, a nonprofit organization actively supplying monthly medical supplies for EB children on five continents and working on EB research, has innovated, developed, collected, and now offers here seven such practical and actionable items learned from its experience in the real world assisting children in less-developed nations, typically with hot climates. These are based on real-world clinical experience dealing with a complex disorder under challenging circumstances. The goal of this short paper is to provide advice to EB caregivers and their loved ones that may make things easier and enhance quality of life, including blister and pain reduction.
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Affiliation(s)
- Aaron Tabor
- Research, No Baby Blisters, Colorado Springs, USA
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Guertin JR, Gilbert-Ouimet M, Dugas M, Carnovale V, Jalbert L, Svyntozelska O, Demers J, Matteau L, Bergeron F, LeBlanc A. Methods used to account for caregivers' sex and gender within studies examining the financial burden of caregivers of children and adolescents : Results from a scoping review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:35-53. [PMID: 38298908 PMCID: PMC10829241 DOI: 10.2147/ceor.s443077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
Background Interest in the financial burden of informal caregivers has been growing. Unfortunately, it remains unclear which method(s) should be used when quantifying this burden. Purpose We conducted a scoping review aimed at identifying which methods have been used to conduct such work and quantified their performance. We were also interested in examining how sex and gender considerations were considered within selected studies. Data Sources Using a standardized approach, we identified studies published between 2012 and 2022 that aimed to document the financial burden of caregivers to child and adolescent patients. Our search strategy was applied to the MEDLINE, Embase, CINHAL, and Academic Search Premier databases. Study Selection Manuscript selection was performed by pairs of reviewers. Data Extraction Data extraction was performed by one reviewer with a second reviewer performing quality control. Results were reported using a narrative approach. Data Synthesis We identified 9801 unique citations, of which 200 were included in our review. Selected studies covered various disease area (eg, infection/parasitic diseases [n = 31, 16%]) and included quantitative (n = 180, 90%), qualitative (n = 4, 2%) and mixed study designs (n = 16, 8%). Most studies (n = 182, 91%) used questionnaires/surveys, either alone or in combination with other methods, to assess caregivers' financial burden. Less than half (n = 93, 47%) of studies reported on caregivers' sex and none reported on their gender. Conclusion We conducted an unrestricted review of published studies examining caregiver's financial burden which allowed us to identify general methodological trends observed in this literature. We believe this work may help improve future studies focusing on this important issue.
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Affiliation(s)
- Jason Robert Guertin
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de recherche en organogénèse expérimentale de l’Université Laval/LOEX, Quebec City, Quebec, Canada
| | - Mahée Gilbert-Ouimet
- Centre de recherche du Centre de recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Valérie Carnovale
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Laura Jalbert
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Olha Svyntozelska
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Juliette Demers
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
| | - Léonie Matteau
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Health Sciences, Université du Québec À Rimouski, Levis, Quebec, Canada
| | - Frédéric Bergeron
- Bibliothèque-Direction des services-conseils, Université Laval, Quebec City, Quebec, Canada
| | - Annie LeBlanc
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center, Quebec City, Quebec, Canada
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Cuadrado-Corrales N, Lopez-de-Andres A, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Omaña-Palanco R, Del-Barrio JL, De-Miguel-Díez J, Jimenez-Garcia R, Montoya JJ. Clinical Characteristics and Outcomes of Patients Hospitalized with Epidermolysis Bullosa: A Retrospective Population-Based Observational Study in Spain (2016-2021). Biomedicines 2023; 11:2584. [PMID: 37761025 PMCID: PMC10526251 DOI: 10.3390/biomedicines11092584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Epidermolysis bullosa (EB) comprises a group of rare skin diseases. We assessed diagnostic procedures, comorbidity profiles, length of hospital stay (LOHS), costs, and in-hospital mortality (IHM) associated with EB. (2) Methods: A retrospective, population-based observational study was performed using the Spanish National Hospital Discharge Database. Hospitalized patients with EB in Spain were identified for the period 2016 to 2021. (3) Results: A total of 677 hospitalizations were identified among 342 patients with a diagnosis of EB. Fifty percent of patients had at least one readmission during the 6-year follow-up. Notably, rehospitalizations were more common among patients aged 2-17 years. The most prevalent comorbidity was digestive disorders, which were associated with the frequency of esophageal dilatation procedures and percutaneous endoscopic gastrostomy. The longest LOHS was recorded for the 0- to 1-year age group. IHM increased with age, and the difference was statistically significant. The prevalence of malignant neoplasm was 36.88%, with cutaneous squamous cell carcinoma being the most frequent. The overall cost per hospitalized patient was estimated to be EUR 10,895.22 (SD EUR 13,394.81), with significant variations between age groups. (4) Conclusions: Readmissions are very frequent among people with EB. We observed a higher LOHS in the 0- to 1-year age group, while the highest rates of IHM were observed in patients older than 50 years. There was a substantial prevalence of comorbidities, namely, digestive disorders, infectious diseases, and especially cancer.
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Affiliation(s)
- Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, 28922 Madrid, Spain; (V.H.-B.); (J.L.D.-B.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Ricardo Omaña-Palanco
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Jose L. Del-Barrio
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, 28922 Madrid, Spain; (V.H.-B.); (J.L.D.-B.)
| | - Javier De-Miguel-Díez
- Respiratory Care Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 28007 Madrid, Spain;
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.C.-C.); (D.C.-A.); (J.J.Z.-L.); (R.O.-P.); (R.J.-G.)
| | - Juan J. Montoya
- Faculty of Medicine, School of Sport Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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Popenhagen MP, Genovese P, Blishen M, Rajapakse D, Diem A, King A, Chan J, Pellicer Arasa E, Baird S, Ferreira da Rocha AC, Stitt G, Badger K, Zmazek V, Ambreen F, Mackenzie C, Price H, Roberts T, Moore Z, Patton D, Murphy P, Mayre-Chilton K. Consensus-based guidelines for the provision of palliative and end-of-life care for people living with epidermolysis bullosa. Orphanet J Rare Dis 2023; 18:268. [PMID: 37667330 PMCID: PMC10476410 DOI: 10.1186/s13023-023-02870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a cluster of rare, genetic skin and mucosal fragility disorders with multi-system and secondary effects, in which blistering and erosions occur in response to friction/mechanical trauma. Considering the incurable and potentially life-limiting nature of the condition and the challenges posed by its symptoms, a palliative approach to EB-related care is necessary. However, knowledge and experience related to the provision of EB palliative care is minimal. Evidence-based, best care guidelines are needed to establish a base of knowledge for practitioners to prevent or ease suffering while improving comfort at all stages of the illness, not just the end of life. METHODS This consensus guideline (CG) was begun at the request of DEBRA International, an international organization dedicated to improvement of care, research, and dissemination of knowledge for EB patients, and represents the work of an international panel of medical experts in palliative care and EB, people living with EB, and people who provide care for individuals living with EB. Following a rigorous, evidence-based guideline development process, the author panel identified six clinical outcomes based on the results of a survey of people living with EB, carers, and medical experts in the field, as well as an exhaustive and systematic evaluation of literature. Recommendations for the best clinical provision of palliative care for people living with EB for each of the outcomes were reached through panel consensus of the available literature. RESULTS This article presents evidence-based recommendations for the provision of palliative healthcare services that establishes a base of knowledge and practice for an interdisciplinary team approach to ease suffering and improve the quality of life for all people living with EB. Any specific differences in the provision of care between EB subtypes are noted. CONCLUSIONS Because there is yet no cure for EB, this evidence-based CG is a means of optimizing and standardizing the IDT care needed to reduce suffering while improving comfort and overall quality of life for people living with this rare and often devastating condition.
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Affiliation(s)
- Mark P Popenhagen
- Department of Anesthesiology B090, Children's Hospital Colorado, University of Colorado School of Medicine, Anschutz Medical Campus, 13123 E 16Th Ave, Aurora, CO, 80045, USA.
- Section of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
| | | | - Mo Blishen
- DEBRA New Zealand, Newtown, Wellington, New Zealand
| | | | - Anja Diem
- EB House Austria, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | | | - Jennifer Chan
- Lucile Packard Children's Hospital, Stanford, Menlo Park, CA, USA
| | | | - Simone Baird
- DEBRA Australia, Pittsworth, QLD, Australia
- , Melbourne, Australia
| | | | - Gideon Stitt
- Division of Clinical Pharmacology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Faiza Ambreen
- DEBRA Pakistan, Lahore, Punjab, Pakistan
- , London, UK
| | - Caroline Mackenzie
- Guys and St Thomas' Foundation NHS Foundation Trust, EB Adult Service, East Hampshire, England, UK
| | | | - Toni Roberts
- DEBRA South Africa, Western Cape, Cape Town, South Africa
- , Cape Town, South Africa
| | - Zena Moore
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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Korte EWH, Welponer T, Kottner J, van der Werf S, van den Akker PC, Horváth B, Kiritsi D, Laimer M, Pasmooij AMG, Wally V, Bolling MC. Heterogeneity of reported outcomes in epidermolysis bullosa clinical research: a scoping review as a first step towards outcome harmonization. Br J Dermatol 2023; 189:80-90. [PMID: 37098154 DOI: 10.1093/bjd/ljad077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a rare, genetically and clinically heterogeneous group of skin fragility disorders. No cure is currently available, but many novel and repurposed treatments are upcoming. For adequate evaluation and comparison of clinical studies in EB, well-defined and consistent consensus-endorsed outcomes and outcome measurement instruments are necessary. OBJECTIVES To identify previously reported outcomes in EB clinical research, group these outcomes by outcome domains and areas and summarize respective outcome measurement instruments. METHODS A systematic literature search was performed in the databases MEDLINE, Embase, Scopus, Cochrane CENTRAL, CINAHL, PsycINFO and trial registries covering the period between January 1991 and September 2021. Studies were included if they evaluated a treatment in a minimum of three patients with EB. Two reviewers independently performed the study selection and data extraction. All identified outcomes and their respective instruments were mapped onto overarching outcome domains. The outcome domains were stratified according to subgroups of EB type, age group, intervention, decade and phase of clinical trial. RESULTS The included studies (n = 207) covered a range of study designs and geographical settings. A total of 1280 outcomes were extracted verbatim and inductively mapped onto 80 outcome domains and 14 outcome areas. We found a steady increase in the number of published clinical trials and outcomes reported over the past 30 years. The included studies mainly focused on recessive dystrophic EB (43%). Wound healing was reported most frequently across all studies and referred to as a primary outcome in 31% of trials. Great heterogeneity of reported outcomes was observed within all stratified subgroups. Moreover, a diverse range of outcome measurement instruments (n = 200) was identified. CONCLUSIONS We show substantial heterogeneity in reported outcomes and outcome measurement instruments in EB clinical research over the past 30 years. This review is the first step towards harmonization of outcomes in EB, which is necessary to expedite the clinical translation of novel treatments for patients with EB.
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Affiliation(s)
| | | | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
| | - Sjoukje van der Werf
- Central Medical Library, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter C van den Akker
- Department of Genetics, UMCG Expertise Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Dimitra Kiritsi
- Department of Dermatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Anna M G Pasmooij
- Department of Dermatology
- Dutch Medicines Evaluation Board, Utrecht, the Netherlands
| | - Verena Wally
- Research Programme for Molecular Therapy of Genodermatoses, EB House Austria, University Hospital of the Paracelsus Medical University, Salzburg, Austria
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Naso G, Gkazi S, Georgiadis C, Jayarajan V, Jacków J, Fleck R, Allison L, Ogunbiyi O, McGrath J, Ilic D, Di W, Petrova A, Qasim W. Cytosine deaminase base editing to restore COL7A1 in dystrophic epidermolysis bullosa human:murine skin model. JID INNOVATIONS 2023; 3:100191. [DOI: 10.1016/j.xjidi.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 02/22/2023] Open
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Has C, Hess M, Anemüller W, Blume-Peytavi U, Emmert S, Fölster-Holst R, Frank J, Giehl K, Günther C, Hammersen J, Hillmann K, Höflein B, Hoeger PH, Hotz A, Mai TA, Oji V, Schneider H, Süßmuth K, Tantcheva-Póor I, Thielking F, Zirn B, Fischer J, Reimer-Taschenbrecker A. Epidemiology of inherited epidermolysis bullosa in Germany. J Eur Acad Dermatol Venereol 2023; 37:402-410. [PMID: 36196047 DOI: 10.1111/jdv.18637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/17/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a rare genetic disorder manifesting with skin and mucosal membrane blistering in different degrees of severity. OBJECTIVE Epidemiological data from different countries have been published, but none are available from Germany. METHODS In this population-based cross-sectional study, people living with EB in Germany were identified using the following sources: academic hospitals, diagnostic laboratories and patient organization. RESULTS Our study indicates an overall EB incidence of 45 per million live births in Germany. With 14.23 per million live births for junctional EB, the incidence is higher than in other countries, possibly reflecting the availability of early molecular genetic diagnostics in severely affected neonates. Dystrophic EB was assessed at 15.58 cases per million live births. The relatively low incidence found for EB simplex, 14.93 per million live births, could be explained by late or missed diagnosis, but also by 33% of cases remaining not otherwise specified. Using log-linear models, we estimated a prevalence of 54 per million for all EB types, 2.44 for junctional EB, 12.16 for dystrophic EB and 28.44 per million for EB simplex. These figures are comparable to previously reported data from other countries. CONCLUSIONS Altogether, there are at least 2000 patients with EB in the German population. These results should support national policies and pharmaceutical companies in decision-making, allow more precise planning of drug development and clinical trials, and aid patient advocacy groups in their effort to improve quality of life of people with this orphan disease.
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Affiliation(s)
- Cristina Has
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - Moritz Hess
- Medical Faculty and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | | | - Ulrike Blume-Peytavi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jorge Frank
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen, Germany
| | - Kathrin Giehl
- Department of Dermatology and Allergy, University of Munich LMU, Munich, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital, Technical University Dresden, Dresden, Germany
| | - Johanna Hammersen
- Department of Pediatrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Höflein
- "Interessengemeinschaft Epidermolysis bullosa (IEB) e.V. Debra Deutschland", Biedenkopf, Germany
| | - Peter H Hoeger
- Fachbereich Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Alrun Hotz
- Medical Faculty and Medical Center, Institute of Human Genetics, University of Freiburg, Freiburg, Germany
| | - Thuy Anh Mai
- Fachbereich Pädiatrie und Pädiatrische Dermatologie/Allergologie, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Vinzenz Oji
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Holm Schneider
- Department of Pediatrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kira Süßmuth
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Frederieke Thielking
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Birgit Zirn
- Genetikum® Stuttgart, Genetic Counselling and Diagnostics, Stuttgart, Germany
| | - Judith Fischer
- Medical Faculty and Medical Center, Institute of Human Genetics, University of Freiburg, Freiburg, Germany
| | - Antonia Reimer-Taschenbrecker
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany.,Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Silva CB, Okido ACC, Carlos DM, Wernet M, Barbosa NG. Experiences of mothers in the care of children and adolescents with epidermolysis bullosa. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0231en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Objective to know and analyze mothers’ experiences in caring for children and adolescents with Epidermolysis Bullosa. Method a descriptive qualitative study was developed with ten mothers of children and adolescents with epidermolysis bullosa from different regions of Brazil using semi-structured interviews recorded remotely using Google Meet® between September and November 2021. The thematic analysis technique guided the appreciation of the empirical material. Results mothers aged between 23 and 53 years participated in the study. Two categories translate the maternal experience: i) the “shock” of the diagnosis and the initial challenges and ii) “Stop living to live for them”: the changes in the families’ daily life. Final considerations and implications for practice mothers experienced fear and insecurity when their child was diagnosed, and the care routine, especially the daily dressing changes, caused a physical and emotional burden. These results can support the follow-up of these families to provide them with care tools and emotional support.
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13
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Bourrat E, Taieb C, Marquié A, Causse P, Bergqvist C, Sauvestre A, Bellon N. Burden of caregivers and out-of-pocket expenditures related to epidermolysis bullosa in France. J Eur Acad Dermatol Venereol 2023; 37:194-203. [PMID: 35994204 DOI: 10.1111/jdv.18554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Inherited epidermolysis bullosa (EB) is a heterogeneous group of genodermatoses characterized by localized or generalized skin and/or mucosal fragility. The objective of this work was to evaluate in France the burden of disease and out-of-pocket (OOP) expenditures for families with a child affected by EB. MATERIAL AND METHODS A digital questionnaire was built and distributed to parents of children with EB in partnership with the patients' association DEBRA France. The questionnaire collected clinical and socioeconomic characteristics including the estimated amount of money caregivers had to pay out of their own pockets. The burden of caregivers was assessed using the validated Epidermolysis Bullosa Burden of Disease (EB-BoD) tool. Linear univariate regression models were conducted to search for factors associated with higher burden and higher OOP. RESULTS Between October and December 2021, 77 parents answered the questionnaire. The responder was the child's mother in 77% (n = 59) of cases. Parents represented 40 girls and 37 boys with a mean age of 7.5 years and with different EB types and disease severity. The mean BE-BOD score was 63.9 ± 20.2. The mean score observed in children with severe EB was 69.0 ± 21 versus 59.0 ± 18.6 for moderate/mild. Similarly, the mean BE-BOD scores observed in parents performing daily wound care were 67.9 ± 19.6. All parents (100%) reported OOP expenses. The mean annual OOP cost was 4129€ ± 4321€. Linear regression demonstrated that for each one-point increase in the EB-BoD score, OOP expense increases by 91.1 euros (35.1-147) p = 0.002. CONCLUSION EB places a considerable burden on families' daily lives. This burden is closely associated with OOP expenditures to manage EB which were on average 20 times higher compared with the French population.
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Affiliation(s)
| | - Charles Taieb
- Patients Priority, European Market Maintenance Assessment, Fontenay Sous Bois, France
| | - Adrien Marquié
- Patients Priority, European Market Maintenance Assessment, Fontenay Sous Bois, France
| | | | | | | | - Nathalia Bellon
- Department of Dermatology, Necker Enfants-Malades Hospital, MAGEC Referal Center of Rare Skin Diseases, Paris, France
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14
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Silva CB, Okido ACC, Carlos DM, Wernet M, Barbosa NG. Vivências de mães no cuidado a crianças e adolescentes com Epidermólise Bolhosa. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0231pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Resumo Objetivo conhecer e analisar as vivências de mães no cuidado a crianças e adolescentes com Epidermólise Bolhosa. Método estudo descritivo de abordagem qualitativa desenvolvido junto a dez mães de crianças e adolescentes com Epidermólise Bolhosa de diferentes regiões do Brasil, a partir de entrevistas semiestruturadas, áudio e vídeo gravadas, por via remota, utilizando-se a plataforma Google Meet®, entre setembro e novembro de 2021. A técnica da análise temática direcionou a apreciação do material empírico. Resultados participaram do estudo mães com idade entre 23 e 53 anos. Duas categorias traduzem a vivência materna: i) O “baque” do diagnóstico e os desafios iniciais e ii) “Deixar de viver para viver para ele”: as mudanças no cotidiano das famílias. Considerações finais e implicações para a prática as mães vivenciaram sentimentos de medo e insegurança diante do diagnóstico do filho e a rotina de cuidados, em especial, as trocas diárias de curativos, acarretaram sobrecarga física e emocional. Esses resultados podem subsidiar o acompanhamento dessas famílias de modo a instrumentalizá-las para o cuidado e apoiá-las emocionalmente.
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15
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Sheriff A, Guri I, Zebrowska P, Llopis-Hernandez V, Brooks IR, Tekkela S, Subramaniam K, Gebrezgabher R, Naso G, Petrova A, Balon K, Onoufriadis A, Kujawa D, Kotulska M, Newby G, Łaczmański Ł, Liu DR, McGrath JA, Jacków J. ABE8e adenine base editor precisely and efficiently corrects a recurrent COL7A1 nonsense mutation. Sci Rep 2022; 12:19643. [PMID: 36385635 PMCID: PMC9666996 DOI: 10.1038/s41598-022-24184-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Base editing introduces precise single-nucleotide edits in genomic DNA and has the potential to treat genetic diseases such as the blistering skin disease recessive dystrophic epidermolysis bullosa (RDEB), which is characterized by mutations in the COL7A1 gene and type VII collagen (C7) deficiency. Adenine base editors (ABEs) convert A-T base pairs to G-C base pairs without requiring double-stranded DNA breaks or donor DNA templates. Here, we use ABE8e, a recently evolved ABE, to correct primary RDEB patient fibroblasts harboring the recurrent RDEB nonsense mutation c.5047 C > T (p.Arg1683Ter) in exon 54 of COL7A1 and use a next generation sequencing workflow to interrogate post-treatment outcomes. Electroporation of ABE8e mRNA into a bulk population of RDEB patient fibroblasts resulted in remarkably efficient (94.6%) correction of the pathogenic allele, restoring COL7A1 mRNA and expression of C7 protein in western blots and in 3D skin constructs. Off-target DNA analysis did not detect off-target editing in treated patient-derived fibroblasts and there was no detectable increase in A-to-I changes in the RNA. Taken together, we have established a highly efficient pipeline for gene correction in primary fibroblasts with a favorable safety profile. This work lays a foundation for developing therapies for RDEB patients using ex vivo or in vivo base editing strategies.
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Affiliation(s)
- Adam Sheriff
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Ina Guri
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Paulina Zebrowska
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Virginia Llopis-Hernandez
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Imogen R Brooks
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Stavroula Tekkela
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Kavita Subramaniam
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Ruta Gebrezgabher
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Gaetano Naso
- Molecular and Cellular Immunology Unit, UCL GOS Institute of Child Health, London, UK
| | - Anastasia Petrova
- Molecular and Cellular Immunology Unit, UCL GOS Institute of Child Health, London, UK
| | - Katarzyna Balon
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Alexandros Onoufriadis
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Dorota Kujawa
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Martyna Kotulska
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Gregory Newby
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - Łukasz Łaczmański
- Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - David R Liu
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA
- Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA
| | - John A McGrath
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK
| | - Joanna Jacków
- St John's Institute of Dermatology, Faculty of Life Sciences and Medicine, King's College London, 9th Floor Tower Wing, Guy's Hospital, Great Maze Pond Road, London, SE1 9RT, UK.
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Chung CCY, Chu ATW, Chung BHY. Rare disease emerging as a global public health priority. Front Public Health 2022; 10:1028545. [PMID: 36339196 PMCID: PMC9632971 DOI: 10.3389/fpubh.2022.1028545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 01/29/2023] Open
Abstract
The genomics revolution over the past three decades has led to great strides in rare disease (RD) research, which presents a major shift in global policy landscape. While RDs are individually rare, there are common challenges and unmet medical and social needs experienced by the RD population globally. The various disabilities arising from RDs as well as diagnostic and treatment uncertainty were demonstrated to have detrimental influence on the health, psychosocial, and economic aspects of RD families. Despite the collective large number of patients and families affected by RDs internationally, the general lack of public awareness and expertise constraints have neglected and marginalized the RD population in health systems and in health- and social-care policies. The current Coronavirus Disease of 2019 (COVID-19) pandemic has exposed the long-standing and fundamental challenges of the RD population, and has reminded us of the critical need of addressing the systemic inequalities and widespread disparities across populations and jurisdictions. Owing to the commonality in goals between RD movements and universal health coverage targets, the United Nations (UN) has highlighted the importance of recognizing RDs in policies, and has recently adopted the UN Resolution to promote greater integration of RDs in the UN agenda, advancing UN's commitment in achieving the 2030 Sustainable Development Goals of "leav[ing] no one behind." Governments have also started to launch Genome Projects in their respective jurisdictions, aiming to integrate genomic medicine into mainstream healthcare. In this paper, we review the challenges experienced by the RD population, the establishment and adoption of RD policies, and the state of evidence in addressing these challenges from a global perspective. The Hong Kong Genome Project was illustrated as a case study to highlight the role of Genome Projects in enhancing clinical application of genomic medicine for personalized medicine and in improving equity of access and return in global genomics. Through reviewing what has been achieved to date, this paper will provide future directions as RD emerges as a global public health priority, in hopes of moving a step toward a more equitable and inclusive community for the RD population in times of pandemics and beyond.
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Affiliation(s)
| | | | | | - Brian Hon Yin Chung
- Hong Kong Genome Institute, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Feinstein JA, Bruckner AL, Chastek B, Anderson A, Roman J. Clinical characteristics, healthcare use, and annual costs among patients with dystrophic epidermolysis bullosa. Orphanet J Rare Dis 2022; 17:367. [PMID: 36175960 PMCID: PMC9524120 DOI: 10.1186/s13023-022-02509-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dystrophic epidermolysis bullosa (DEB) is a serious, ultra-rare, genetic blistering disease that requires a multidisciplinary care team and lifelong, proactive disease management. To organize and optimize care, we comprehensively examined diagnoses, healthcare use, and annual costs in patients with DEB across all healthcare settings. Methods A retrospective study was performed using electronic health record (EHR) data from Optum Clinical Database (January 1, 2016, through June 30, 2020). Patients with an epidermolysis bullosa (EB) diagnosis between July 1, 2016, and December 31, 2019, with ≥ 6 months of baseline and 12 months of follow-up activity were included. Patients were stratified by EB type: recessive DEB (RDEB), dominant DEB (DDEB), DEB (type unknown), and EB unspecified. Demographics, comorbid conditions, and healthcare resource utilization were identified from EHR data. Cost of bandages and total medical costs (US$) were identified from linked claims data. Results A total of 412 patients were included, classified as having DDEB (n = 17), RDEB (n = 85), DEB (type unknown; n = 45), and EB unspecified (n = 265). Mean age was 38.4 years, and 41.7% had commercial insurance coverage. The most common comorbidities were mental health disorders, malnutrition, and constipation. Rates of cutaneous squamous cell carcinoma ranged from 0% (DDEB) to 4.4% (RDEB). Prescriptions included antibiotics (56.6%), pain medications (48.3%), and itch medications (50.7%). On average, patients had 19.7 ambulatory visits during the 12-month follow-up, 22.8% had an emergency department visit, and 23.8% had an inpatient stay. Direct medical costs among patients with claims data (n = 92) ranged from $22,179 for EB unspecified to $48,419 for DEB (type unknown). Conclusions This study demonstrated the range of comorbidities, multiple healthcare visits and prescription medications, and treatment costs during 1 year of follow-up for patients with DEB. The results underscore that the clinical and economic burden of DEB is substantial and primarily driven by supportive and palliative strategies to manage sequelae of this disease, highlighting the unmet need for treatments that instead directly address the underlying pathology of this disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02509-0.
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Affiliation(s)
- James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Anna L Bruckner
- Department of Dermatology, University of Colorado School of Medicine, 13123 E 16th Ave, B570, Aurora, CO, 80045, USA
| | | | - Amy Anderson
- Optum, 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Juan Roman
- Krystal Biotech, 2100 Wharton Street, Suite 701, Pittsburgh, PA, 15203, USA.
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Understanding the socioeconomic costs of dystrophic epidermolysis bullosa in Europe: a costing and health-related quality of life study. Orphanet J Rare Dis 2022; 17:346. [PMID: 36068590 PMCID: PMC9450448 DOI: 10.1186/s13023-022-02419-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Dystrophic epidermolysis bullosa (EB) is a family of rare genetic dermatological conditions. Recent evidence indicated that in addition to its detrimental implications on patient health-related quality of life (HRQoL), there are substantial socioeconomic cost implications, especially regarding direct non-medical costs. This study aims to understand the burden of dystrophic EB (DEB) in Europe, using a primary EB patient-level dataset.
Methods A bottom-up, cross-sectional, study design was adopted for non-institutionalised patients diagnosed with EB who received outpatient care across EU5 countries: France, Germany, Italy, Spain, and the United Kingdom. A prevalence-based approach was used to estimate resource utilisation from a societal perspective, including direct (medical and non-medical) and indirect costs for patients and caregivers. Patient and caregiver outcomes were obtained using the EQ-5D questionnaire. Results A sample of 91 DEB patients was analysed. Overall, average EU5 annual cost per patient was estimated at €53,359, ranging from €18,783 (France) to €79,405 (Germany). Average EU5 annual direct medical costs were estimated at €8357 (15.7% of total), ranging from €5658 (France) to €12,576 (Germany); average direct non-medical costs were estimated at €41,353 (77.5% of total), ranging from €11,961 (France) to €57,000 (Germany); and average indirect costs were estimated at €3649 (6.8% of total), ranging from €1025 (Italy) to €9930 (United Kingdom). Costs varied across patients with different disability but also between children and adults. The mean EQ-5D index score for adult DEB patients ranged between 0.304 (United Kingdom) and 0.541 (Germany), with an EU5 average of 0.456, whereas the mean EQ-5D visual analogue scale score ranged between 47.5 (Germany) and 70.0 (France), with an EU5 average of 61.9. Limitations included potential patient selection bias, recall bias, and exclusion of bandaging and related costs. Conclusions The study revealed a substantial socioeconomic burden for DEB in Europe, attributable mostly to high direct non-medical costs, with the majority of patients requiring support from caregivers at home. Compared to the average economic burden of the overall EB patient population, costs for DEB patients are higher across all components of direct medical, direct non-medical and indirect costs. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02419-1.
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Ng YNC, Ng NYT, Fung JLF, Lui ACY, Cheung NYC, Wong WHS, Lee SL, Knapp M, Chung CCY, Chung BHY. Evaluating the Health-Related Quality of Life of the Rare Disease Population in Hong Kong Using EQ-5D 3-Level. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1624-1633. [PMID: 35568675 DOI: 10.1016/j.jval.2022.04.1725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to establish a normative profile of health-related quality of life (HRQOL) of the rare disease (RD) population in Hong Kong (HK) and identify potential predictors. METHODS Between March 2020 and October 2020, patients with RD and caregivers were recruited through Rare Disease Hong Kong, the largest RD patient group alliance in HK. HRQOL was derived using the EQ-5D 3-Level with reference to the established HK value set. Utility scores were stratified according to demographics and disease-related information. Multiple linear regression was performed to explore the associations between patient characteristics and HRQOL. RESULTS A total of 286 patients, covering 107 unique RDs, reported a mean utility score of 0.53 (SD 0.36). Thirty patients (10.5%) reported negative utility scores, indicating worse-than-death health states. More problems were recorded in the "usual activities" and "self-care" dimensions. Univariate analyses revealed that neurologic diseases, high out-of-pocket expenditure, home modification, and living in public housing or subdivided flats/units were significantly associated with lower HRQOL. A total of 99 caregivers reported a mean utility score of 0.78 (SD 0.17), which was significantly associated with the utility score of patients they took care of (r = 0.32; P = .001). CONCLUSIONS The normative profile of the RD population was established, which revealed lower HRQOL in the RD population than other chronic disease groups and general population in HK. Findings were corroborated by evidence from other cohorts using EQ-5D, combined as part of a meta-analysis. Identifying predictors highlight areas that should be prioritized to improve HRQOL of RD population through clinical and psychosocial dimensions.
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Affiliation(s)
- Yvette N C Ng
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Nicole Y T Ng
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jasmine L F Fung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Adrian C Y Lui
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Nicholas Y C Cheung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - So Lun Lee
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, England, UK
| | - Claudia C Y Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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20
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Delaye J, Cacciatore P, Kole A. Valuing the "Burden" and Impact of Rare Diseases: A Scoping Review. Front Pharmacol 2022; 13:914338. [PMID: 35754469 PMCID: PMC9213803 DOI: 10.3389/fphar.2022.914338] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Rare diseases (RDs) are a severe, chronic, degenerative and often life-threatening group of conditions affecting more than 30 million people in Europe. Their impact is often underreported and ranges from psychological and physical symptoms seriously compromising quality of life. There is then a need to consolidate knowledge on the economic, social, and quality of life impacts of rare diseases. Methods: This scoping review is the result of 9 qualitative interviews with experts and a literature search on Cost-of-Illness (COI) studies and quality of life (QoL) studies following the PRISMA methodology. Grey literature was also included to complement findings. Results. 63 COI studies were retrieved, covering 42 diseases and a vast majority of them using a prevalence-based approach (94%). All studies included medical costs, while 60% included non-medical costs, 68% productivity losses and 43% informal care costs. 56 studies on QoL were retrieved, mostly from Europe, with 30 different measurement tools. Grey literature included surveys from the pharmaceutical industry and patient organisations. Discussion: The majority of studies evaluating the impact of RDs on the individual and society use the COI approach, mostly from a societal perspective. Studies often vary in scope, making them difficult to consolidate or compare results. While medical costs and productivity losses are consistently included, QoL aspects are rarely considered in COI and are usually measured through generic tools. Conclusion: A comprehensive study on impact of rare disease across countries in Europe is lacking. Existing studies are heterogeneous in their scope and methodology and often lack a holistic picture of the impact of rare. Consensus on standards and methodology across countries and diseases is then needed. Studies that consider a holistic approach are often conducted by pharmaceutical companies and patient organisations exploring a specific disease area but are not necessarily visible in the literature and could benefit from the sharing of standards and best practices.
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Affiliation(s)
- Julien Delaye
- European Organisation for Rare Diseases (EURORDIS), Paris, France
| | | | - Anna Kole
- European Organisation for Rare Diseases (EURORDIS), Paris, France
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21
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Villar Hernández AR, Molero Alonso F, Aguado Marín ÁJ, Posada de la Paz M. Transcultural Validation of a Spanish Version of the Quality of Life in Epidermolysis Bullosa Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7059. [PMID: 35742308 PMCID: PMC9222315 DOI: 10.3390/ijerph19127059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Epidermolysis bullosa (EB) is a relatively infrequent genodermatosis for which there is still no cure, and which impacts the quality of life of those that are affected by it. The Quality of Life evaluation in Epidermolysis Bullosa (QoLEB) questionnaire was specifically developed for English-speaking persons with EB. OBJECTIVES To undertake the transcultural adaptation and analysis of the psychometric properties of a Spanish version of the QoLEB questionnaire. METHOD We designed an observational study to implement the process of translation and validation of the scale in accordance with World Health Organisation guidelines. We assessed the content validity of the Spanish version with the participation of 33 adult patients who presented with four principal subtypes of EB. The subjects were examined and evaluated using the QoLEB and Short Form-36 (SF-36) questionnaires. RESULTS The Spanish version of the QoLEB displayed excellent internal consistency and content validity, α = 0.91. Test-retest reliability was likewise excellent (ps = 0.93), as was the reliability among subtypes (range ps = 0.82-0.93). The functional part of the QoLEB correlated well with the SF-36 physical component summary (ps = 0.70). The emotional QoLEB was moderately correlated with the SF-36 mental component summary (ps = 0.49). Significant discriminant validity existed between the global score of the questionnaire (p = 0.033) and the functional scale (p = 0.003). CONCLUSIONS The Spanish version of the QoLEB questionnaire can be recommended for use in any subsequent studies seeking to assess the efficacy of possible treatments and care programmes in this group.
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Affiliation(s)
- Alvaro Rafael Villar Hernández
- Dystrophic Epidermolysis Bullosa Research Association ONG DEBRA España Piel de Mariposa, 29601 Marbella, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | - Fernando Molero Alonso
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), 28040 Madrid, Spain;
| | | | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain;
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22
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Spencer-Tansley R, Meade N, Ali F, Simpson A, Hunter A. Mental health care for rare disease in the UK - recommendations from a quantitative survey and multi-stakeholder workshop. BMC Health Serv Res 2022; 22:648. [PMID: 35568910 PMCID: PMC9107210 DOI: 10.1186/s12913-022-08060-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rare disease patients and carers report significant impacts on mental health but studies on UK populations have focussed on relatively few, specific conditions. Collectively rare conditions represent a substantial health burden, with an estimated 3.5 million affected individuals in the UK. Method We explored the impact on mental health of living with a rare condition, and experiences of health service support, through an online survey. The survey assessed the impact of specific experiences commonly reported by those affected by a rare condition through multiple choice questions and Likert scale items, and open text question boxes. Through a multi-stakeholder workshop that involved facilitated discussion of our findings with patients/carers, clinicians and a government advisor, we developed recommendations for policy and practice toward a more person-centred and integrated approach. Results Eligible responses came from 1231 patients and 564 carers. Due to their rare condition, the majority of respondents (> 90%) had felt worried/anxious; stressed; and /or low/depressed. Thirty-six percent of patients and 19% of carers had had suicidal thoughts. Challenges that are particular to rare conditions and which negatively affect mental health included limited knowledge of the condition amongst healthcare professionals (88%), and not being believed or taken seriously by them. Only 23% of respondents felt healthcare professionals considered mental and physical health as equally important. Almost half reported never having been asked about mental health by healthcare professionals. Our findings indicate that access to, and appropriateness of, professional psychological support needs to be improved. Peer group support is important but signposting is inadequate. Our recommendations are for healthcare professionals to be supported to effectively and sensitively recognise and address patients’ and carers’ mental health needs; and for service level coordination of care to integrate professional psychological support with rare disease services. Conclusion Living with a rare disease substantially impacts mental health. Many of the drivers of poor mental health reflect issues specific to managing rare conditions. To meet UK government commitments, there should be a focus on empowering healthcare professionals who treat rare disease patients and on integration of mental health support with rare disease services.
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Affiliation(s)
| | - Nick Meade
- Genetic Alliance UK, Creative Works, Blackhorse Lane, London, E17 6DS, UK
| | - Farhana Ali
- Genetic Alliance UK, Creative Works, Blackhorse Lane, London, E17 6DS, UK
| | - Amy Simpson
- Genetic Alliance UK, Creative Works, Blackhorse Lane, London, E17 6DS, UK
| | - Amy Hunter
- Genetic Alliance UK, Creative Works, Blackhorse Lane, London, E17 6DS, UK.
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23
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Morren MA, Legius E, Giuliano F, Hadj-Rabia S, Hohl D, Bodemer C. Challenges in Treating Genodermatoses: New Therapies at the Horizon. Front Pharmacol 2022; 12:746664. [PMID: 35069188 PMCID: PMC8766835 DOI: 10.3389/fphar.2021.746664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 01/28/2023] Open
Abstract
Genodermatoses are rare inherited skin diseases that frequently affect other organs. They often have marked effects on wellbeing and may cause early death. Progress in molecular genetics and translational research has unravelled many underlying pathological mechanisms, and in several disorders with high unmet need, has opened the way for the introduction of innovative treatments. One approach is to intervene where cell-signaling pathways are dysregulated, in the case of overactive pathways by the use of selective inhibitors, or when the activity of an essential factor is decreased by augmenting a molecular component to correct disequilibrium in the pathway. Where inflammatory reactions have been induced by a genetically altered protein, another possible approach is to suppress the inflammation directly. Depending on the nature of the genodermatosis, the implicated protein or even on the particular mutation, to correct the consequences or the genetic defect, may require a highly personalised stratagem. Repurposed drugs, can be used to bring about a "read through" strategy especially where the genetic defect induces premature termination codons. Sometimes the defective protein can be replaced by a normal functioning one. Cell therapies with allogeneic normal keratinocytes or fibroblasts may restore the integrity of diseased skin and allogeneic bone marrow or mesenchymal cells may additionally rescue other affected organs. Genetic engineering is expanding rapidly. The insertion of a normal functioning gene into cells of the recipient is since long explored. More recently, genome editing, allows reframing, insertion or deletion of exons or disruption of aberrantly functioning genes. There are now several examples where these stratagems are being explored in the (pre)clinical phase of therapeutic trial programmes. Another stratagem, designed to reduce the severity of a given disease involves the use of RNAi to attenuate expression of a harmful protein by decreasing abundance of the cognate transcript. Most of these strategies are short-lasting and will thus require intermittent life-long administration. In contrast, insertion of healthy copies of the relevant gene or editing the disease locus in the genome to correct harmful mutations in stem cells is more likely to induce a permanent cure. Here we discuss the potential advantages and drawbacks of applying these technologies in patients with these genetic conditions. Given the severity of many genodermatoses, prevention of transmission to future generations remains an important goal including offering reproductive choices, such as preimplantation genetic testing, which can allow selection of an unaffected embryo for transfer to the uterus.
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Affiliation(s)
- Marie-Anne Morren
- Pediatric Dermatology Unit, Departments of Dermatology and Venereology and Pediatrics, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Eric Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, ERN Genturis and ERN Skin, Leuven, Belgium
| | - Fabienne Giuliano
- Department of Medical Genetics, University Hospital Lausanne, Lausanne, Switzerland
| | - Smail Hadj-Rabia
- Department of Pediatric Dermatology and Dermatology, National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Hôpital Necker-Enfants Malades, and Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, ERN Skin, Paris, France
| | - Daniel Hohl
- Department of Dermatology and Venereology, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Christine Bodemer
- Department of Pediatric Dermatology and Dermatology, National Reference Centre for Genodermatosis and Rare Diseases of the Skin (MAGEC), Hôpital Necker-Enfants Malades, and Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, ERN Skin, Paris, France
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24
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Padniewski JJ, Shaver RL, Schultz B, Pearson DR. Patient Quality of Life Improvement in Bullous Disease: A Review of Primary Literature and Considerations for the Clinician. Clin Cosmet Investig Dermatol 2022; 15:27-42. [PMID: 35046687 PMCID: PMC8759990 DOI: 10.2147/ccid.s324331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/24/2021] [Indexed: 12/14/2022]
Abstract
Autoimmune and inherited bullous disorders are rare skin diseases that may have a profound negative impact on quality of life (QOL). Common symptoms include pain, pruritus, and scarring, and complications may result in the loss of the ability to perform daily tasks. Diagnosis may have a negative psychological impact, and ongoing management may require a significant allocation of time and resources by both patients and providers. To provide patient-centered care, consideration of these factors is of utmost importance for the dermatologist treating patients with bullous disorders. Herein, we present a review of the primary literature evaluating QOL in autoimmune and inherited bullous disorders, including pemphigus, pemphigoid, epidermolysis bullosa, and Hailey-Hailey disease.
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Affiliation(s)
| | - Rob L Shaver
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Brittney Schultz
- University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - David R Pearson
- University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
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25
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Chogani F, Parvizi MM, Murrell DF, Handjani F. Assessing the quality of life in the families of patients with epidermolysis bullosa: The mothers as main caregivers. Int J Womens Dermatol 2022; 7:721-726. [PMID: 35028371 PMCID: PMC8714583 DOI: 10.1016/j.ijwd.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/21/2021] [Accepted: 08/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background Epidermolysis bullosa (EB) is an uncommon group of inherited disorders characterized by skin blistering after friction or mechanical trauma. EB affects patients and their families physically, socially, and emotionally. Objective This study aimed to assess the family quality of life of these patients using the Family Dermatology Life Quality Index (FDLQI) questionnaire. Methods In this cross-sectional study, we enrolled caregivers of patients with EB registered at the Molecular Dermatology Research Center, affiliated with Shiraz University of Medical Sciences, up to 2020. Participants filled out a demographic data collection form and the FDLQI questionnaire. The data were analyzed using SPSS software, version 22. Results Overall, 80 participants, consisting of 65 mothers (81.2%) and 15 fathers (18.7%) as primary caregivers, were enrolled in this study. The average FDLQI score was 19.88 ± 4.71. The FDLQI scores of caregivers of patients with EB simplex was significantly lower than scores observed in those with other types of EB (p < .001). There was a significant positive association between the number of patients with EB in the family and FDLQI score (p = .049). FDLQI scores were lower in caregiving mothers who had a higher education (p < .001) and those who were employed (p < .001). Conclusion Family quality of life is affected in patients with EB. Families with lower socioeconomic status and unemployed caregivers require special attention. More studies are needed to determine the parameters involved in the quality of life of patients with EB and their families.
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Affiliation(s)
- Fatemeh Chogani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author.
| | - Dedee F. Murrell
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Petrof G, Papanikolaou M, Martinez AE, Mellerio JE, McGrath JA, Bardhan A, Harper N, Heagerty A, Ogboli M, Chiswell C, Moss C. The epidemiology of epidermolysis bullosa in England and Wales: data from the national epidermolysis bullosa database. Br J Dermatol 2021; 186:843-848. [PMID: 34927719 DOI: 10.1111/bjd.20958] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The NHS Epidermolysis Bullosa (EB) service set up in 2002 offers comprehensive, free care to all patients in England and Wales. OBJECTIVE To quantify prevalence, incidence and mortality of EB in England and Wales. METHODS Demographic data for patients in England and Wales was collected on a secure electronic database, prospectively from January 2002 to April 2021 and retrospectively before that. Vital status was verified using central NHS data. RESULTS By March 2021, 2594 individuals were registered, of whom 2361 were living, giving prevalence per million of the population for all EB types of 34.8; EB simplex (EBS) 17, dystrophic EB (DEB) 10.7, junctional EB (JEB) 1 and Kindler EB 0.3. We recorded 1200 babies with EB born since 2002, average incidence per million live births, for EBS, DEB, JEB and Kindler EB being 32.5, 26.1, 8.9, 0.9 respectively, total 67.8 for all types of EB. Birth rates fell progressively over the 19-year period for JEB-severe (JEB-S) (r = - 0.56) and recessive DEB-severe (RDEB-S) (r = -0.44) and also for milder types of EB. We observed longer survival in JEB-S over the 19 years (r2 = 0.18) with a median of 12.7 months over the past 5 years. CONCLUSIONS We provide the first accurate epidemiological data for EB in England and Wales. We believe the observed reduction in birth incidence of severe types of EB reflects uptake of genetic counselling advice while that of milder types may be due to delayed presentation. A potential small trend towards longer survival of babies with JEB-S may reflect improved multidisciplinary care.
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Affiliation(s)
- Gabriela Petrof
- Dermatology Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Anna E Martinez
- Dermatology Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jemima E Mellerio
- St John's Institute of Dermatology, King's College London, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John A McGrath
- St John's Institute of Dermatology, King's College London, London, UK.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ajoy Bardhan
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Solihull, UK.,University of Birmingham, Birmingham, UK
| | - Natasha Harper
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Solihull, UK
| | - Adrian Heagerty
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Solihull, UK.,University of Birmingham, Birmingham, UK
| | - Malobi Ogboli
- Dermatology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Christopher Chiswell
- Department of Public Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Celia Moss
- University of Birmingham, Birmingham, UK.,Dermatology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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27
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Identifying Epidermolysis Bullosa Patient Needs and Perceived Treatment Benefits: An Explorative Study Using the Patient Benefit Index. J Clin Med 2021; 10:jcm10245836. [PMID: 34945131 PMCID: PMC8709493 DOI: 10.3390/jcm10245836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Abstract
Epidermolysis bullosa (EB) is a genetic blistering skin condition for which no cure exists. Symptom alleviation and quality of life are therefore central to EB care. This study aimed to gain insight into EB patient needs and benefits from current clinical care. Two questionnaires were administered cross-sectionally to adult EB patients at the Dutch expertise centre for blistering diseases. Patient needs and benefits were analyzed using the patient benefit index survey (PBI-S). Ancillary data were compiled pertaining to self-reported EB severity, pain and pruritus, as well as current and previous treatments. In total, 104 participants were included (response rate 69.8%). Sixty-eight participants comprised the analyzed cohort (n = 36 omitted from analysis). The needs given the highest importance were to get better skin quickly (64.7%) and to be healed of all skin alterations (61.8%). A positive correlation between pain and EB severity and the importance of most needs was observed. Minimal clinically important differences within the PBI-S, relating to reported benefits from clinical care, were reported by 60.3% of the cohort. This study highlights a discrepancy between patient needs and feasible treatment outcomes. Utilizing the PBI-S in conjunction with well-established multidisciplinary care may catalyze the process of tailoring treatments to the needs of individual patients.
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28
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Schräder NHB, Gorell ES, Stewart RE, Duipmans JC, Harris N, Perez VA, Tang JY, Wolff AP, Bolling MC. Cannabinoid use and effects in patients with epidermolysis bullosa: an international cross-sectional survey study. Orphanet J Rare Dis 2021; 16:377. [PMID: 34488820 PMCID: PMC8419930 DOI: 10.1186/s13023-021-02010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been characterized in the EB patient population. OBJECTIVES To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications. METHODS English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects. RESULTS Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0-10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%). CONCLUSIONS CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs.
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Affiliation(s)
- Nicholas H. B. Schräder
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Emily S. Gorell
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH USA
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | - Roy E. Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - José C. Duipmans
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Nicole Harris
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | | | - Jean Y. Tang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA USA
| | - André P. Wolff
- Anaesthesiology Pain Centre, Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke C. Bolling
- Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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29
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García-Pérez L, Linertová R, Valcárcel-Nazco C, Posada M, Gorostiza I, Serrano-Aguilar P. Cost-of-illness studies in rare diseases: a scoping review. Orphanet J Rare Dis 2021; 16:178. [PMID: 33849613 PMCID: PMC8045199 DOI: 10.1186/s13023-021-01815-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 04/06/2021] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases.
Methods We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis.
Results We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively. Conclusion This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01815-3.
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Affiliation(s)
- Lidia García-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain. .,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain. .,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. .,Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Campus de Guajara, Camino de la Hornera, s/n, 38071, La Laguna, Santa Cruz de Tenerife, Spain. .,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain.
| | - Renata Linertová
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Cristina Valcárcel-Nazco
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Manuel Posada
- Institute of Rare Diseases Research, Institute of Health Carlos III, Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER of Rare Diseases (CIBERER), Madrid, Spain
| | - Inigo Gorostiza
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Osakidetza Basque Health Service, Basurto University Hospital, Avenida de Montevideo Nº 18, 48013, Bilbao, Spain
| | - Pedro Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.,Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
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García-Pérez L, Linertová R, Valcárcel-Nazco C, Posada M, Gorostiza I, Serrano-Aguilar P. Cost-of-illness studies in rare diseases: a scoping review. Orphanet J Rare Dis 2021. [PMID: 33849613 DOI: 10.1186/s13023-021-01815-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE The aim of this scoping review was to overview the cost-of-illness studies conducted in rare diseases. METHODS We searched papers published in English in PubMed from January 2007 to December 2018. We selected cost-of-illness studies on rare diseases defined as those with prevalence lower than 5 per 10,000 cases. Studies were selected by one researcher and verified by a second researcher. Methodological characteristics were extracted to develop a narrative synthesis. RESULTS We included 63 cost-of-illness studies on 42 rare diseases conducted in 25 countries, and 9 systematic reviews. Most studies (94%) adopted a prevalence-based estimation, where the predominant design was cross-sectional with a bottom-up approach. Only four studies adopted an incidence-based estimation. Most studies used questionnaires to patients or caregivers to collect resource utilisation data (67%) although an important number of studies used databases or registries as a source of data (48%). Costs of lost productivity, non-medical costs and informal care costs were included in 68%, 60% and 43% of studies, respectively. CONCLUSION This review found a paucity of cost-of-illness studies in rare diseases. However, the analysis shows that the cost-of-illness studies of rare diseases are feasible, although the main issue is the lack of primary and/or aggregated data that often prevents a reliable estimation of the economic burden.
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Affiliation(s)
- Lidia García-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
- Instituto Universitario de Desarrollo Regional (IUDR), Universidad de La Laguna, Campus de Guajara, Camino de la Hornera, s/n, 38071, La Laguna, Santa Cruz de Tenerife, Spain.
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain.
| | - Renata Linertová
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Cristina Valcárcel-Nazco
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
| | - Manuel Posada
- Institute of Rare Diseases Research, Institute of Health Carlos III, Monforte de Lemos, 5, 28029, Madrid, Spain
- CIBER of Rare Diseases (CIBERER), Madrid, Spain
| | - Inigo Gorostiza
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Osakidetza Basque Health Service, Basurto University Hospital, Avenida de Montevideo Nº 18, 48013, Bilbao, Spain
| | - Pedro Serrano-Aguilar
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, 38109, Canary Islands, El Rosario, Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain
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Kocher T, Koller U. Advances in gene editing strategies for epidermolysis bullosa. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2021; 182:81-109. [PMID: 34175052 DOI: 10.1016/bs.pmbts.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Epidermolysis bullosa represents a monogenetic disease comprising a variety of heterogeneous mutations in at least 16 genes encoding structural proteins crucial for skin integrity. Due to well-defined mutations but still lacking causal treatment options for the disease, epidermolysis bullosa represents an ideal candidate for gene therapeutic interventions. Recent developments and improvements in the genome editing field have paved the way for the translation of various gene repair strategies into the clinic. With the ability to accurately predict and monitor targeting events within the human genome, the translation might soon be possible. Here, we describe current advancements in the genome editing field for epidermolysis bullosa, along with a discussion of aspects and strategies for precise and personalized gene editing-based medicine, in order to develop efficient and safe ex vivo as well as in vivo genome editing therapies for epidermolysis bullosa patients in the future.
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Affiliation(s)
- Thomas Kocher
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrich Koller
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.
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Titeux M, Bonnet des Claustres M, Izmiryan A, Ragot H, Hovnanian A. Emerging drugs for the treatment of epidermolysis bullosa. Expert Opin Emerg Drugs 2020; 25:467-489. [DOI: 10.1080/14728214.2020.1839049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Matthias Titeux
- Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Université de Paris, Paris, France
| | | | - Araksya Izmiryan
- Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Université de Paris, Paris, France
| | - Helene Ragot
- Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Université de Paris, Paris, France
| | - Alain Hovnanian
- Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Université de Paris, Paris, France
- Départment de Génétique, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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DE Stefano S, Grassi FS, Lalatta F, Scuvera G, Brena M, Grillo P, Peves Rios WE, Guez S. Family burden of children suffering from epidermolysis bullosa. Ital J Dermatol Venerol 2020; 156:580-587. [PMID: 33034432 DOI: 10.23736/s2784-8671.20.06613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Living with a rare disease has profound effects on the patient's life and that of their entire family, with practical and psychosocial consequences. This is particularly true when the patient is a child. The principal aim of this study was to measure the family burden in Epidermolysis Bullosa (EB). The secondary endpoint was to evaluate the possible correlation between family burden and the severity of EB. METHODS A sample of 50 families with one or two children affected by EB were recruited between January 2016 and February 2017 to answer a 20-item questionnaire - the EB Burden of Disease (EB-BoD) - developed and validated to assess the family burden of children with EB. RESULTS The presence of a child with EB may have profound negative implications on several different areas of daily life. In particular, the results demonstrate important differences between the different subtypes of epidermolysis bullosa regarding most of the categories considered by the questionnaire. For three categories out of four (family life, child's life, economic and social impact), a higher score is observed for children with the more debilitating forms of EB: recessive dystrophic EB (RDEB) and junctional EB (JEB). CONCLUSIONS It is important to work with patients and their families to identify and strengthen adaptive and coping behaviors. That is possible only through the synergistic working of a multidisciplinary team made up of experienced doctors, psychologists, and social workers while in contact with patient Associations.
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Affiliation(s)
- Santa DE Stefano
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | | | - Faustina Lalatta
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulietta Scuvera
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Brena
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Grillo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Sophie Guez
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Inês M, Coelho T, Conceição I, Landeiro F, de Carvalho M, Costa J. Societal costs and burden of hereditary transthyretin amyloidosis polyneuropathy. Amyloid 2020; 27:89-96. [PMID: 31854198 DOI: 10.1080/13506129.2019.1701429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Hereditary transthyretin amyloidosis polyneuropathy (ATTRv-PN) is a rare life-threatening disease that imposes considerable mortality and morbidity associated with increased costs, high social support and productivity losses. This study aims to estimate the societal costs and burden of ATTRv-PN.Methods: A cost-of-illness (COI) and burden of disease model were specified from a societal perspective, using a prevalence-based approach. Direct and indirect costs were included. Healthcare resource use was retrieved from public databases, previous Portuguese studies and the literature. The burden of disease was expressed in terms of disability-adjusted life years (DALYs), as defined by the World Health Organisation.Results: In 2016, the total annual COI of ATTRv-PN in Portugal was 52,502,796€ and the mean cost per patient was 28,152€ (79% direct; 21% indirect costs). Treatments accounted for 52% of total costs, while 0.18% were devoted to disease prevention. A total of 2056 DALYs were lost, 26% due to disability and 74% due to death.Conclusions: Annual costs and burden of ATTRv-PN were considerable but within the range of other rare diseases. Policies and public interventions to prevent and reduce the burden of disease should be prioritised, since patients experience excess morbidity, mortality and total costs will likely increase in the future.
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Affiliation(s)
- Mónica Inês
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Coelho
- Andrade's Center for Familial Amyloidosis, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Department of Neurosciences, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Isabel Conceição
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Filipa Landeiro
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Mamede de Carvalho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - João Costa
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Kwong A, Cogan J, Hou Y, Antaya R, Hao M, Kim G, Lincoln V, Chen Q, Woodley DT, Chen M. Gentamicin Induces Laminin 332 and Improves Wound Healing in Junctional Epidermolysis Bullosa Patients with Nonsense Mutations. Mol Ther 2020; 28:1327-1338. [PMID: 32222156 PMCID: PMC7210719 DOI: 10.1016/j.ymthe.2020.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023] Open
Abstract
Generalized severe junctional epidermolysis bullosa (GS-JEB) is an incurable and fatal autosomal recessively inherited blistering skin disease caused by mutations in the LAMA3, LAMB3, or LAMC2 genes. Most of these mutations are nonsense mutations that create premature termination codons that lead to impaired production of functional laminin 332, a protein needed for epidermal-dermal adherence. Gentamicin induces readthrough of nonsense mutations and restores the full-length protein in various genetic diseases. Using primary keratinocytes from three GS-JEB patients, we showed that gentamicin induced functional laminin 332 that reversed a JEB-associated, abnormal cell phenotype. In a subsequent open-label trial involving the same patients, we examined whether 0.5% gentamicin ointment applied topically to open skin wounds could promote nonsense mutation readthrough and create new laminin 332 in the patients' skin. Gentamicin-treated wounds exhibited increased expression of laminin 332 at the dermal-epidermal junction for at least 3 months and were associated with improved wound closure. There were no untoward side effects from topical gentamicin. The newly induced laminin 332 did not generate anti-laminin 332 autoantibodies in either the patients' blood or skin. Gentamicin readthrough therapy may be a treatment for GS-JEB patients with nonsense mutations.
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Affiliation(s)
- Andrew Kwong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jon Cogan
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Yingping Hou
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Richard Antaya
- Departments of Dermatology and Pediatrics, Yale School of Medicine, New Haven, CT 06519, USA
| | - Michelle Hao
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Gene Kim
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Vadim Lincoln
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Qiuyang Chen
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - David T Woodley
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Mei Chen
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Flannery D, Doyle C, Hickey S, Aherne F, Kennan A. Direct Costs of Epidermolysis Bullosa by Disease Severity. Acta Derm Venereol 2020; 100:adv00116. [PMID: 32176311 PMCID: PMC9128898 DOI: 10.2340/00015555-3456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Darragh Flannery
- Department of Economics, Kemmy Business School, University of Limerick, V94 T9PX Limerick, Ireland.
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Czech M, Baran-Kooiker A, Atikeler K, Demirtshyan M, Gaitova K, Holownia-Voloskova M, Turcu-Stiolica A, Kooiker C, Piniazhko O, Konstandyan N, Zalis'ka O, Sykut-Cegielska J. A Review of Rare Disease Policies and Orphan Drug Reimbursement Systems in 12 Eurasian Countries. Front Public Health 2020; 7:416. [PMID: 32117845 PMCID: PMC6997877 DOI: 10.3389/fpubh.2019.00416] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Despite international initiatives on collaboration within the field of rare diseases, patient access to orphan medicinal products (OMPs) and healthcare services differ greatly between countries. This study aimed to create a comprehensive and in-depth overview of rare diseases policies and reimbursement of OMPs in a selection of 12 countries in the Western Eurasian region: Armenia, France, Germany, Kazakhstan, Latvia, The Netherlands, Poland, Romania, Russia, Turkey, Ukraine, and the United Kingdom. Methods: A systematic literature review was performed and an analysis of publicly available legislative and rare disease health policy data was undertaken in five focus areas: rare disease definition, newborn screening, registries, national plans, access to/reimbursement of OMPs. Results: Screening programs are broadly implemented but the number of screened diseases differs significantly (2-35 diseases), either between EU and non-EU countries, between EU member states and sometimes even within a single country. In most countries rare disease registries are operating with regional, national, European or worldwide coverage. The number of rare disease registries is growing, as a result of the National Plans (EU) and increased international scientific cooperation. France, Russia, and Poland have a centrally acting registry. National plans are present in all EU countries but implementation varies and is ongoing. The number of reimbursed OMPs in the selected countries ranges from nearly all available OMPs in the Netherlands, Germany, and France to zero in Armenia. Reimbursement rules differ considerably regionally and a trend is observed of reimbursement conditions getting stricter for expensive (orphan) drugs. Discussion: Inequality in patient access to new OMPs still exists due to variations in national policies, healthcare budgets, health insurance, and reimbursement systems. The observed differences are challenging for rare disease patients, health authorities and manufacturers alike. Progress can be seen, however, and international cooperation and harmonization is slowly but steadily expanding in the rare disease arena.
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Affiliation(s)
- Marcin Czech
- Department of Pharmacoeconomics, The Institute of Mother and Child, Warsaw, Poland
| | - Aleksandra Baran-Kooiker
- Department of Pharmacoeconomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Kagan Atikeler
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
- Unit of Health Technology Assessments, Turkish Ministry of Health, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Maria Demirtshyan
- Ascent Global Market Solutions (Non-profit), Walnut Creek, CA, United States
| | - Kamilla Gaitova
- Center for Economics and Health Technology Assessment, Republican Center for Health Development, Ministry of Health, Nur-Sultan, Kazakhstan
| | - Malwina Holownia-Voloskova
- State Budgetary Institution Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department, Moscow, Russia
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | | | - Oresta Piniazhko
- Department of Management and Economy of Pharmacy, Medicine Technology and Pharmacoeconomics, Postgraduate Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Natella Konstandyan
- Republican Center of Medical Genetics, Yerevan State Medical University, Yerevan, Armenia
| | - Olha Zalis'ka
- Department of Management and Economy of Pharmacy, Medicine Technology and Pharmacoeconomics, Postgraduate Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, The Institute of Mother and Child, Warsaw, Poland
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Bruckner AL, Losow M, Wisk J, Patel N, Reha A, Lagast H, Gault J, Gershkowitz J, Kopelan B, Hund M, Murrell DF. The challenges of living with and managing epidermolysis bullosa: insights from patients and caregivers. Orphanet J Rare Dis 2020; 15:1. [PMID: 31900176 PMCID: PMC6942340 DOI: 10.1186/s13023-019-1279-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Little information is available regarding the burden of living with and managing epidermolysis bullosa, including the distinct challenges faced by patients with different disease types/subtypes. METHODS A 90-question/item survey was developed to collect demographics, diagnostic data, management practices, and burden of illness information for patients with epidermolysis bullosa living in the United States. Recruitment was conducted via email and social media in partnership with epidermolysis bullosa patient advocacy organizations in the United States, and the survey was conducted via telephone interview by a third-party health research firm. Respondents aged ≥ 18 years with a confirmed diagnosis of epidermolysis bullosa or caring for a patient with a confirmed diagnosis of epidermolysis bullosa were eligible to participate in the survey. RESULTS In total, 156 responses were received from patients (n = 63) and caregivers (n = 93) representing the epidermolysis bullosa types of simplex, junctional, and dystrophic (subtypes: dominant and recessive). A large proportion of patients (21%) and caregivers (32%) reported that the condition was severe or very severe, and 19% of patients and 26% of caregivers reported a visit to an emergency department in the 12 months prior to the survey. Among the types/subtypes represented, recessive dystrophic epidermolysis bullosa results in the greatest wound burden, with approximately 60% of patients and caregivers reporting wounds covering > 30% of total body area. Wound care is time consuming and commonly requires significant caregiver assistance. Therapeutic options are urgently needed and reducing the number and severity of wounds was generally ranked as the most important treatment factor. CONCLUSIONS Survey responses demonstrate that epidermolysis bullosa places a considerable burden on patients, their caregivers, and their families. The limitations caused by epidermolysis bullosa mean that both patients and caregivers must make difficult choices and compromises regarding education, career, and home life. Finally, survey results indicate that epidermolysis bullosa negatively impacts quality of life and causes financial burden to patients and their families.
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Affiliation(s)
- Anna L Bruckner
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, B570, Aurora, CO, 80045, USA.
| | - Michael Losow
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jayson Wisk
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Nita Patel
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Allen Reha
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Hjalmar Lagast
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jamie Gault
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jayne Gershkowitz
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Brett Kopelan
- Debra of America, 75 Broad St #300, New York, NY, 10004, USA
| | - Michael Hund
- EB Research Partnership, 132 East 43rd St, Suite 432, New York, NY, 10017, USA
| | - Dedee F Murrell
- St. George-Hospital, University of Sydney, NSW, 2052, Australia
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Brodszky V, Beretzky Z, Baji P, Rencz F, Péntek M, Rotar A, Tachkov K, Mayer S, Simon J, Niewada M, Hren R, Gulácsi L. Cost-of-illness studies in nine Central and Eastern European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:155-172. [PMID: 31104219 PMCID: PMC6544593 DOI: 10.1007/s10198-019-01066-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/15/2019] [Indexed: 05/02/2023]
Abstract
BACKGROUND To date, a multi-country review evaluating the cost-of-illness (COI) studies from the Central and Eastern European (CEE) region has not yet been published. Our main objective was to provide a general description about published COI studies from CEE. METHODS A systematic search was performed between 1 January 2006 and 1 June 2017 in Medline, EMBASE, The Cochrane Library, CINAHL, and Web of Science to identify all relevant COI studies from nine CEE countries. COI studies reporting costs without any restrictions by age, co-morbidities, or treatment were included. Methodology, publication standards, and cost results were analysed. RESULTS We identified 58 studies providing 83 country-specific COI results: Austria (n = 9), Bulgaria (n = 16), Croatia (n = 3), the Czech Republic (n = 10), Hungary (n = 24), Poland (n = 11), Romania (n = 3), Slovakia (n = 3), and Slovenia (n = 4). Endocrine, nutritional, and metabolic diseases (18%), neoplasms (12%), infections (11%), and neurological disorders (11%) were the most frequently studied clinical areas, and multiple sclerosis was the most commonly studied disease. Overall, 57 (98%) of the studies explicitly stated the source of resource use data, 45 (78%) the study perspective, 34 (64%) the costing method, and 24 (58%) reported at least one unit costs. Regardless of methodological differences, a positive relationship was observed between costs of diseases and countries' per capita GDP. CONCLUSIONS Cost-of-illness studies varied considerably in terms of methodology, publication practice, and clinical areas. Due to these heterogeneities, transferability of the COI results is limited across Central and Eastern European countries.
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Affiliation(s)
- Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary.
| | - Zsuzsanna Beretzky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
- Doctoral School of Business and Management, 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
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
- Hungarian Academy of Sciences, Premium Postdoctoral Research Program, Nádor u. 7, 1051, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Alexandru Rotar
- Department of Social Medicine, University of Amsterdam, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - Konstantin Tachkov
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, 2, Dunav str., 1000, Sofia, Bulgaria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, Vienna, 1090, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland
| | - Rok Hren
- Institute of Mathematics, Physics, and Mechanics, Jadranska 19, 1000, Ljubljana, Slovenia
- Department of Physics, University of Ljubljana, Jadranska 19, 1000, Ljubljana, Slovenia
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
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Baran-Kooiker A, Czech M, Kooiker C. Multi-Criteria Decision Analysis (MCDA) Models in Health Technology Assessment of Orphan Drugs-a Systematic Literature Review. Next Steps in Methodology Development? Front Public Health 2018; 6:287. [PMID: 30374435 PMCID: PMC6197072 DOI: 10.3389/fpubh.2018.00287] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Multi-criteria decision analysis (MCDA) is a decision-making tool that can take into account multidimensional factors and enables comparison of (medical) technologies by combining individual criteria into one overall appraisal. The MCDA approach has slowly gained traction within Health Technology Assessment (HTA) and its elements are gradually being incorporated into HTA across Europe. Several groups of scientists have proposed MCDA approaches targeted toward orphan drugs and rare diseases by including criteria specific to rare diseases. The goal of this article is to provide an overview of the current state of knowledge and latest developments in the field of MCDA in HTA for orphan drugs, to review existing models, their design characteristics, as well as to identify opportunities for further model improvement. Methods: A systematic literature search was conducted in January 2018 using four databases: MEDLINE (Pubmed), EBSCO HOST, EMBASE, and Web of science to find publications related to use of MCDA in the rare disease field (keywords: MCDA/orphan drug/rare disease and synonyms). Identified MCDA models were analyzed, e.g., structure, criteria, scoring, and weighting methodology. Results: Two hundred and eleven publications were identified, of which 29 were included after removal of duplicates. 9 authors developed own MCDA models, 7 of which based on literature reviews intended to identify the most important and relevant decision criteria in the model. In 13 publications (8 models) weights were assigned to criteria based on stakeholder input. The most commonly chosen criteria for creation of the MCDA models were: comparative effectiveness/efficacy, the need for intervention, and disease severity. Some models have overlapping criteria, especially in the treatment cost and effectiveness areas. Conclusions: A range of MCDA models for HTA have been developed, each with a slightly different approach, focus, and complexity, including several that specifically target rare diseases and orphan drug appraisal. Models have slowly progressed over the years based on pilots, stakeholder input, sharing experiences and scientific publications. However, full consensus on model structure, criteria selection and weighting is still lacking. A simplification of the MCDA model approach may increase its acceptance. A multi-stakeholder discussion on fundamental design and implementation strategies for MCDA models would be beneficial to this end.
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Affiliation(s)
- Aleksandra Baran-Kooiker
- Department of Pharmacoeconomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, The Institute of Mother and Child, Warsaw, Poland
- Warsaw University of Technology Business School, Warsaw, Poland
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Dufresne H, Hadj-Rabia S, Bodemer C. Impact of a rare chronic genodermatosis on family daily life: the example of epidermolysis bullosa. Br J Dermatol 2018; 179:1177-1178. [PMID: 29710387 DOI: 10.1111/bjd.16710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- H Dufresne
- Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC) and Department of Dermatology, Paris, France.,Department of Paediatric Social Work, Paris, France
| | - S Hadj-Rabia
- Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC) and Department of Dermatology, Paris, France.,INSERM U1163 and Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Descartes - Sorbonne Paris Cité, 149 rue de Sèvres, 75015, Paris, France
| | - C Bodemer
- Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC) and Department of Dermatology, Paris, France.,INSERM U1163 and Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Descartes - Sorbonne Paris Cité, 149 rue de Sèvres, 75015, Paris, France
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De Rosa L, Koller U, Bauer JW, De Luca M, Reichelt J. Advances on potential therapeutic options for epidermolysis bullosa. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1463216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Laura De Rosa
- Center for Regenerative Medicine “Stefano Ferrari”, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ulrich Koller
- EB House Austria, University Hospital of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - Johann W. Bauer
- EB House Austria, University Hospital of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - Michele De Luca
- Center for Regenerative Medicine “Stefano Ferrari”, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Julia Reichelt
- EB House Austria, University Hospital of Dermatology, Paracelsus Medical University, Salzburg, Austria
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Tabor A, Pergolizzi JV, Marti G, Harmon J, Cohen B, Lequang JA. Raising Awareness Among Healthcare Providers about Epidermolysis Bullosa and Advancing Toward a Cure. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2017; 10:36-48. [PMID: 28670357 PMCID: PMC5479476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: Epidermolysis bullosa (EB) is an orphan disease that affects about half a million people worldwide, but may not be familiar to all clinicians. The authors' goal was to present a short description of this condition and current research in the form of a narrative review. Methods: The authors reviewed the literature on epidermolysis bullosa in order to describe the condition and current genetic research. Results: There are at least 31 subtypes of EB, including junctional EB, dystrophic EB, and Kindler syndrome. Genetic research is crucial in finding strategies to manage and possibly cure EB, which is often undiagnosed or misdiagnosed. EB may present in newborns and may persist over the course of a lifetime. Serious complications can occur with EB, including chronic blisters, wounds, ulcers, pruritus, clubbing of hands and feet, and amputations. Pain is frequently reported. About 80 percent of patients with recessive dystrophic EB will succumb to squamous cell carcinoma by age 55. Promising directions for future research include genome editing, gene therapy, and cell-based therapies. Conclusion: Our growing understanding of genetics and cell therapies may lead to promising therapeutic advances to treat this challenging condition.
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Affiliation(s)
| | | | - Guy Marti
- Department of Surgery and Hendrix Burn/Wound Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Harmon
- Department of Surgery and Hendrix Burn/Wound Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bernard Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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March OP, Reichelt J, Koller U. Gene editing for skin diseases: designer nucleases as tools for gene therapy of skin fragility disorders. Exp Physiol 2017; 103:449-455. [DOI: 10.1113/ep086044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/03/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Oliver P. March
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology; University Hospital of the Paracelsus Medical University; Salzburg Austria
- Institute of Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
| | - Julia Reichelt
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology; University Hospital of the Paracelsus Medical University; Salzburg Austria
| | - Ulrich Koller
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology; University Hospital of the Paracelsus Medical University; Salzburg Austria
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López-Bastida J, Oliva-Moreno J, Linertová R, Serrano-Aguilar P. Social/economic costs and health-related quality of life in patients with rare diseases in Europe. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17 Suppl 1:1-5. [PMID: 27023708 DOI: 10.1007/s10198-016-0780-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/13/2016] [Indexed: 05/07/2023]
Affiliation(s)
- Julio López-Bastida
- University of Castilla-La Mancha, Talavera de la Reina, Toledo, Spain.
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - Juan Oliva-Moreno
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- University of Castilla-La Mancha, Toledo, Spain
| | - Renata Linertová
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Las Palmas de Gran Canaria, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Evaluation and Planning Service at Canary Islands Health Service (SESCS), Santa Cruz de Tenerife, Spain
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