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Smith A, Finnigan K, Clarke S, Barry M, Gorry C. Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1039-1045. [PMID: 38615937 DOI: 10.1016/j.jval.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/19/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are novel high-cost treatments for the prevention of migraine. This study presents data on utilization, expenditure, and treatment patterns with CGRP mAbs available under a managed access protocol in Ireland, to a cohort of treatment refractory patients (failed 3 or more previous treatments) with chronic migraine. METHODS Data were extracted from the Primary Care Reimbursement Service High Tech claims database and special drug request online system and analyzed using Microsoft Excel and SAS. Treatment persistence was evaluated by refill patterns, and adherence was evaluated using the proportion of days covered method. Expenditure data were extracted directly from the database. RESULTS Between September 1, 2021 and April 30, 2023, 1517 applications for reimbursement approval for a CGRP mAb were received; 1458 (96.1%) were approved for reimbursement. Total expenditure on CGRP mAbs in year 1 (September 1, 2021 to August 31, 2022) was €3.2 million. The majority of patients initiated treatment with fremanezumab (60.8%) or erenumab (37.1%). Almost 90% of patients were considered adherent, and treatment persistence was high, with more than 75% of patients receiving more than 12 months of treatment in our 18-month study time frame. CONCLUSIONS This study demonstrates the importance of active health technology management, after reimbursement, in enabling cost-effective use of high-cost treatments while providing budget certainty for the healthcare payer. High levels of adherence and persistence suggest that treatment is successfully targeted in situations which unmet clinical need is greatest.
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Affiliation(s)
- Amelia Smith
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; Health Services Executive (HSE) Medicines Management Programme, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland.
| | - Karen Finnigan
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; Health Services Executive (HSE) Medicines Management Programme, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland
| | - Sarah Clarke
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; Health Services Executive (HSE) Medicines Management Programme, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; Health Services Executive (HSE) Medicines Management Programme, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; National Centre for Pharmacoeconomics, Dublin 8, Ireland
| | - Claire Gorry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland; Health Services Executive (HSE) Medicines Management Programme, Trinity Centre for Health Sciences, St James' Hospital, Dublin 8, Ireland
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Giovinazzo S, Carmisciano L, Toma M, Benenati S, Tomasoni D, Sormani MP, Porto I, Canepa M, Senni M, Metra M, Ameri P. Sacubitril/valsartan in real-life European patients with heart failure and reduced ejection fraction: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:3547-3556. [PMID: 34338429 PMCID: PMC8497227 DOI: 10.1002/ehf2.13547] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/22/2021] [Accepted: 07/16/2021] [Indexed: 01/13/2023] Open
Abstract
AIMS We systematically reviewed the European real-world evidence (RWE) about sacubitril-valsartan for heart failure with reduced ejection fraction. METHODS AND RESULTS Twenty-one articles, including 16 952 subjects, were identified until 31 October 2020. Taking as reference the PARADIGM-HF cohort, few baseline characteristics were presented in >80% of these studies, most often with high heterogeneity. In random-effects model meta-analysis, age was higher (mean difference +3.84, 95% CI 1.92-5.76), ischaemic aetiology (OR 0.76, 95% CI 0.64-0.91), hypertension (OR 0.55, 95% CI 0.37-0.82), and diabetes (OR 0.77, 95% CI 0.64-0.92) were less common, and the use of mineralocorticoid receptor antagonists was more frequent (OR 3.54, 95% CI 2.27-5.53) in real-life than in PARADIGM-HF. Other clinical and medical features were presented in 19-76% of the selected publications and suggested more severe heart failure with reduced ejection fraction. Sacubitril-valsartan was titrated to 97/103 mg b.i.d. in 35% (95% CI 23-47) and discontinued in 12.8% (95% CI 7.4-18.3) patients. When reported, the incidence of hyperkalaemia (six studies, no. 1076), all-cause mortality (five studies, no. 684), and any hospitalization (three studies, no. 390) was 12 (95% CI 5-19)/100 person-year, 8 (95% CI 4-12)/100 person-year, and 24 (95% CI 5-42)/100 person-year, respectively. Knowledge contribution, a metric measuring the proportion of RWE provided by each article based on the number of reported variables and the sample size, was 58.8% and 13.6% for the two biggest investigations (12 082 and 2037 patients), and <5% for all others (most with <100 subjects). CONCLUSIONS Limited-quality RWE indicates that there are important differences between European patients prescribed sacubitril-valsartan and the PARADIGM-HF population, including the frequency of target dose achievement.
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Affiliation(s)
- Stefano Giovinazzo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy
| | - Luca Carmisciano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy
| | - Stefano Benenati
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy.,Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Daniela Tomasoni
- Cardiology Unit, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy.,Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy.,Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy.,Department of Internal Medicine, University of Genova, Genoa, Italy
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Chen W, Liu Y, Tang L, Li Z, Liu Y, Dang H. Clinical characteristics, prescription patterns, and persistence associated with sacubitril/valsartan adoption: A STROBE-compliant study. Medicine (Baltimore) 2021; 100:e26809. [PMID: 34397739 PMCID: PMC8322537 DOI: 10.1097/md.0000000000026809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023] Open
Abstract
Sacubitril/valsartan (sac/val) was launched in China in 2018; however, the adoption of sac/val in real-world clinical practice has yet to be described.This study aimed to analyze real-world treatment patterns of sac/val using data from 3 tertiary hospitals in China.A non-interventional, retrospective cohort study of patients with Heart failure (HF) prescribed sac/val from 3 tertiary hospitals in China between January 1, 2018 and June 30, 2020 was conducted. The analysis included sac/val dose titration patterns and persistence during 6 months post-index.A total of 267 patients were included, with a mean age of 63.9 ± 13.1 years. At index, 27% of patients were prescribed sac/val 12/13 mg b.i.d., 63.7% were prescribed 24/26 mg b.i.d., 4.5% were prescribed the target dose of 49/51 mg b.i.d., and 4.8% were not prescribed according to the recommended dose. During the 6 months post-index, 8.3% of patients had only 1 dose titration record. Good therapeutic persistence was observed across sac/val doses, and only 15.7% of patients discontinued sac/val during the 6 months post-index.In China, the majority of patients prescribed sac/val are not initiated on the recommended dose nor up-titrated according to drug instruction. Notably, good persistence with sac/val is observed in the real-world cohort study.
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Affiliation(s)
- Wenwen Chen
- Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Shandong, Tai’an, China
| | - Yanyan Liu
- Department of Pharmacy, Tengzhou Central People's Hospital, Shandong, Tengzhou, China
| | - Longlong Tang
- Department of Pharmacy, Xintai People's Hospital, Shandong, Xintai, China
| | - Zhenshan Li
- Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Shandong, Tai’an, China
| | - Yanlin Liu
- Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Shandong, Tai’an, China
| | - Heqin Dang
- Department of Pharmacy, the Second Affiliated Hospital of Shandong First Medical University, Shandong, Tai’an, China
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Smith A, Barry M. Combining health technology assessment and health technology management to deliver cost-effective prescribing and cost containment - the Irish experience. Expert Rev Pharmacoecon Outcomes Res 2020; 20:431-436. [PMID: 32909850 DOI: 10.1080/14737167.2020.1822739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Health technology assessment (HTA) is a widely used process to systematically evaluate the properties, effects, and impacts of health technology, with the main purpose of informing policymaking in healthcare. However, to ensure optimal use of scarce healthcare budgets, there is a need to look beyond HTA - to post-reimbursement health technology management (HTM). AREAS COVERED This review aims to describe the significant impact HTA, in combination with HTM, has made to the cost-effective prescribing and cost-containment in Ireland. This review will cover a number of specific examples, such as; specific reimbursement criteria for sacubitril/valsartan (Entresto®) and evolocumab (Repatha®), the introduction of a reimbursement application system for lidocaine 5% medicated plaster (Versatis®), and the introduction of 'preferred' biosimilars for patent-expired biologic medicines. EXPERT OPINION Healthcare payers are increasingly recognizing the benefits of HTM particularly when used in conjunction with HTA. This review highlights several examples whereby significant cost-savings can be made through HTM of not only new drugs but also drugs which are already available on the market.
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Affiliation(s)
- Amelia Smith
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital , Dublin 8, Ireland.,Medicines Management Programme, Health Service Executive, St. James' Hospital , Dublin 8, Ireland
| | - Michael Barry
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre for Health Sciences, St. James' Hospital , Dublin 8, Ireland.,Medicines Management Programme, Health Service Executive, St. James' Hospital , Dublin 8, Ireland
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