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Bernard L, Valsecchi V, Mura T, Aouinti S, Padern G, Ferreira R, Pastor J, Jorgensen C, Mercier G, Pers YM. Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial. Joint Bone Spine 2022; 89:105368. [PMID: 35248737 DOI: 10.1016/j.jbspin.2022.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring. METHODS An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights. RESULTS Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P<0.01). The incremental cost-utility ratio of the intervention was equal to -1,029€ per QALY (95% CI: -32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained. CONCLUSION Implementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03005925).
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Affiliation(s)
- Laurene Bernard
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Guillaume Padern
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Jenica Pastor
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Grégoire Mercier
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France.
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[Algorithms to identify chronic inflammatory rheumatism and psoriasis in medico-administrative databases: A review of the literature]. Rev Epidemiol Sante Publique 2021; 69:225-233. [PMID: 34215479 DOI: 10.1016/j.respe.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/31/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We aimed to describe and discuss the algorithms used to identify chronic inflammatory rheumatisms and psoriasis in medico-administrative databases. METHODS We performed a literature review on the Medline database of articles published up to 31 January 2018. Our inclusion criteria were: original articles using medico-administrative databases in accordance with the International Classification of Diseases, version 10 (ICD-10) and concerning rheumatoid arthritis (RA) or ankylosing spondylitis (AS) or psoriatic arthritis (PsoA) or Psoriasis (Pso). Our exclusion criteria were: letters to the editor, commentaries on published articles, studies using codes other than those of the ICD or a previous version. RESULTS Out of the 590 articles identified, 37 studies were included. Concerning RA (n=10), all studies used the M05 code, associated with the M06 code in six studies. The remaining four studies specifically targeted codes M06.0, M06.2, M06.3, M06.8, M06.9, and two of them also used code M12.3. For AS (n=8), 7 studies used the M45 code, while only one study used M45.9, M46.1 or M46.8. For Pso (n=17), all studies used the L40 code and/or at least two dispensations of vitamin D. Concerning PsoA (n=13), all studies used the same codes: M07.0, M07.1, M07.2, M07.3. CONCLUSION We recommend using codes M05 and M06 rather than M06.1 and M06.4 for RA, M45 for AS, the algorithm L40 and/or two dispensations of topical vitamin D for psoriasis, and codes M070 to M073 to identify PsoA patients in medico-administrative databases.
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Couret C, Servant M, Lebranchu P, Hamidou M, Weber M. Efficacy and Safety of Interferon Alpha 2A and Pegylated Interferon Alpha 2A in Inflammatory Macular Edema. Ocul Immunol Inflamm 2019; 28:329-336. [PMID: 31821064 DOI: 10.1080/09273948.2019.1604001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated interferon-α2b.Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.
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Affiliation(s)
- Chloé Couret
- Department of Ophthalmology, Nantes University Hospital, Nantes, France
| | - Marion Servant
- Department of Ophthalmology, Nantes University Hospital, Nantes, France
| | - Pierre Lebranchu
- Department of Ophthalmology, Nantes University Hospital, Nantes, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Michel Weber
- Department of Ophthalmology, Nantes University Hospital, Nantes, France
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Cabane L, Baillif S, Baldin B, Breuil V, Euller-Ziegler L, Tieulié N. [Uveitis treated with biotherapy and/or DMARD: Analysis from the French Pharmacovigilance Study Base]. J Fr Ophtalmol 2018; 41:350-356. [PMID: 29656829 DOI: 10.1016/j.jfo.2017.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE To report the characteristics of uveitis cases occurring while on biologic therapy or disease-modifying antirheumatic drugs (DMARDs) reported to the French national pharmacovigilance database. METHODS All the uveitis cases occurring in patients with chronic rheumatologic diseases, chronic inflammatory intestinal diseases or connective tissue diseases, while treated with DMARDs and/or biologic therapies between 2000 and 2015 and reported to the French National Pharmacovigilance Database were collected. RESULTS During the study period, 32 cases of uveitis were reported (15 men, 17 women). Two patients were treated with one DMARD alone, 24 with biologic therapy alone, and six with both treatments. Anterior uveitis was diagnosed in 19 patients (8 cases were bilateral); intermediate uveitis was found (unilaterally) in one patient; posterior and diffuse uveitis occurred in 5 and 2 cases respectively. Five cases were inconclusive with regard to the anatomical type of uveitis. The uveitis was of infectious origin in 5 cases: 2 toxoplasmosis, 2 herpes virus and 1 tuberculosis. In the 27 other cases, it was not possible to state whether the uveitis was associated with the underlying disease (uncontrolled) or a side effect of the biologic/DMARD treatments. The occurrence of the uveitis led to 9 switches in biologic therapy and 13 discontinuations of treatment (8 complete discontinuations, 5 discontinuations only until uveitis remission was obtained). In 4 cases, the treatments were not modified. The database does not specify the ultimate course or rheumatologic disease activity at the time of the uveitis. CONCLUSIONS The presence of uveitis while on biologic therapy must not be taken to indicate a therapeutic failure, especially if the ocular manifestation is isolated. In the case of uveitis occurring in patients treated with biologic therapies and/or DMARDs, infectious complications should be ruled out.
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Affiliation(s)
- L Cabane
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - S Baillif
- Service d'ophtalmologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - B Baldin
- Service de pharmacovigilance, hôpital de Cimiez, CHU de Nice, 4, avenue Reine-Victoria, 06003 Nice, France
| | - V Breuil
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - L Euller-Ziegler
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France
| | - N Tieulié
- Service de rhumatologie, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, CS 51069, 06001 Nice cedex 1, France.
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Baudouin A, Armoiry X, Dussart C. L’évaluation médico-économique des stratégies thérapeutiques en milieu hospitalier : une revue systématique des travaux français. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:227-235. [DOI: 10.1016/j.pharma.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Coûts d’utilisation des services de soins de santé imputables à la polyarthrite rhumatoïde en France : analyse d’une base de données représentative nationale. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rhum.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Healthcare service utilisation costs attributable to rheumatoid arthritis in France: Analysis of a representative national claims database. Joint Bone Spine 2016; 83:53-6. [DOI: 10.1016/j.jbspin.2015.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/17/2015] [Indexed: 02/04/2023]
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Beck M, Velten M, Rybarczyk-Vigouret MC, Covassin J, Sordet C, Michel B. Analysis and Breakdown of Overall 1-Year Costs Relative to Inpatient and Outpatient Care Among Rheumatoid Arthritis Patients Treated with Biotherapies Using Health Insurance Claims Database in Alsace. Drugs Real World Outcomes 2015; 2:205-215. [PMID: 27747567 PMCID: PMC4883212 DOI: 10.1007/s40801-015-0030-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The economic burden linked to rheumatoid arthritis (RA) has greatly increased since the inclusion of biotherapies in the therapeutic arsenal. Objectives This study aimed first to look at the breakdown of the rheumatoid arthritis patients on biotherapy in Alsace, France, in 2012, then to evaluate the annual cost per treated patient for each management pathway: inpatient care with intravenous biotherapies and/or outpatient care through the use of subcutaneous drugs, and finally to conduct a cost comparison with a focus on infliximab, adalimumab and etanercept. Methods This observational study was conducted in Alsace using 2012 health claims data from the DCIR (Données de Consommation Inter Régime) and PMSI (Programme de Médicalisation des Systèmes d’Information) databases, taking into account direct medical and non-medical costs in a real-life setting and from a National Health Insurance perspective. Results There were 5702 RA patients, i.e. 0.31 % of the Alsace population in 2012, including 1075 subjects (18.85 %) receiving biotherapy treatment. The most frequently prescribed biotherapies were etanercept and adalimumab. The estimated overall cost of care of these 5702 patients was €30.3 million, with about 50 % for the care of the 18.85 % patients on biotherapy. Average costs for inpatient, outpatient and mixed care ranged from €14,197 to €16,873 per patient per year. Annual average cost for management of a single RA patient with infliximab was significantly higher than with adalimumab and etanercept: €16,480 versus €14,116 and €14,338, respectively. Conclusion These findings confirm the trends of initial modelling approaches and quantify the cost difference between various biotherapy management pathways.
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Affiliation(s)
- Morgane Beck
- Laboratoire d'épidémiologie et de santé publique-EA 3430, Faculté de Médecine, Université de Strasbourg, 67085, Strasbourg Cedex, France. .,OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 14, rue du Maréchal Juin, 67084, Strasbourg Cedex, France.
| | - Michel Velten
- Laboratoire d'épidémiologie et de santé publique-EA 3430, Faculté de Médecine, Université de Strasbourg, 67085, Strasbourg Cedex, France
| | | | - José Covassin
- Direction Régionale du Service Médical d'Alsace-Moselle, 67003, Strasbourg Cedex, France
| | - Christelle Sordet
- Service de rhumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67098, Strasbourg Cedex, France
| | - Bruno Michel
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 14, rue du Maréchal Juin, 67084, Strasbourg Cedex, France.,Service de Pharmacie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Laboratoire HuManiS-EA 7308, Faculté de Pharmacie, Université de Strasbourg, 67098, Strasbourg Cedex, France
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Efficacy of low-dose etanercept (25mg/week): How much do we know? Joint Bone Spine 2012; 79:335-7. [DOI: 10.1016/j.jbspin.2012.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2012] [Indexed: 11/23/2022]
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Campbell J, Lowe D, Sleeman MA. Developing the next generation of monoclonal antibodies for the treatment of rheumatoid arthritis. Br J Pharmacol 2011; 162:1470-84. [PMID: 21182494 DOI: 10.1111/j.1476-5381.2010.01183.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis is one of the commonest autoimmune diseases affecting 0.8% of the population. Over the last decade the treatment of this chronic disease has been revolutionized by the use of monoclonal antibodies and fusion proteins, targeting molecules like tumour necrosis factor alpha. Nevertheless, approximately one-third of subjects fail to respond to these therapies and therefore significant unmet medical need remains. Following a decade of use, clinical, government and regulatory agency expectations have changed for new antibodies therapies entering this highly competitive area. In this review, we discuss the current advances being made in antibody engineering and how they are being considered and used in the development of the next generation of antibodies to meet future expectations of healthcare providers, physicians and patients. Moreover, we discuss how pattern recognition receptors may provide new antibody tractable targets that may break the cycle of autoimmunity in rheumatoid arthritis.
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Affiliation(s)
- Jamie Campbell
- Department of Respiratory, Inflammation and Autoimmunity, MedImmune Ltd, Cambridge, UK
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BERESNIAK ARIEL, GOSSEC LAURE, GOUPILLE PHILIPPE, SARAUX ALAIN, BAMBERGER MARION, BREGMAN BRUNO, DUPONT DANIELLE. Direct Cost-Modeling of Rheumatoid Arthritis According to Disease Activity Categories in France. J Rheumatol 2010; 38:439-45. [PMID: 21123324 DOI: 10.3899/jrheum.100589] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective.The objective of this cost-of-illness study was to assess the use of direct medical resources, excluding drug costs, by patients with rheumatoid arthritis (RA) in France, and to construct cost estimates according to level of disease activity.Methods.Three categories of RA disease activity were defined according to Disease Activity Score 28-joint count (DAS28) thresholds: remission (DAS28 < 2.6), low disease activity state (LDAS; i.e., DAS28 ≤ 3.2), and moderate to high disease activity (MHDAS; i.e., DAS28 > 3.2). Eight resource utilization items were defined: medical visits, laboratory tests, hospitalization, imaging, physiotherapy, nursing, adaptive aids, and transportation. Resource utilization and unit costs from the national-payer perspective were estimated through expert opinion and simulated using distribution ranges for each item. Cost distributions were computed by Monte-Carlo simulations estimating overall costs per 6 months over a 2-year period.Results.For patients achieving remission, costs were estimated at a mean of €771 (SD 199) for the first 6 months and at €511 (SD 162) for each subsequent 6-month period. For patients achieving LDAS, costs were estimated at €905 (SD 263) for the first 6 months and €696 (SD 240) for each subsequent 6-month period. For patients in MHDAS, costs were estimated at €1215 per 6 months (SD 405).Conclusion.This cost-of-illness assessment provided current estimates of direct medical costs for RA according to disease activity in France. The findings suggest that achieving remission or LDAS is associated with substantially lower medical costs for RA versus being in MHDAS.
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