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Feng J, Zhang K, Dou L, Shi Z, Chen G, Li S. Health state utility values in patients with Ankylosing Spondylitis: a systematic review and meta-analysis. Qual Life Res 2024; 33:2321-2334. [PMID: 38824212 DOI: 10.1007/s11136-024-03670-8] [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] [Accepted: 04/19/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic condition that requires lifelong treatment and results in a serious disease burden. Health state utility values (HSUVs) are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE We conducted a systematic review and meta-analysis to obtain estimates of HSUVs in patients with AS, explored potential sources of heterogeneity, and compared pooled patient HSUVs with population norms. METHOD We searched PubMed, Embase, Web of science, Cochrane database and Scopus until July, 2023 to obtain eligible studies. The methodological quality of the included studies was assessed using the ROBINS-I checklist. RESULTS Forty-two publications involving 11,354 participants were included in this systematic review. The most commonly used instrument is the EQ-5D (38 studies). The estimated HSUVs for patients with AS from all available studies was pooled as 0.62 (95% CI 0.59 to 0.65). The pooled mean utility estimates from the random effects meta-analysis for SF-6D, EQ-5D-3L, EQ-5D-5L, and HUI3 were 0.65 (95% CI 0.62,0.68), 0.63 (95% CI 0.59,0.66), 0.60 (95% CI 0.42,0.79), and 0.48 (95% CI 0.43,0.53), respectively. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression based on key subgroups. The pooled estimates of EQ-5D-3L were lower for patients published before 2010, with high disease activity, long duration of disease, and in developed countries. CONCLUSION Pooled estimates of HSUVs for people with AS were substantially lower than population norms. These estimates provide robust evidence that can inform the economic evaluation of new therapies for individuals with AS.
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Affiliation(s)
- JunChao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | | | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
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Rodríguez Esquíroz A, Arrondo Velasco A, Egüés Lugea A, Sarobe Carricas M. Improvement in RAID questionnaire results in patients with rheumatoid arthritis treated with advanced therapies. Eur J Hosp Pharm 2023; 31:21-26. [PMID: 35228268 PMCID: PMC10800251 DOI: 10.1136/ejhpharm-2021-003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/15/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To analyse the changes in patient-reported outcomes after starting advanced antirheumatic treatment. METHODS The study included all patients who started self-administered biological or targeted synthetic treatments for rheumatoid arthritis between February and November 2020. The patients were given the RAID quality of life questionnaire to complete before starting the treatment and after 4 months. Univariate and multivariate analyses were performed to determine the association between patients' clinical and sociodemographic characteristics and quality of life improvement. The level of significance was set at 0.05. RESULTS Forty-six patients were included. Their ratings in the RAID questionnaire were improved after 4 months of treatment, both in the final overall total, which improved by 1.63±2.29 points, and in the different subtopics of the questionnaire (range 0-10). Pain was the domain that improved the most (2.33±2.82 points), followed by functional disability (2.15±2.51) and physical well-being (1.96±3.18). The improvement was statistically significant in all domains except the sleep score, which showed no statistically significant difference between the two time points analysed. CONCLUSIONS Advanced antirheumatic treatment improves the quality of life of patients after 4 months of treatment.
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Mega TP, da Silva RM. Expenditure of biological drugs for rheumatoid arthritis treatment in the Brazilian public health system. Rev Saude Publica 2023; 57:41. [PMID: 37556663 PMCID: PMC10355319 DOI: 10.11606/s1518-8787.2023057004280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/18/2022] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE This work aims to analyze the quantity and expenses related to biological drugs used for the treatment of rheumatoid arthritis (RA) in outpatient public care within the Brazilian Unified Health System (SUS). METHODS It is a cross-sectional descriptive study based on secondary data from a historical series, referring to the purchase, volume, and the number of patients treated with different biological drugs (infliximabe, etanercept, adalimumab, rituximab, abatacept, tocilizumab, golimumab, and certolizumab pegol) for RA treatment in outpatient care from 2012 to 2017. The data were extracted from the SUS Outpatient Information System database-SIA/SUS and included ten drugs used for RA treatment. The study assessed the quantity and expenditure of these drugs, the number of RA patients treated, and the expenditure by RA subtypes. The National Broad Consumer Price Index was used to adjust the expenditures for December 2017. RESULTS The Ministry of Health allocated approximately $500 million to provide about 2 million units of biological drugs for RA patients from 2012 to 2017. The supply of adalimumab 40 mg and etanercept 50 mg accounted for 68.3% of the total expenditure. The subtypes "other rheumatoid arthritis with rheumatoid factor" (ICD-10 M05.8), "rheumatoid arthritis without rheumatoid factor" (ICD-10 M06.0), and "Felty's syndrome" (M05. 0) represented 84.5% of the total expenditures. The proportion of patients treated with biological drugs increased by 33.0%. There was a significant 83.0% increase in the number of patients using biological drugs compared to the overall number of RA patients treated during the study period. CONCLUSIONS The results obtained allow us to draw a more recent profile of expenditure on RA treatment and indicate trends in the use of biological drugs for this condition, generating data that can support management decisions in public health policies.
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Affiliation(s)
- Tacila Pires Mega
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sergio AroucaPrograma de Pós-Graduação em Saúde PúblicaRio de JaneiroRJBrasil Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Programa de Pós-Graduação em Saúde Pública. Rio de Janeiro, RJ, Brasil
| | - Rondineli Mendes da Silva
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sergio AroucaDepartamento de Política de Medicamentos e Assistência FarmacêuticaRio de JaneiroRJBrasil Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Política de Medicamentos e Assistência Farmacêutica. Rio de Janeiro, RJ, Brasil
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Barrett R, Barrett R, Lin SX, Culliford D, Fraser S, Edwards CJ. Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (January 2019 to January 2021) using the English Prescribing Dataset. BMJ Open 2022; 12:e051936. [PMID: 36564115 PMCID: PMC9791141 DOI: 10.1136/bmjopen-2021-051936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use. DESIGN AND SETTING A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point). OUTCOME MEASURES Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown. RESULTS Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines' use patterns changed with a strong signal only for sulfasalazine in March/April 2020. CONCLUSIONS Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.
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Affiliation(s)
- Ravina Barrett
- School of Applied Sciences, University of Brighton, Brighton, UK
| | | | - Sharon X Lin
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Culliford
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon Fraser
- Faculty of Medicine, University of Southampton, Southampton, UK
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Moraes FA, da Silva MRR, Dos Santos JBR, Acurcio FA, Almeida AM, Kakehasi AM, Alvares-Teodoro J. Health-Related Quality of Life in Psoriatic Arthritis: Findings and Implications. Value Health Reg Issues 2021; 26:135-141. [PMID: 34390960 DOI: 10.1016/j.vhri.2021.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess the quality of life (QOL) and its associated factors in patients with psoriatic arthritis (PsA) who would start treatment with biologic drugs at the Brazilian Unified Health System. METHODS A cross-sectional study was performed at a single center pharmacy in Belo Horizonte, State of Minas Gerais, Brazil. EQ-5D was used to assess the patients' QOL. The functional status was assessed using the Health Assessment Questionnaire-Disability Index, whereas disease activity was evaluated through the Bath Ankylosing Spondylitis Disease Activity Index and the Clinical Disease Activity Index. Simple and multiple linear regression analyses were performed to assess the factors associated with QOL. RESULTS A total of 212 patients with PsA were included, of which 185 (87.3%) reported having some pain/discomfort, and 148 (69.8%) presented some level of anxiety/depression. Patients with PsA had a mean QOL score of 0.651 (SD 0.12) with a significant reduction in female patients, concomitant use of nonsteroidal anti-inflammatory drugs, comorbidity, and worse clinical and functional status. Poor QOL was associated with worse functional status by the Health Assessment Questionnaire-Disability Index, disease activity by the Bath Ankylosing Spondylitis Disease Activity Index, and with diagnoses of osteoporosis, hypothyroidism, and depression. CONCLUSION PsA and its associated comorbidities negatively affect the QOL, evidencing the need for a comprehensive and effective clinical approach.
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Affiliation(s)
- Felipe A Moraes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Michael R R da Silva
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural, and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil
| | - Jéssica B R Dos Santos
- Health Assessment, Technology, and Economy Group, Center for Exact, Natural, and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil.
| | - Francisco A Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra M Almeida
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana M Kakehasi
- Medicine School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Souza AF, Silva MRD, Santos JBD, Almeida AM, Acurcio FA, Alvares-Teodoro J. Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study. Pharm Pract (Granada) 2021; 19:2312. [PMID: 34221199 PMCID: PMC8216708 DOI: 10.18549/pharmpract.2021.2.2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Pharmaceutical services in Brazil provide access, supply, and rational use of
drugs for all population and an effort has been made to improve the quality
of these services. Biological drugs are high-cost drugs supplied in Brazil
that can inhibit disease progression and improve the quality of life of
psoriatic arthritis (PsA) patients. However, some patients did not achieve
therapeutic goals. Objective: To evaluate the medication adherence and persistence of PsA patients treated
with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated
factors. Methods: A prospective observational study was performed at a single-specialty
pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and
clinical outcomes were evaluated at 12 months of follow-up. Medication
persistence was historically compared to overall PsA patients treated in
Brazil. Associated factors were identified through log-binomial
regression. Results: One hundred ninety-seven PsA patients were included in the study, of whom 147
(74.6%) and 142 (72.1%) had medication adherence and
persistence, respectively. Patients treated with infliximab presented the
highest adherence (90.5%) and persistence rate (95.2%) in
comparison to patients treated with other drugs, except for adalimumab
versus infliximab for adherence outcome. All clinical measures significantly
improved in patients with medication adherence and persistence. Medication
persistence was higher for patients attended by specialty pharmacy than
other PsA patients in Brazil. The associated factors to higher medication
adherence were lower disease activity by BASDAI, being non-white race, and
intravenous drug use. The associated factors to higher medication
persistence were lower disease activity by Bath Ankylosing Spondylitis
Activity Index (BASDAI), intravenous drug use, non-use of corticoids and
non-steroidal anti-inflammatory drugs, and comorbidity. Conclusions: Patients with medication adherence and persistence had significant
improvements in clinical measures, functionality, and quality of life. High
medication adherence and persistence to biological therapy were observed and
associated with lesser disease activity at baseline. Also, medication
persistence to PsA patients attended in specialty pharmacy was higher than
the overall PsA population in Brazil, which indicates the importance of
pharmaceutical services to provide health care and promote the effectiveness
and safety of biological therapies.
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Affiliation(s)
- Ana F Souza
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Michael R Da Silva
- PhD. Professor. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Jéssica B Dos Santos
- PhD. Department of Pharmacy and Nutrition; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, ES (Brazil).
| | - Alessandra M Almeida
- PhD. Professor. Faculty of Medical Sciences of Minas Gerais. Belo Horizonte, MG (Brasil).
| | - Francisco A Acurcio
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
| | - Juliana Alvares-Teodoro
- PhD. Professor. Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais. Belo Horizonte, MG (Brazil).
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