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Azuaga AB, Ramírez J, Cañete JD. Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci 2023; 24:4901. [PMID: 36902329 PMCID: PMC10003101 DOI: 10.3390/ijms24054901] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Psoriatic arthritis (PsA), a heterogeneous chronic inflammatory immune-mediated disease characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis), generally occurs in patients with psoriasis. PsA is also associated with uveitis and inflammatory bowel disease (Crohn's disease and ulcerative colitis). To capture these manifestations as well as the associated comorbidities, and to recognize their underlining common pathogenesis, the name of psoriatic disease was coined. The pathogenesis of PsA is complex and multifaceted, with an interplay of genetic predisposition, triggering environmental factors, and activation of the innate and adaptive immune system, although autoinflammation has also been implicated. Research has identified several immune-inflammatory pathways defined by cytokines (IL-23/IL-17, TNF), leading to the development of efficacious therapeutic targets. However, heterogeneous responses to these drugs occur in different patients and in the different tissues involved, resulting in a challenge to the global management of the disease. Therefore, more translational research is necessary in order to identify new targets and improve current disease outcomes. Hopefully, this may become a reality through the integration of different omics technologies that allow better understanding of the relevant cellular and molecular players of the different tissues and manifestations of the disease. In this narrative review, we aim to provide an updated overview of the pathophysiology, including the latest findings from multiomics studies, and to describe current targeted therapies.
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Affiliation(s)
- Ana Belén Azuaga
- Rheumatology Department, Hospital Clinic and IDIBAPS of Barcelona, 08036 Barcelona, Spain
| | | | - Juan D. Cañete
- Rheumatology Department, Hospital Clinic and IDIBAPS of Barcelona, 08036 Barcelona, Spain
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Sigurdardottir V, Engstrom A, Berling P, Olofsson T, Oldsberg L, Sadler S, Parra-Padilla D, Melis L, Willems D. Cost-effectiveness analysis of bimekizumab for the treatment of active psoriatic arthritis in Sweden. J Med Econ 2023; 26:1190-1200. [PMID: 37712618 DOI: 10.1080/13696998.2023.2259609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023]
Abstract
AIMS To evaluate the cost-effectiveness of bimekizumab, an inhibitor of IL-17F and IL-17A, against biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARD) for psoriatic arthritis (PsA) from the Swedish healthcare system perspective. MATERIALS AND METHODS A Markov model was developed to simulate the clinical pathway of biologic [b] DMARD-naïve or tumor necrosis factor inhibitor experienced [TNFi-exp] PsA patients over a lifetime horizon. Treatment response was incorporated as achievement of the American College of Rheumatology 50% (ACR50) and Psoriasis Area and Severity Index 75% (PASI75) response, and changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score. The efficacy of bimekizumab was obtained from the BE OPTIMAL (bDMARD-naïve) and BE COMPLETE (TNFi-experienced) trials while a network meta-analysis (NMA) informed the efficacy of the comparators. Resource use and drug costs were obtained from published studies and databases of drug retail prices in Sweden. A willingness-to-pay threshold of €50,000 per quality-adjusted life year (QALY) was applied. RESULTS In bDMARD-naïve patients, bimekizumab achieved greater QALYs (14.08) than with all comparators except infliximab (14.22), dominated guselkumab every 4 and 8 weeks, ixekizumab, secukinumab 300 mg, ustekinumab 45 mg and 90 mg, and was cost-effective against risankizumab, tofacitinib, upadacitinib and TNFis, except adalimumab biosimilar. In TNFi-experienced patients, bimekizumab led to greater QALYs (13.56) than all comparators except certolizumab pegol (13.84), and dominated ixekizumab and secukinumab 300 mg while being cost-effective against all other IL-17A-, IL-23- and JAK inhibitors. LIMITATIONS An NMA informed the comparative effectiveness estimates. Given gaps in evidence of disease management and indirect costs specific to HAQ-DI scores, and sequential clinical trial evidence in PsA, non-PsA cost data from similar joint conditions were used, and one line of active treatment followed by best supportive care was assumed. CONCLUSIONS Bimekizumab was cost-effective against most available treatments for PsA in Sweden, irrespective of prior TNFi exposure.
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Affiliation(s)
- Valgerdur Sigurdardottir
- Department of Rheumatology, Falun Hospital, Centre for Clinical Research, Dalarna, Uppsala University, Falun, Sweden
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Cost-Effectiveness of Therapeutic Drug Monitoring-Guided Adalimumab Therapy in Rheumatic Diseases: A Prospective, Pragmatic Trial. Rheumatol Ther 2021; 8:1323-1339. [PMID: 34278555 PMCID: PMC8380594 DOI: 10.1007/s40744-021-00345-5] [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: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To assess the clinical and cost-effectiveness of therapeutic drug monitoring (TDM) based on serum adalimumab levels compared to standard of care in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
Methods This was a non-inferiority, multicentric, non-randomized, pragmatic trial including adult patients diagnosed with moderate-to-severe, clinically stable rheumatic diseases treated with adalimumab. Consecutive patients were assigned 1:2 to the control (CG) or the intervention group (IG), based on the site of inclusion, and followed up for 18 months. Adalimumab serum levels were measured at each study visit and released to the IG only to modify dosing strategy. Data on disease activity, healthcare resource utilization and health-related quality of life (HRQoL) measured through the EQ-5D-5L were collected. Number of persistent and overall flares, time to first flare, days experiencing high disease activity, total direct costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. Results Of the 169 recruited patients, 150 were included in the analysis (52 and 98 patients in the CG and IG, respectively). The primary endpoint was not met as persistent flares were not significantly lower in the IG, although mean (SD) number of flares was numerically lower in the IG (0.67 [0.70] versus 0.90 [0.82], P = 0.073), respectively. Based on EQ-5D-5L utilities, HRQoL was significantly higher in the IG at 3 (P = 0.001) and 6 months (P = 0.035), which overall translated into 0.075 QALYs gained per patient for the IG at month 18. Overall, direct costs were significantly lower for the IG patients (€15,311.59 [4,870.04] versus €17,378.46 [6,556.51], P = 0.030), resulting in the intervention being dominant, leading to increased QALY at a lower overall cost Conclusion Adalimumab dose tapering based on TDM for rheumatic patients led to an increased quality of life and QALY gain and entailed lower costs, being a more cost-effective alternative than clinically guided management. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00345-5.
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Jones GT, Macfarlane GJ, Forrest Keenan K, McNamee P, Neilson AR, Siebert S, Burden AD, Kay L, Helliwell PS. The BSR-PsA: study protocol for the British Society for Rheumatology psoriatic arthritis register. BMC Rheumatol 2021; 5:19. [PMID: 33993880 PMCID: PMC8126428 DOI: 10.1186/s41927-021-00189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) presents a unique clinical challenge. Affecting joints, skin, nails, and other organs, it is associated with various comorbidities and has a significant impact on quality of life, social participation and working life. While biologic and other targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs and tsDMARDs) have revolutionised therapy, questions remain about the long-term safety of these agents, and their effectiveness and cost-effectiveness in the real-world clinical setting. METHODS/DESIGN The British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA) is a prospective registry of patients with PsA, recruited from across Great Britain, who are (a) commencing a bDMARD/tsDMARD; or (b) naïve to all bDMARDs/tsDMARDs. Ethical approval was given by the NHS West of Scotland Research Ethics Committee 3 (reference: 18/WS/0126). Clinical data are extracted from participants' medical records, including symptom onset and diagnosis, joint, skin and nail symptoms, dactylitis and enthesitis. Physical measurements (height, weight and 66/68 joint counts) and a detailed drug history are taken. Participants are also asked to complete questionnaires comprising instruments relating to general health and quality of life, axial disease, sleep and fatigue, impact of disease, functional status, mental health, other symptoms, and occupational status. The study duration is 5 years in the first instance, and all participants are followed up annually until the end of the study. Participants commencing a bDMARD/tsDMARD are also followed up three and six months after the start of therapy. Disease activity, including C-reactive protein, is assessed at each visit; and participants from some centres are invited to donate blood and urine samples for the creation of a biobank. DISCUSSION Complementing data from randomised trials, results from this study will contribute to the evidence base underpinning the clinical management of psoriatic arthritis. Various analyses will determine the effectiveness and safety of bDMARDs/tsDMARDs in the real-world, will examine the clinical and biological predictors of treatment response, and will provide real-world data on the cost-effectiveness of these therapies, as well as providing informative data important to patients such as quality of life and occupational outcomes. TRIAL REGISTRATION The full study protocol is registered on the Open Science Framework ( https://osf.io/jzs8n ).
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Affiliation(s)
- Gareth T Jones
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Gary J Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Karen Forrest Keenan
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paul McNamee
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aileen R Neilson
- Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Lesley Kay
- Musculoskeletal Services Directorate, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Iragorri N, Hazlewood G, Manns B, Bojke L, Spackman E. Model to Determine the Cost-Effectiveness of Screening Psoriasis Patients for Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2021; 73:266-274. [PMID: 31733035 DOI: 10.1002/acr.24110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Screening psoriasis patients for psoriatic arthritis (PsA) is intended to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. Our objective was to determine the cost-effectiveness of screening for PsA in patients with psoriasis in Canada. METHODS A Markov model was built to estimate the costs and quality-adjusted life years (QALYs) of screening tools for PsA in psoriasis patients. The screening tools included the Toronto Psoriatic Arthritis Screen, Psoriasis Epidemiology Screening Tool, Psoriatic Arthritis Screening and Evaluation, and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires. States of health were defined by disability levels as measured by the Health Assessment Questionnaire. State transitions were modeled based on annual disease progression. Incremental cost-effectiveness ratios and incremental net monetary benefits were estimated. Sensitivity analyses were undertaken to account for parameter uncertainty and to test model assumptions. RESULTS Screening was cost-effective compared to no screening. The EARP tool had the lowest total cost ($2,000 per patient per year saved compared to no screening) and the highest total QALYs (additional 0.18 per patient compared to no screening). The results were most sensitive to test accuracy and the efficacy of disease-modifying antirheumatic drugs (DMARDs). No screening was cost-effective (at $50,000 per QALY) relative to screening when DMARDs failed to slow disease progression. CONCLUSION If early therapy with DMARDs delays biologic treatment, implementing screening in patients with psoriasis in Canada is expected to represent a cost savings of $220 million per year and improve the quality of life.
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Affiliation(s)
- Nicolas Iragorri
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Braden Manns
- Cumming School of Medicine, University of Calgary, Calgary, and Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Eldon Spackman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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da Silva MRR, Dos Santos JBR, Almeida AM, Alvares-Teodoro J, Acurcio FDA. Economic evaluation of adalimumab versus etanercept for psoriatic arthritis in a Brazilian real-world model. Expert Rev Pharmacoecon Outcomes Res 2021; 22:473-479. [PMID: 33474995 DOI: 10.1080/14737167.2021.1880325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND TNF inhibitors are costly drugs supplied generally on health systems or private insurances. Performance analysis is essential to verify the results achieved by health technologies in these systems. The objective of the study was to compare the two most used biological drugs for the treatment of psoriatic arthritis (PsA) in Brazil. METHODS A cost-utility analysis was built using a Markov model, with a five-year time horizon, a discount rate of 5%, and from the perspective of the Unified Health System. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Etanercept was the most cost-effective drug. Adalimumab became the most cost-effective drug in one of the four analysis scenarios with a willingness to pay from one gross domestic product per capita. The deterministic sensitivity analysis identified that the cost parameters had the greatest impact on the most effective drug. The probabilistic sensitivity analysis indicated that etanercept is the drug most likely to be cost-effective. CONCLUSION The difference between the drugs in terms of utility was minimal and the costs were the main factor that impacted the cost-utility ratio, which points to the benefits of price renegotiation for the efficient allocation of resources in the health system.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- Health Assessment, Technology, and Economy Group; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil.,College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jéssica Barreto Ribeiro Dos Santos
- Health Assessment, Technology, and Economy Group; Center for Exact, Natural and Health Sciences, Federal University of Espírito Santo, Alegre, Espírito Santo, Brazil.,College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Maciel Almeida
- College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Faculty of Medical Sciences of Minas Gerais, Medical Sciences Research and Graduate Institute, Minas Gerais, Brasil
| | - Juliana Alvares-Teodoro
- College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco De Assis Acurcio
- College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Social and Preventive Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Lewis RA, Hughes D, Sutton AJ, Wilkinson C. Quantitative Evidence Synthesis Methods for the Assessment of the Effectiveness of Treatment Sequences for Clinical and Economic Decision Making: A Review and Taxonomy of Simplifying Assumptions. PHARMACOECONOMICS 2021; 39:25-61. [PMID: 33242191 PMCID: PMC7790782 DOI: 10.1007/s40273-020-00980-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 05/29/2023]
Abstract
Sequential use of alternative treatments for chronic conditions represents a complex intervention pathway; previous treatment and patient characteristics affect both the choice and effectiveness of subsequent treatments. This paper critically explores the methods for quantitative evidence synthesis of the effectiveness of sequential treatment options within a health technology assessment (HTA) or similar process. It covers methods for developing summary estimates of clinical effectiveness or the clinical inputs for the cost-effectiveness assessment and can encompass any disease condition. A comprehensive review of current approaches is presented, which considers meta-analytic methods for assessing the clinical effectiveness of treatment sequences and decision-analytic modelling approaches used to evaluate the effectiveness of treatment sequences. Estimating the effectiveness of a sequence of treatments is not straightforward or trivial and is severely hampered by the limitations of the evidence base. Randomised controlled trials (RCTs) of sequences were often absent or very limited. In the absence of sufficient RCTs of whole sequences, there is no single best way to evaluate treatment sequences; however, some approaches could be re-used or adapted, sharing ideas across different disease conditions. Each has advantages and disadvantages, and is influenced by the evidence available, extent of treatment sequences (number of treatment lines or permutations), and complexity of the decision problem. Due to the scarcity of data, modelling studies applied simplifying assumptions to data on discrete treatments. A taxonomy for all possible assumptions was developed, providing a unique resource to aid the critique of existing decision-analytic models.
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Affiliation(s)
- Ruth A Lewis
- North Wales Centre for Primary Care Research, College of Health and Behavioural Sciences, Bangor University, CAMBRIAN 2, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
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Schweikert B, Malmberg C, Åkerborg Ö, Kumar G, Nott D, Kiri S, Sapin C, Hartz S. Cost-Effectiveness Analysis of Sequential Biologic Therapy with Ixekizumab Versus Secukinumab in the Treatment of Active Psoriatic Arthritis with Concomitant Moderate-to-Severe Psoriasis in the UK. PHARMACOECONOMICS - OPEN 2020; 4:635-648. [PMID: 32166657 PMCID: PMC7688884 DOI: 10.1007/s41669-020-00202-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Interleukin-17A (IL-17A) antagonists are a recent innovation for treating psoriatic arthritis (PsA). There are currently no cost-effectiveness analyses (CEAs) comparing the IL-17A antagonists ixekizumab and secukinumab in PsA from a UK perspective. OBJECTIVE We conducted a CEA from the UK National Health Service perspective to compare ixekizumab versus secukinumab in patients with PsA and concomitant moderate-to-severe plaque psoriasis. METHODS A Markov model was developed based on the widely accepted York model. In biologic disease-modifying antirheumatic drug (bDMARD)-naïve patients, ixekizumab → ustekinumab → best supportive care (BSC) was compared with secukinumab → ustekinumab → BSC. For bDMARD-experienced patients, ixekizumab → BSC was compared with secukinumab → BSC. At the end of the bDMARD trial period, Psoriatic Arthritis Response Criteria (PsARC) responders continued to receive the bDMARD in the continuous treatment period. PsARC nonresponders and patients who ceased continuous treatment transitioned to the trial period of the next treatment. RESULTS Ixekizumab was less costly and provided more quality-adjusted life-years (QALYs) than secukinumab in bDMARD-naïve and -experienced patients based on list prices, although cost savings and QALY gains were small to modest. In bDMARD-naïve patients, total costs were £155,455 compared with £155,530 for secukinumab (year 2017 values). Total QALYs were 8.127 versus 7.989. In bDMARD-experienced patients, the corresponding values were £140,051 versus £140,264 for total costs and 3.996 versus 3.875 for total QALYs. CONCLUSION Ixekizumab provided more QALYs at a marginally lower cost than secukinumab, and the results were most sensitive to changes in drug costs. Other factors, such as patient preferences for the number of injections and confidential price discounts, may be important considerations in clinical decision-making.
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Affiliation(s)
| | | | | | | | - Debby Nott
- Eli Lilly and Company Ltd, Basingstoke, UK
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The Potential Added Value of Novel Hearing Therapeutics: An Early Health Economic Model for Hearing Loss. Otol Neurotol 2020; 41:1033-1041. [PMID: 33169949 DOI: 10.1097/mao.0000000000002744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To construct an early health economic model to assess the potential added value of novel hearing therapeutics, compared with the current standard of care. We use idiopathic sudden sensorineural hearing loss (ISSNHL) as a case example, because it is a lead indication for several emerging hearing therapeutics. METHODS A decision analytic model was developed to assess the costs and effects of using novel hearing therapeutics for patients with ISSNHL. This was compared to the current standard of care. Input data were derived from literature searches and expert opinion. The study adopted a healthcare perspective of the UK National Health Service. Four analyses were conducted: 1) headroom, 2) scenario, 3) threshold, 4) sensitivity. RESULTS The decision analytic model showed that novel therapeutics for ISSNHL have potential value both in terms of improved patient outcomes, as well as incremental net monetary benefit (iNMB). The base case analysis revealed an iNMB of £39,032 for novel therapeutics compared with the current standard of care. Results of the threshold and scenario analysis revealed that age of treatment and severity of ISSNHL are major determinants of iNMB for novel therapeutics. CONCLUSION This article describes the first health economic model for novel therapeutics for hearing loss; and shows that novel hearing therapeutics can be cost-effective under NICE's cost-effectiveness threshold, with considerable room for improvement in the current standard of care. Our model can be used to inform the development of cost-effective hearing therapeutics; and help decision makers decide which therapeutics represent value for money.
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Analisi costo-utilità di dupilumab per il trattamento della dermatite atopica grave negli adulti in Italia. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2020; 7:57-65. [PMID: 36627954 PMCID: PMC9677604 DOI: 10.33393/grhta.2020.710] [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: 12/02/2019] [Accepted: 07/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Atopic dermatitis (AD) is a chronic, multifactorial, inflammatory skin disease with significant impact on patients’ quality of life. Objective: The objective of this analysis was to estimate the incremental cost-utility ratio (ICUR) of dupilumab, administered every other week, plus supportive care (SC), vs SC, in the Italian adult population with severe AD, for whom ciclosporin treatment is contraindicated, ineffective or not tolerated. Methods: Simulation of outcomes and costs was conducted using a 1-year decision tree, followed by a lifetime horizon Markov model. Clinical data were derived from a pooled analysis of two studies. The analysis was conducted adopting the Italian National Health Service (NHS) perspective. In the model, the following costs were considered: i) Drug acquisition costs; ii) Disease management costs; iii) Costs of adverse events. Robustness of findings was tested using both one-way deterministic and probabilistic sensitivity analyses. Results: In the base case, dupilumab plus SC was more effective than SC (+2.42 quality adjusted life years, QALYs). The total lifetime cost per patient treated with dupilumab was higher than SC (€ 137,267 and € 56,744, respectively). Dupilumab plus SC was cost-effective vs. SC, with an ICUR of € 33,263 per QALY gained. The ICUR fell in the informal range of ICUR acceptability proposed for Italy (range: € 25,000-€ 40,000 per QALY gained). Sensitivity analyses confirmed robustness and reliability of base case results. Conclusions: Dupilumab plus SC is a cost-effective option for the treatment of patients with severe AD in Italy, compared with SC, when NHS perspective is considered.
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Rahman P, Arendse R, Khraishi M, Sholter D, Sheriff M, Rampakakis E, Lehman AJ, Nantel F. Long-term effectiveness and safety of infliximab, golimumab and ustekinumab in patients with psoriatic arthritis from a Canadian prospective observational registry. BMJ Open 2020; 10:e036245. [PMID: 32792436 PMCID: PMC7430557 DOI: 10.1136/bmjopen-2019-036245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objectives of this study were to describe the demographic profile and baseline disease characteristics of patients with psoriatic arthritis (PsA) treated with either infliximab (IFX), subcutaneous golimumab (GLM) or ustekinumab (UST) treatment in Canadian routine care setting along with assessing long-term effectiveness and safety. METHODS Patients with PsA were enrolled into the Biologic Treatment Registry Across Canada registry (ClinicalTrials.gov Identifier: NCT00741793) from 2005 to 2017. The study visits occurred at study enrolment (baseline) and every 6 months thereafter. Effectiveness was assessed by changes in disease parameters (joint counts, Psoriasis Area Severity Index (PASI), Health Assessment Questionnaire, patient/physician global, minimal disease activity, enthesitis, dactylitis, erythrocyte sedimentation rate, C reactive protein). Improvements from baseline were explored with the paired t-test and the McNemar's test. Safety was evaluated by assessing the incidence of adverse events (AEs) and drug survival rates. RESULTS A total of 111 IFX-treated, 281 GLM-treated and 70 UST-treated patients were enrolled. Most baseline disease parameters remained similar over time in all three cohorts. UST-treated patients had lower mean baseline Disease Activity Score in 28 joints CRP, swollen joint based on 28 joints and higher PASI compared with patients treated with GLM. Treatment with IFX, GLM and UST was associated with significant improvements in all disease parameters over time (p<0.001) from baseline up to 84, 84 and 40 months, respectively.AEs were reported for 74.8%, 69.8% and 52.9% (138, 114 and 115 events/100 patient-years (PYs)) covering 325, 567 and 87 years of exposure for IFX-treated, GLM-treated and UST-treated patients, respectively. Severe AEs were reported in 19.8%, 8.5% and 5.7% (8.8, 7.2 and 8.0 events/100 PYs) in IFX-treated, GLM-treated and UST-treated patients, respectively. The proportion of patients who discontinued treatment were 63.1%, 50.9% and 50.0%, respectively. CONCLUSIONS IFX, GLM and UST treatment significantly reduced disease activity and improved functionality in patients with PsA followed by routine clinical practice and had a safety profile similar to that previously reported in the literature. TRIAL REGISTRATION NUMBER NCT00741793.
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Affiliation(s)
- Proton Rahman
- Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Regan Arendse
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Majed Khraishi
- Department of Medicine, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Dalton Sholter
- Faculty of Medicine & Dentistry - Medicine Dept, University of Alberta, Edmonton, Alberta, Canada
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Schweikert B, Malmberg C, Núñez M, Dilla T, Sapin C, Hartz S. Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain. BMJ Open 2020; 10:e032552. [PMID: 32792421 PMCID: PMC7430486 DOI: 10.1136/bmjopen-2019-032552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To conduct a cost-effectiveness analysis from the perspective of the Spanish National Health System (NHS) comparing ixekizumab versus secukinumab. DESIGN A Markov model with a lifetime horizon and monthly cycles was developed based on the York model. Four health states were included: a biological disease-modifying antirheumatic drug (bDMARD) induction period of 12 or 16 weeks, maintenance therapy, best supportive care (BSC) and death. Treatment response was assessed based on both Psoriatic Arthritis Response Criteria (PsARC) and ≥90% improvement in the Psoriasis Area Severity Index score (PASI90). At the end of the induction period, responders transitioned to maintenance therapy. Non-responders and patients who discontinued maintenance therapy transitioned to BSC. Clinical efficacy data were derived from a network meta-analysis. Health utilities were generated by applying a regression analysis to Psoriasis Area Severity Index and Health Assessment Questionnaire‒Disability Index scores collected in the ixekizumab SPIRIT studies. Results were subject to extensive sensitivity and scenario analysis. SETTING Spanish NHS. PARTICIPANTS A hypothetical cohort of bDMARD-naïve patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis was modelled. INTERVENTIONS Ixekizumab and secukinumab. RESULTS Ixekizumab performed favourably over secukinumab in the base-case analysis, although cost savings and quality-adjusted life-year (QALY) gains were modest. Total costs were €153 901 compared with €156 559 for secukinumab (difference -€2658). Total QALYs were 9.175 vs 9.082 (difference 0.093). Base-case results were most sensitive to the annual bDMARD discontinuation rate and the modification of PsARC and PASI90 response to ixekizumab or secukinumab. CONCLUSION Ixekizumab provided more QALYs at a lower cost than secukinumab, with differences being on a relatively small scale. Sensitivity analysis showed that base-case results were generally robust to changes in most input parameters. TRIAL REGISTRATION NUMBER SPIRIT-P1: NCT01695239; Post-results, SPIRIT-P2: NCT02349295; Post-results.
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Affiliation(s)
- Bernd Schweikert
- Real World Evidence Strategy and Analytics, Commercialisation and Outcomes, ICON, Munich, Germany
| | - Chiara Malmberg
- Access, Commercialisation and Communications, ICON, Munich, Germany
| | - Mercedes Núñez
- Health Outcomes and Real World Evidence, Eli Lilly and Company, Madrid, Spain
| | - Tatiana Dilla
- Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Madrid, Spain
| | - Christophe Sapin
- European Statistics, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Susanne Hartz
- Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Windlesham, UK
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13
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Capri S, Migliore A, Loconsole F, Barbieri M. A cost-effectiveness and budget impact analysis of apremilast in patients with psoriatic arthritis in Italy. J Med Econ 2020; 23:353-361. [PMID: 31856609 DOI: 10.1080/13696998.2019.1707208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The aim of this study was to conduct a cost-effectiveness analysis, as well as a budget impact analysis, on the use of apremilast for the treatment of adult patients with psoriatic arthritis (PsA), within the Italian National Health Service (NHS).Methods: A Markov state transition cohort model, which was adapted to the Italian context, was used to compare the costs of the currently available treatments and of the patients' quality of life with two alternative treatment sequences, with or without apremilast as pre-biologic therapy. Moreover, a budget impact model was developed based on the population of patients treated for PsA in Italy, who can be eligible for treatment with apremilast. The eligible population was represented by adult patients with PsA who had an inadequate response to or were intolerant to previous disease-modifying antirheumatic drugs (DMARDs), for the approved indication, and for the treatment studied in the economic analytic model.Results: This cost-effectiveness analysis estimated that the strategy of using apremilast before biologic therapy is cost-effective, with an incremental cost-effectiveness ratio of €32,263.00 per QALY gained which is slightly over the normal threshold found in other Italian economic studies, which usually considers a 40-year-period. Conversely, the budget impact analysis was conducted over 3 years, and it led to an estimated annual saving of €1.6 million, €4.6 million and €5.5 million in the first, second and third year of apremilast commercialization, respectively, for a total saving of €11.75 million in 3 years.Limitations: Limitations of this analysis include the absence of head-to-head trials comparing therapies included in the economic model, the lack of comparative long-term data on treatment efficacy, and the assumption of complete independence between the considered response rates to therapy.Conclusion: The use of apremilast as a first option before the use of biologic agents may represent a cost-effective treatment strategy for patients with PsA who fail to respond to, or are intolerant to, previous DMARD therapy. In addition, based on a budget impact perspective, the use of apremilast may lead to cost savings to the Italian healthcare system.
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Affiliation(s)
- Stefano Capri
- School of Economics and Management, Università Cattaneo-LIUC, Castellanza, Italy
| | - A Migliore
- Rheumatology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - F Loconsole
- Department of Dermatology, University of Bari, Bari, Italy
| | - Marco Barbieri
- Centre for Health Economics, University of York, York, UK
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14
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Mashayekhi K, Ganji A, Sankian M. Designing a new dimerized anti human TNF-α aptamer with blocking activity. Biotechnol Prog 2020; 36:e2969. [PMID: 31989789 DOI: 10.1002/btpr.2969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/10/2023]
Abstract
The human tumor necrosis factor α (hTNF-α) is an important pro-inflammatory cytokine which plays critical roles in inflammatory diseases such as rheumatoid arthritis (RA). The anti-TNF-α proteins can reduce symptoms of RA. Due to limitations of protein-based therapies, it is necessary to find new anti-TNF-α agents instead of common anti-TNF-α proteins. Therefore, the aim of the current study was to identify a new DNA aptamer with anti-hTNF-α activity. The protein systematic evolution of ligands by exponential enrichment (SELEX) process was used for identifying DNA aptamers. Anti-hTNF-α aptamers were selected using dot blot, real-time PCR, and in vitro inhibitory assay. The selected aptamers were truncated in two steps, and finally, a dimer aptamer was constructed from different selected truncates to improve their inhibitory effect. Also, Etanercept was used as a positive control to inhibit TNF-α, in comparison to the designed aptamers. After 11 rounds, four aptamers with anti-hTNF-α inhibitory effect were identified. The truncation and dimerization strategy revealed a new dimer aptamer with 67 nM Kd , which has 40% inhibitory effect compared with Etanercept (60%). Overall, the dimerization and truncation aptamers could improve its activity. With regard to the several limitations of anti-TNF-α proteins therapies including immunogenicity, side effects, and cost-intensive, a new designed anti-hTNF-α dimer aptamer could be considered as a potential therapeutic and/or diagnostic agent for hTNF-α-related disorders.
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Affiliation(s)
- Kazem Mashayekhi
- Immuno-Biochemistry Lab, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ganji
- Department of Microbiology and Immunology, School of Medicine, Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Mojtaba Sankian
- Immuno-Biochemistry Lab, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Cazzaniga S, Anzengruber F, Augustin M, Boehncke WH, Borradori L, Conrad C, Cozzio A, Djamei V, French LE, Gilliet M, Häusermann P, Heidemeyer K, Itin P, Kolios AGA, Laffitte E, Maul JT, Mainetti C, Naldi L, Navarini AA, Rustenbach SJ, Simon D, Sorbe C, Streit M, Yawalkar N. Linkage between patients' characteristics and prescribed systemic treatments for psoriasis: a semantic connectivity map analysis of the Swiss Dermatology Network for Targeted Therapies registry. J Eur Acad Dermatol Venereol 2019; 33:2313-2318. [PMID: 31562785 DOI: 10.1111/jdv.15983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several treatment options are currently available for the treatment of psoriasis. OBJECTIVE To explore the main associations between patients' characteristics and systemic treatments prescribed for psoriasis in a large group of patients observed in real-life clinical practice. METHODS This was a retrospective analysis of baseline data collected within the Swiss Dermatology Network for Targeted Therapies registry in Switzerland between March 2011 and December 2017. Semantic map analysis was used in order to capture the best associations between variables taking into account other covariates in the system. RESULTS A total of 549 patients (mean age 46.7 ± 14.7 years) were included in the analysis. Conventional therapies such as retinoids and methotrexate were associated with no previous systemic therapies for psoriasis, a moderate quality of life (QoL) at therapy onset and older age (≥60 years). Fumaric acid derivatives were associated with mild psoriasis (psoriasis area severity index < 10) and long disease duration (≥20 years). On the other side, cyclosporine and psoralen and ultraviolet A/ultraviolet B treatments were linked to a more severe condition, including impaired QoL, hospitalization and inability to work. Regarding biological therapies, both infliximab and adalimumab were connected to the presence of psoriatic arthritis, severe disease condition and other comorbidities, including chronic liver or kidney diseases and tuberculosis. Etanercept, ustekinumab and secukinumab were all connected to a complex history of previous systemic treatments for psoriasis, moderate disease condition, overweight and university education. CONCLUSIONS The analysis shows multifaceted associations between patients' characteristics, comorbidities, disease severity and systemic treatments prescribed for psoriasis. In particular, our semantic map indicates that comorbidities play a central role in decision-making of systemic treatments usage for psoriasis. Future studies should further investigate specific connections emerging from our data.
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Affiliation(s)
- S Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - F Anzengruber
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - W H Boehncke
- Division of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
| | - L Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Conrad
- Department of Dermatology and Venereology, Hôpital de Beaumont, Lausanne University Hospital Center, Lausanne, Switzerland
| | - A Cozzio
- Clinic of Dermatology and Allergology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - V Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - L E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - M Gilliet
- Department of Dermatology and Venereology, Hôpital de Beaumont, Lausanne University Hospital Center, Lausanne, Switzerland
| | - P Häusermann
- Department of Dermatology, University Basel Hospital, Basel, Switzerland
| | - K Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Itin
- Department of Dermatology, University Basel Hospital, Basel, Switzerland
| | - A G A Kolios
- Department of Immunology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - E Laffitte
- Division of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
| | - J-T Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Mainetti
- Department of Dermatology, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - L Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Azienda USL 8 Berica - San Bortolo Hospital, Vicenza, Italy
| | - A A Navarini
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - S J Rustenbach
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Streit
- Department of Dermatology and Allergology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - N Yawalkar
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Palsson O, Love TJ, Gunnarsdottir AI, Gunnarsson PS, Runarsdottir EE, Krogh NS, Gudbjornsson B. Patients with psoriatic arthritis who are not eligible for randomised controlled trials for TNF inhibitors have treatment response and drug survival similar to those who are eligible. RMD Open 2019; 5:e000984. [PMID: 31413869 PMCID: PMC6667974 DOI: 10.1136/rmdopen-2019-000984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/05/2019] [Accepted: 06/23/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives To determine in a retrospective cohort whether patients with psoriatic arthritis (PsA) who would not have fulfilled the inclusion criteria for randomised controlled trials (RCTs) for the TNF inhibitor (TNFi) chosen for their treatment (excl) have similar benefits and drug survival as those patients who would have (incl). Methods All patients with rheumatic disorders who are treated with biological disease-modifying antirheumatic drugs in Iceland are registered in ICEBIO. On 1 February 2016, 329 individuals with PsA were registered in ICEBIO, of whom 231 had data available for their first start of TNFi and could be evaluated according to the inclusion criteria of the respective RCTs. Disease activity was collected at baseline using Visual Analogue Scale (pain, fatigue and global (patient and physician) assessments), swollen joint count (SJC) and tender joint count (TJC), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) and Health Assessment Questionnaire (HAQ). Treatment response was measured at 6 and 18 months according to American College of Rheumatology response criteria, DAS28-CRP and Disease Activity Score in Psoriatic Arthritis for 28 joints. Drug survival rate was also analysed. Results The demographics of these two groups were similar at baseline, although the incl group had higher SJC (5.5 vs 3.8) and subsequently higher DAS28-CRP (4.6 vs 4.2). While a larger change in disease activity was observed in the incl group with respect to HAQ and SJC, both groups had similar disease activity at follow-up. Drug survival was similar in both groups. Conclusions Patients with PsA who would not have fulfilled the inclusion criteria in RCTs reach similar disease activity scores at follow-up of 6 and 18 months and have similar drug survival as those patients who would have been included in RCTs.
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Affiliation(s)
- Olafur Palsson
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Department of Science and Research, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anna Ingibjorg Gunnarsdottir
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.,Hospital Pharmacy, Landspitali University Hospital, Reykjavik, Iceland
| | - Petur Sigurdur Gunnarsson
- Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland.,Hospital Pharmacy, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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17
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McHugh N, Maguire Á, Handel I, Tillett W, Morris J, Hawkins N, Cavill C, Korendowych E, Mughal F. Evaluation of the Economic Burden of Psoriatic Arthritis and the Relationship Between Functional Status and Healthcare Costs. J Rheumatol 2019; 47:701-707. [PMID: 31416922 DOI: 10.3899/jrheum.190083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This analysis aimed to evaluate the economic burden of patients with psoriatic arthritis (PsA) on the UK healthcare system and estimate the relationship between functional status and direct healthcare costs. METHODS Functional status [measured using the Health Assessment Questionnaire-Disability Index (HAQ-DI)], demographics, disease history, and healthcare resource use data were extracted from a cohort of patients at the Royal National Hospital for Rheumatic Diseases, Bath, UK. Each resource use item per patient was then allocated a unit cost. Linear regression models were used to predict costs as a function of HAQ-DI. Medication costs were not included in the primary analysis, which was carried out from the UK National Health Service perspective. RESULTS Data were available for 101 patients. Mean HAQ-DI score was 0.84 (SD 0.75) and mean age at HAQ-DI measurement was 57.8 (SD 10.7). Total annual healthcare costs per patient, excluding medication costs, ranged between £174 and £8854, with a mean of £1586 (SD £1639). A 1-point increase in HAQ-DI score was associated with an increase in total costs of £547.49 (standard error £224), with secondary care consultations appearing to be the primary factor. Subgroup analyses suggested higher cost increases in patients with HAQ-DI scores of 2-3 and with a disease duration > 10 years. CONCLUSION Patients with PsA place a significant economic burden on the healthcare system. Functional status is highly correlated with costs and appears to be driven mainly by the cost of secondary care consultations. Results were similar to previous studies in rheumatoid arthritis populations.
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Affiliation(s)
- Neil McHugh
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK. .,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted. .,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly).
| | - Áine Maguire
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Ian Handel
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - William Tillett
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - James Morris
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Neil Hawkins
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Charlotte Cavill
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Eleanor Korendowych
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
| | - Farhan Mughal
- From the Royal National Hospital for Rheumatic Disease, NHS Foundation Trust, Bath; University of Cambridge, Cambridge; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh; University of Bath, Bath; Cogentia Healthcare Consulting Ltd., Cambridge; University of Glasgow, Glasgow; and Celgene Ltd., Uxbridge, UK.,J. Morris has received consultancy fees from Celgene Ltd. N. Hawkins and C. Cavill have received grant/research support from Celgene Ltd. F. Mughal was an employee of Celgene Ltd. at the time the study was conducted.,N. McHugh, MB, ChB, MD, FRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and Department of Pharmacy and Pharmacology, University of Bath; Á. Maguire, MSc, PhD student, Department of Psychology, University of Cambridge; I. Handel, PhD, MS, BVSc, Royal (Dick) School of Veterinary Studies, University of Edinburgh; W. Tillett, BSc, MB, ChB, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust, and the Department of Pharmacy and Pharmacology, University of Bath; J. Morris, MPH, Cogentia Healthcare Consulting Ltd.; N. Hawkins, PhD, Health Economics and Health Technology Assessment, University of Glasgow; C. Cavill, BSc, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, NHS Foundation Trust; F. Mughal, MPharm, Celgene Ltd. (formerly)
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Himmler S, Mueller M, Sherif B, Ostwald D. A case study applying a novel approach to estimate the social impact of a medical innovation - the use of secukinumab for psoriatic arthritis in Germany. Expert Rev Pharmacoecon Outcomes Res 2019; 20:369-378. [DOI: 10.1080/14737167.2019.1644169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Bintu Sherif
- Biostatistics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Dennis Ostwald
- Health Economics, WifOR GmbH, Darmstadt, Germany
- School of International Business and Entrepreneurship (SIBE), Steinbeis University Berlin, Berlin, Germany
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Aiello E, Bianculli PM, Bhattacharyya D, Gunda P, Citera G. Cost-Effectiveness of Secukinumab Versus Other Biologics in the Treatment of Psoriatic Arthritis: An Argentinean Perspective. Value Health Reg Issues 2019; 20:86-94. [PMID: 31103950 DOI: 10.1016/j.vhri.2019.03.002] [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] [Received: 07/16/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. This study assessed the cost-effectiveness of secukinumab, an interleukin-17A inhibitor, versus other biologics in PsA from the Argentinean social security perspective. METHODS A semi-Markov model evaluated subcutaneous (sc) treatment with secukinumab 150 mg and 300 mg against other sc treatments such as adalimumab, certolizumab pegol, etanercept, golimumab, ustekinumab, and intravenous treatment infliximab in biologic-naïve (with or without moderate to severe psoriasis) and biologic-experienced PsA patients over a lifetime horizon. Response to treatments was determined using the PsA Response Criteria (PsARC) at 12 weeks. Model inputs were derived from randomized controlled trials, network meta-analyses, published literature, and other Argentinean sources. Model outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios. Sensitivity analyses and alternative scenarios with a higher cost option were also conducted. RESULTS Among biologic-naïve PsA patients without psoriasis, secukinumab 150 mg provided the highest QALYs (7.18) versus all sc biologics at the lowest cost ($3 755 678 Argentine peso), thus dominating them. Among biologic-naïve PsA patients with psoriasis and biologic-experienced PsA patients, secukinumab 300 mg provided highest QALYs (6.99 and 7.53, respectively), dominated infliximab, and was cost-effective versus other sc biologics. Deterministic sensitivity analyses indicated sensitivity of results to variation in PsARC rates, drug acquisition costs, Health Assessment Questionnaire change, and utilities. A probabilistic sensitivity analysis showed maximum net monetary benefits with both secukinumab doses. Results from an alternative scenario analysis were similar to base-case analysis. CONCLUSIONS For both biologic-naïve and experienced PsA patients, secukinumab is either a dominant or cost-effective treatment option compared with other biologics in Argentina.
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Affiliation(s)
| | | | | | - Praveen Gunda
- Novartis Healthcare Private Limited, Hyderabad, India
| | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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Neilson C, Lê ML. A failed attempt at developing a search filter for systematic review methodology articles in Ovid Embase. J Med Libr Assoc 2019; 107:203-209. [PMID: 31019389 PMCID: PMC6466493 DOI: 10.5195/jmla.2019.519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This paper describes the development, execution, and subsequent failure of an attempt to create an Ovid Embase search filter for locating systematic review methodology articles. METHODS The authors devised a work plan, based on best practices, for search filter development that has been outlined in the literature. Three reference samples were gathered by identifying the OVID Embase records for specific articles that were included in the PubMed Systematic Review Methods subset. The first sample was analyzed to develop a set of keywords and subject headings to include in the search filter. The second and third samples would have been used to calibrate the search filter and to calculate filter sensitivity and precision, respectively. RESULTS Technical shortcomings, database indexing practices, and the fuzzy nature of keyword terminology relevant to the topic prevented us from designing the search filter. CONCLUSION Creating a search filter to identify systematic review methodology articles in Ovid Embase is not possible at this time.
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Affiliation(s)
- Christine Neilson
- Neil John Maclean Health Sciences Library, University of Manitoba-Winnipeg, Canada,
| | - Mê-Linh Lê
- Neil John Maclean Health Sciences Library, University of Manitoba-Winnipeg, Canada,
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Smith K, Golder S, Sarker A, Loke Y, O'Connor K, Gonzalez-Hernandez G. Methods to Compare Adverse Events in Twitter to FAERS, Drug Information Databases, and Systematic Reviews: Proof of Concept with Adalimumab. Drug Saf 2018; 41:1397-1410. [PMID: 30167992 PMCID: PMC6223697 DOI: 10.1007/s40264-018-0707-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are associated with significant health-related and financial burden, and multiple sources are currently utilized to actively discover them. Social media has been proposed as a potential resource for monitoring ADRs, but drug-specific analytical studies comparing social media with other sources are scarce. OBJECTIVES Our objective was to develop methods to compare ADRs mentioned in social media with those in traditional sources: the US FDA Adverse Event Reporting System (FAERS), drug information databases (DIDs), and systematic reviews. METHODS A total of 10,188 tweets mentioning adalimumab collected between June 2014 and August 2016 were included. ADRs in the corpus were extracted semi-automatically and manually mapped to standardized concepts in the Unified Medical Language System. ADRs were grouped into 16 biologic categories for comparisons. Frequencies, relative frequencies, disproportionality analyses, and rank ordering were used as metrics. RESULTS There was moderate agreement between ADRs in social media and traditional sources. "Local and injection site reactions" was the top ADR in Twitter, DIDs, and systematic reviews by frequency, ranked frequency, and index ranking. The next highest ADR in Twitter-fatigue-ranked fifth and seventh in FAERS and DIDs. CONCLUSION Social media posts often express mild and symptomatic ADRs, but rates are measured differently in scientific sources. ADRs in FAERS are reported as absolute numbers, in DIDs as percentages, and in systematic reviews as percentages, risk ratios, or other metrics, which makes comparisons challenging; however, overlap is substantial. Social media analysis facilitates open-ended investigation of patient perspectives and may reveal concepts (e.g. anxiety) not available in traditional sources.
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Affiliation(s)
- Karen Smith
- Rueckert-Hartman College for Health Professions, Regis University, Denver, CO, USA
| | - Su Golder
- Department of Health Sciences, University of York, York, UK
| | - Abeed Sarker
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yoon Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Graciela Gonzalez-Hernandez
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Purmonen T, Puolakka K, Bhattacharyya D, Jain M, Martikainen J. Cost-effectiveness analysis of secukinumab versus other biologics and apremilast in the treatment of active Psoriatic arthritis: a Finnish perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:56. [PMID: 30479574 PMCID: PMC6240184 DOI: 10.1186/s12962-018-0162-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/08/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To study cost-effectiveness of an interleukin (IL)-17A inhibitor secukinumab, with other biologics and apremilast in patients with Psoriatic arthritis (PsA) from payer perspective in Finland. METHODS In this semi-Markov model, subcutaneous (SC) secukinumab was compared with SC treatments etanercept and its biosimilar, certolizumab pegol, adalimumab and its biosimilar, golimumab, ustekinumab, intravenous (IV) treatment infliximab, as well as oral non-biologic apremilast. Patients without prior exposure (naïve) to biologics and without moderate to severe psoriasis were considered for secukinumab 150 mg group. Secukinumab 300 mg group included naïve patients with moderate to severe psoriasis and all patients with prior biologic exposure. The PsA Response Criteria (PsARC) at 12-week was primary criteria for treatment response. Other clinical as well as cost related model inputs were derived from relevant clinical trials as well as Finnish publications. The key model outcomes were quality-adjusted life years and incremental cost-effectiveness ratio. An annual 3% discount rate was applied to all future costs and benefits. Model input variations were assessed through sensitivity analyses and alternative scenario analyses. RESULTS For a lifetime horizon (60 years), secukinumab 150 mg dominated all branded SC biologics and apremilast with highest QALY of 8.01 and lowest lifetime cost of €187,776, while it was cost-effective against IV infliximab among biologic-naïve patients without moderate to severe psoriasis. Secukinumab 300 mg was cost-effective against all branded SC biologics and apremilast and dominated IV infliximab among biologic-naïve patients with moderate to severe psoriasis, while it was cost-effective in biologic experienced patients. With the one-way sensitivity analysis, PsARC response, drug acquisition cost, and health assessment questionnaire score were the most important parameters affecting the outcomes. Across all treatment groups, patients on secukinumab were most likely to achieve highest net monetary benefit than other competitors in probabilistic sensitivity analysis. With alternative scenario analysis, results largely remained unchanged. CONCLUSIONS Secukinumab is a cost-effective treatment for PsA patients from a Finnish payer's perspective.
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Affiliation(s)
| | - Kari Puolakka
- South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Devarshi Bhattacharyya
- Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - Minal Jain
- Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
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Duarte A, Mebrahtu T, Goncalves PS, Harden M, Murphy R, Palmer S, Woolacott N, Rodgers M, Rothery C. Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-244. [PMID: 29105621 DOI: 10.3310/hta21640] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. DATA SOURCES Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. REVIEW METHODS Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. RESULTS Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks' follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE's usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. LIMITATIONS The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. CONCLUSIONS The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. STUDY REGISTRATION This study is registered as PROSPERO CRD42016039494. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | | | | | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ruth Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
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Corbett M, Chehadah F, Biswas M, Moe-Byrne T, Palmer S, Soares M, Walton M, Harden M, Ho P, Woolacott N, Bojke L. Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation. Health Technol Assess 2018; 21:1-326. [PMID: 28976302 DOI: 10.3310/hta21560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Several biologic therapies are approved by the National Institute for Health and Care Excellence (NICE) for psoriatic arthritis (PsA) patients who have had an inadequate response to two or more synthetic disease-modifying antirheumatic drugs (DMARDs). NICE does not specifically recommend switching from one biologic to another, and only ustekinumab (UST; STELARA®, Janssen Pharmaceuticals, Inc., Horsham, PA, USA) is recommended after anti-tumour necrosis factor failure. Secukinumab (SEC; COSENTYX®, Novartis International AG, Basel, Switzerland) and certolizumab pegol (CZP; CIMZIA®, UCB Pharma, Brussels, Belgium) have not previously been appraised by NICE. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of CZP and SEC for treating active PsA in adults in whom DMARDs have been inadequately effective. DESIGN Systematic review and economic model. DATA SOURCES Fourteen databases (including MEDLINE and EMBASE) were searched for relevant studies from inception to April 2016 for CZP and SEC studies; update searches were run to identify new comparator studies. REVIEW METHODS Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis (NMA) methods to investigate the relative efficacy of SEC and CZP compared with comparator therapies. A de novo model was developed to assess the cost-effectiveness of SEC and CZP compared with the other relevant comparators. The model was specified for three subpopulations, in accordance with the NICE scope (patients who have taken one prior DMARD, patients who have taken two or more prior DMARDs and biologic-experienced patients). The models were further classified according to the level of concomitant psoriasis. RESULTS Nineteen eligible RCTs were included in the systematic review of short-term efficacy. Most studies were well conducted and were rated as being at low risk of bias. Trials of SEC and CZP demonstrated clinically important efficacy in all key clinical outcomes. At 3 months, patients taking 150 mg of SEC [relative risk (RR) 6.27, 95% confidence interval (CI) 2.55 to 15.43] or CZP (RR 3.29, 95% CI 1.94 to 5.56) were more likely to be responders than patients taking placebo. The NMA results for the biologic-naive subpopulations indicated that the effectiveness of SEC and CZP relative to other biologics and each other was uncertain. Limited data were available for the biologic-experienced subpopulation. Longer-term evidence suggested that these newer biologics reduced disease progression, with the benefits being similar to those seen for older biologics. The de novo model generated incremental cost-effectiveness ratios (ICERs) for three subpopulations and three psoriasis subgroups. In subpopulation 1 (biologic-naive patients who had taken one prior DMARD), CZP was the optimal treatment in the moderate-severe psoriasis subgroup and 150 mg of SEC was optimal in the subgroups of patients with mild-moderate psoriasis or no concomitant psoriasis. In subpopulation 2 (biologic-naive patients who had taken two or more prior DMARDs), etanercept (ETN; ENBREL®, Pfizer Inc., New York City, NY, USA) is likely to be the optimal treatment in all subgroups. The ICERs for SEC and CZP versus best supportive care are in the region of £20,000-30,000 per quality-adjusted life-year (QALY). In subpopulation 3 (biologic-experienced patients or patients in whom biologics are contraindicated), UST is likely to be the optimal treatment (ICERs are in the region of £21,000-27,000 per QALY). The optimal treatment in subpopulation 2 was sensitive to the choice of evidence synthesis model. In subpopulations 2 and 3, results were sensitive to the algorithm for Health Assessment Questionnaire-Disability Index costs. The optimal treatment is not sensitive to the use of biosimilar prices for ETN and infliximab (REMICADE®, Merck Sharp & Dohme, Kenilworth, NJ, USA). CONCLUSIONS SEC and CZP may be an effective use of NHS resources, depending on the subpopulation and subgroup of psoriasis severity. There are a number of limitations to this assessment, driven mainly by data availability. FUTURE WORK Trials are needed to inform effectiveness of biologics in biologic-experienced populations. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033357. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Fadi Chehadah
- Centre for Health Economics, University of York, York, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Matthew Walton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Pauline Ho
- The Kellgren Centre for Rheumatology, Central Manchester and Manchester Children's University Hospitals Trust, Manchester, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
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Buchanan V, Sullivan W, Graham C, Miles L, Jugl SM, Gunda P, Halliday A, Kirkham B. Cost Effectiveness of Secukinumab for the Treatment of Active Psoriatic Arthritis in the UK. PHARMACOECONOMICS 2018; 36:867-878. [PMID: 29797187 PMCID: PMC5999172 DOI: 10.1007/s40273-018-0674-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim was to determine the cost effectiveness of secukinumab, a fully human interleukin-17A inhibitor, for adults in the UK with active psoriatic arthritis (PsA) who are tumour necrosis factor inhibitor (TNFi) naïve and without concomitant moderate-to-severe psoriasis, and who have responded inadequately to conventional systemic disease-modifying anti-rheumatic drugs (csDMARDs). PERSPECTIVE AND SETTING The study took the perspective and setting of the UK National Health Service (NHS). METHODS The model structure was a 3-month decision tree leading into a Markov model. Separate analyses based on the number of prior csDMARDs (one and two or more) were conducted, with secukinumab 150 mg compared to standard of care (SoC) and TNFis, respectively, for each subpopulation. Clinical parameters, including response at 3 months, were from the FUTURE 2 trial and a network meta-analysis. Outcomes included total costs and quality-adjusted life years (QALYs) over the 40-year time horizon (3.5% annual discount for both outcomes; cost year 2017), and incremental cost effectiveness ratios (ICERs). RESULTS The ICER for secukinumab 150 mg versus SoC was £28,748 per QALY gained (one prior csDMARD). Secukinumab 150 mg dominated golimumab, certolizumab pegol and etanercept, and had an ICER of £5680 per QALY gained versus adalimumab and > £1 million saved per QALY foregone versus infliximab (two or more prior csDMARDs). Valuing one QALY at between £20,000 and £30,000, the probability of secukinumab having the highest net monetary benefit was 48.9% (one prior csDMARD) and 88.9% (two or more prior csDMARDs). Parameters related to Health Assessment Questionnaire scores were most influential. CONCLUSIONS Secukinumab 150 mg at list price appears to represent a cost-effective use of NHS resources for adults with PsA who have responded inadequately to one or two or more prior csDMARDs.
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Affiliation(s)
| | | | - Chris Graham
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Praveen Gunda
- Novartis Healthcare Private Limited, Hyderabad, India
| | | | - Bruce Kirkham
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
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Cohen HP, Blauvelt A, Rifkin RM, Danese S, Gokhale SB, Woollett G. Switching Reference Medicines to Biosimilars: A Systematic Literature Review of Clinical Outcomes. Drugs 2018; 78:463-478. [PMID: 29500555 PMCID: PMC5854749 DOI: 10.1007/s40265-018-0881-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION To evaluate the possibility that switching from reference biologic medicines to biosimilars could lead to altered clinical outcomes, including enhanced immunogenicity, compromised safety, or diminished efficacy for patients, a systematic literature review was conducted of all switching studies between related biologics (including biosimilars). METHODS A systematic search was conducted using the Medline® and Embase® databases up to 30 June 2017 employing specific medical subject heading terms. Additionally, the snowball method and a hand search were also applied. Publications were considered if they contained efficacy or safety information related to a switch from a reference medicine to a biosimilar. Non-English, non-human studies, editorials, notes, and short surveys were excluded. RESULTS Primary data were available from 90 studies that enrolled 14,225 unique individuals. They included protein medicines used in supportive care as well as those used as therapeutic agents. The medicines contained seven different molecular entities that were used to treat 14 diseases. The great majority of the publications did not report differences in immunogenicity, safety, or efficacy. The nature and intensity of safety signals reported after switching from reference medicines to biosimilars were the same as those already known from continued use of the reference medicines alone. Three large multiple switch studies with different biosimilars did not show differences in efficacy or safety after multiple switches between reference medicine and biosimilar. Two publications reported a loss of efficacy or increased dropout rates. CONCLUSIONS While use of each biologic must be assessed individually, these results provide reassurance to healthcare professionals and the public that the risk of immunogenicity-related safety concerns or diminished efficacy is unchanged after switching from a reference biologic to a biosimilar medicine.
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Affiliation(s)
- Hillel P Cohen
- Sandoz Inc., 100 College Road West, Princeton, NJ, 08540, USA.
| | | | | | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Hospital, Milan, Italy
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Dhar SK, Das M. Engineering Antibodies. J Indian Inst Sci 2018. [DOI: 10.1007/s41745-018-0061-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goeree R, Chiva-Razavi S, Gunda P, Graham CN, Miles L, Nikoglou E, Jugl SM, Gladman DD. Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective. J Med Econ 2018; 21:163-173. [PMID: 28945143 DOI: 10.1080/13696998.2017.1384737] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. METHODS A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. RESULTS Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses indicated the results were most sensitive to variation in PsARC response rates, change in HAQ, and utility values in both populations. CONCLUSIONS Secukinumab is either dominant or cost-effective vs all licensed biologics for the treatment of active PsA in biologic-naive and biologic-experienced populations in Canada.
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MESH Headings
- Adult
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/economics
- Arthritis, Psoriatic/diagnostic imaging
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/economics
- Biological Products/administration & dosage
- Biological Products/economics
- Biological Products/pharmacology
- Biosimilar Pharmaceuticals/administration & dosage
- Biosimilar Pharmaceuticals/economics
- Canada
- Cost-Benefit Analysis
- Decision Support Techniques
- Drug Administration Schedule
- Drug Costs
- Female
- Follow-Up Studies
- Humans
- Injections, Subcutaneous
- Male
- Markov Chains
- Quality-Adjusted Life Years
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Ron Goeree
- a Goeree Consulting Ltd , Hamilton , Ontario , Canada
- b McMaster University , Hamilton , Ontario , Canada
| | | | - Praveen Gunda
- d Novartis Product Life Cycle Services-NBS, Novartis Healthcare Private Limited , Hyderabad , India
| | | | - LaStella Miles
- e RTI Health Solutions , Research Triangle Park , NC , USA
| | - Efthalia Nikoglou
- f Novartis Product Lifecycle Services - NBS, Novartis Global Service Center , Dublin , Ireland
| | | | - Dafna D Gladman
- h Toronto Western Hospital, University of Toronto , Toronto , Ontario , Canada
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Glover M, Montague E, Pollitt A, Guthrie S, Hanney S, Buxton M, Grant J. Estimating the returns to United Kingdom publicly funded musculoskeletal disease research in terms of net value of improved health outcomes. Health Res Policy Syst 2018; 16:1. [PMID: 29316935 PMCID: PMC5761203 DOI: 10.1186/s12961-017-0276-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/12/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Building on an approach applied to cardiovascular and cancer research, we estimated the economic returns from United Kingdom public- and charitable-funded musculoskeletal disease (MSD) research that arise from the net value of the improved health outcomes in the United Kingdom. METHODS To calculate the economic returns from MSD-related research in the United Kingdom, we estimated (1) the public and charitable expenditure on MSD-related research in the United Kingdom between 1970 and 2013; (2) the net monetary benefit (NMB), derived from the health benefit in quality adjusted life years (QALYs) valued in monetary terms (using a base-case value of a QALY of £25,000) minus the cost of delivering that benefit, for a prioritised list of interventions from 1994 to 2013; (3) the proportion of NMB attributable to United Kingdom research; and (4) the elapsed time between research funding and health gain. The data collected from these four key elements were used to estimate the internal rate of return (IRR) from MSD-related research investments on health benefits. We analysed the uncertainties in the IRR estimate using a one-way sensitivity analysis. RESULTS Expressed in 2013 prices, total expenditure on MSD-related research from 1970 to 2013 was £3.5 billion, and for the period used to estimate the rate of return, 1978-1997, was £1.4 billion. Over the period 1994-2013 the key interventions analysed produced 871,000 QALYs with a NMB of £16 billion, allowing for the net NHS costs resulting from them and valuing a QALY at £25,000. The proportion of benefit attributable to United Kingdom research was 30% and the elapsed time between funding and impact of MSD treatments was 16 years. Our best estimate of the IRR from MSD-related research was 7%, which is similar to the 9% for CVD and 10% for cancer research. CONCLUSIONS Our estimate of the IRR from the net health gain to public and charitable funding of MSD-related research in the United Kingdom is substantial, and justifies the research investments made between 1978 and 1997. We also demonstrated the applicability of the approach previously used in assessing the returns from cardiovascular and cancer research. Inevitably, with a study of this kind, there are a number of important assumptions and caveats that we highlight, and these can inform future research.
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Affiliation(s)
- Matthew Glover
- Health Economics Research Group, Brunel University London, Uxbridge, United Kingdom
| | - Erin Montague
- Policy Institute at King’s, King’s College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE United Kingdom
| | - Alexandra Pollitt
- Policy Institute at King’s, King’s College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE United Kingdom
| | | | - Stephen Hanney
- Health Economics Research Group, Brunel University London, Uxbridge, United Kingdom
| | - Martin Buxton
- Health Economics Research Group, Brunel University London, Uxbridge, United Kingdom
| | - Jonathan Grant
- Policy Institute at King’s, King’s College London, Virginia Woolf Building, 22 Kingsway, London, WC2B 6LE United Kingdom
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Mahlich J, Kamae I, Sruamsiri R. Pharmaceutical pricing in Japan: market evidence for rheumatoid arthritis treatment. Expert Rev Pharmacoecon Outcomes Res 2017; 18:339-348. [PMID: 29039214 DOI: 10.1080/14737167.2018.1394187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Drug price setting is one of the key challenges faced by the Japanese health care system. This study aims to identify the determinants of drug price in Japan using the example of the rheumatoid arthritis (RA) treatment market. RESEARCH DESIGN AND METHODS In order to compare prices across different products, we calculated prices per defined daily dose using WHO methodology. Price determinants were calculated both at launch and over time using IMS quarterly data on medicines approved for RA treatment in Japan from 2012 to 2015. Pharmaceutical pricing was modeled as a function of clinical and economic variables using regression analysis. RESULTS For prices at the launch we found that differences in efficacy are not reflected in price differentials. We also report that the number of products within a molecule class had a negative effect on prices while originator drugs maintained higher prices. CONCLUSION Although the existing pricing rules in Japan are very comprehensive they do not necessarily capture differences in product characteristics. The findings here support the notion that competitive forces are weak in highly regulated markets such as Japan.
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Affiliation(s)
- Jörg Mahlich
- a Health Economics , Janssen Pharmaceutical KK , Tokyo , Japan.,b Düsseldorf Institute for Competition Economics (DICE) , University of Düsseldorf , Düsseldorf , Germany
| | - Isao Kamae
- c Graduate School of Public Policy , The University of Tokyo , Tokyo , Japan.,d The Canon Institute for Global Studies , Tokyo , Japan
| | - Rosarin Sruamsiri
- a Health Economics , Janssen Pharmaceutical KK , Tokyo , Japan.,e Center of Pharmaceutical Outcomes Research , Naresuan University , Phitsanulok , Thailand
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Kuznik A, Bégo-Le-Bagousse G, Eckert L, Gadkari A, Simpson E, Graham CN, Miles L, Mastey V, Mahajan P, Sullivan SD. Economic Evaluation of Dupilumab for the Treatment of Moderate-to-Severe Atopic Dermatitis in Adults. Dermatol Ther (Heidelb) 2017; 7:493-505. [PMID: 28933010 PMCID: PMC5698200 DOI: 10.1007/s13555-017-0201-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Dupilumab significantly improves signs and symptoms of atopic dermatitis (AD), including pruritus, symptoms of anxiety and depression, and health-related quality of life versus placebo in adults with moderate-to-severe AD. Since the cost-effectiveness of dupilumab has not been evaluated, the objective of this analysis was to estimate a value-based price range in which dupilumab would be considered cost-effective compared with supportive care (SC) for treatment of moderate-to-severe AD in an adult population. Methods A health economic model was developed to evaluate from the US payer perspective the long-term costs and benefits of dupilumab treatment administered every other week (q2w). Dupilumab q2w was compared with SC; robustness of assumptions and results were tested using sensitivity and scenario analyses. Clinical data were derived from the dupilumab LIBERTY AD SOLO trials; healthcare use and cost data were from health insurance claims histories of adult patients with AD. The annual price of maintenance therapy with dupilumab to be considered cost-effective was estimated for decision thresholds of US$100,000 and $150,000 per quality-adjusted life-year (QALY) gained. Results In the base case, the annual maintenance price for dupilumab therapy to be considered cost-effective would be $28,770 at a $100,000 per QALY gained threshold, and $39,940 at a $150,000 threshold. Results were generally robust to parameter variations in one-way and probabilistic sensitivity analyses. Conclusion Dupilumab q2w compared with SC is cost-effective for the treatment of moderate-to-severe AD in US adults at an annual price of maintenance therapy in the range of $29,000–$40,000 at the $100,000–$150,000 per QALY thresholds. Funding Sanofi and Regeneron Pharmaceuticals, Inc.
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Affiliation(s)
| | | | | | | | - Eric Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | | | - Vera Mastey
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Sean D Sullivan
- Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
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Bojke L, Manca A, Asaria M, Mahon R, Ren S, Palmer S. How to Appropriately Extrapolate Costs and Utilities in Cost-Effectiveness Analysis. PHARMACOECONOMICS 2017; 35:767-776. [PMID: 28470594 DOI: 10.1007/s40273-017-0512-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Costs and utilities are key inputs into any cost-effectiveness analysis. Their estimates are typically derived from individual patient-level data collected as part of clinical studies the follow-up duration of which is often too short to allow a robust quantification of the likely costs and benefits a technology will yield over the patient's entire lifetime. In the absence of long-term data, some form of temporal extrapolation-to project short-term evidence over a longer time horizon-is required. Temporal extrapolation inevitably involves assumptions regarding the behaviour of the quantities of interest beyond the time horizon supported by the clinical evidence. Unfortunately, the implications for decisions made on the basis of evidence derived following this practice and the degree of uncertainty surrounding the validity of any assumptions made are often not fully appreciated. The issue is compounded by the absence of methodological guidance concerning the extrapolation of non-time-to-event outcomes such as costs and utilities. This paper considers current approaches to predict long-term costs and utilities, highlights some of the challenges with the existing methods, and provides recommendations for future applications. It finds that, typically, economic evaluation models employ a simplistic approach to temporal extrapolation of costs and utilities. For instance, their parameters (e.g. mean) are typically assumed to be homogeneous with respect to both time and patients' characteristics. Furthermore, costs and utilities have often been modelled to follow the dynamics of the associated time-to-event outcomes. However, cost and utility estimates may be more nuanced, and it is important to ensure extrapolation is carried out appropriately for these parameters.
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Affiliation(s)
- Laura Bojke
- Centre for Health Economics, University of York, Heslington, York, yo10 5dd, UK.
| | - Andrea Manca
- Centre for Health Economics, University of York, Heslington, York, yo10 5dd, UK
| | - Miqdad Asaria
- Centre for Health Economics, University of York, Heslington, York, yo10 5dd, UK
| | - Ronan Mahon
- Centre for Health Economics, University of York, Heslington, York, yo10 5dd, UK
| | | | - Stephen Palmer
- Centre for Health Economics, University of York, Heslington, York, yo10 5dd, UK
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Patton T, Bojke L, Walton M, Manca A, Helliwell P. Evaluating the cost-effectiveness of biologic treatments for psoriatic arthritis: can we make better use of patient data registries? Clin Rheumatol 2017; 36:1803-1810. [PMID: 28612241 PMCID: PMC5519654 DOI: 10.1007/s10067-017-3703-9] [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: 05/18/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
The primary aim of this study is to explore the extent to which registry data may fulfill the evidence requirements of cost-effectiveness analysis (CEA) studies evaluating biologic therapies for the treatment of psoriatic arthritis (PsA), where trial data are lacking or insufficient. In addition, the paper aims to identify how future data collection in PsA registries might be better tailored to inform CEA research. A review of the literature was performed to identify existing registries containing PsA patients. Where possible, information was extracted on the design and characteristics of the registries. The registries were then appraised according to a set of criteria that was formulated based on the methods currently used to model PsA in the CEA literature. A review of the literature identified 21 potentially relevant registries from around the world containing patients with PsA. There was substantial variation regarding the extent to which the registries, as a whole, were useful for the purposes of CEA studies. There were also notable disparities found in terms of the accessibility of the registries to researchers. The critical review conducted in this study showed that all of the registries identified are potentially useful, at least in some degree, for the purposes of informing CEA studies in PsA. However, no individual registry on its own was found to meet all of the evidence requirements when considering how the disease has been modeled previously.
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Affiliation(s)
- Thomas Patton
- Centre for Health Economics, University of York, York, YO10 5DD, UK.
| | - Laura Bojke
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Matthew Walton
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Philip Helliwell
- Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
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Schwartzman S, Li Y, Zhou H, Palmer JB. Economic impact of biologic utilization patterns in patients with psoriatic arthritis. Clin Rheumatol 2017; 36:1579-1588. [PMID: 28474139 PMCID: PMC5486473 DOI: 10.1007/s10067-017-3636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/16/2022]
Abstract
The aim of the study is to examine the frequency and costs associated with above-label dosing of biologics in patients with psoriatic arthritis (PsA). MarketScan identified adults with ≥1 International Classification of Diseases, Clinical Modification diagnosis for PsA and ≥1 pharmacy claim for biologics of interest between January 1, 2011 and December 31, 2013. The first biologic claim was the index date with a 1-year follow-up period and three additional months to confirm continuous biologic use. Exclusion criteria included switching to a different biologic or diagnosis with another autoimmune disease. During the follow-up period, duration was stratified into three groups: <30, 30–179, and ≥180 days of above-label dosing (>10% of the labeled dose). One-tailed t test was conducted to examine the impact of above-label duration on healthcare costs. We identified 4245 PsA patients receiving etanercept (n = 2342), adalimumab (n = 1788), and golimumab (n = 115). Above-label dosing of <30 days (85% adalimumab, 90.4% etanercept, and 95.7% golimumab) and ≥180 days (9.6% adalimumab, 4.1% etanercept, and 2.6% golimumab) was observed. All-cause total healthcare costs for <30 days of above-label use (etanercept $30,625, adalimumab $31,620, and golimumab $37,224), 30–179 days (etanercept $35,602, adalimumab $38,915, and golimumab $64,349), and ≥180 days (etanercept $55,349, adalimumab $54,176, and golimumab $47,993) were reported. Longer above-label duration (30–179 versus <30 days, ≥180 versus 30–179 and ≥180 days) with etanercept or adalimumab was significantly associated with higher mean increased total all-cause healthcare, PsA-specific healthcare, and biologic costs (p < 0.05). Above-label use of anti-TNF biologics does occur and is associated with significantly increased healthcare costs.
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Affiliation(s)
- Sergio Schwartzman
- The Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
| | - Yunfeng Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Vustina VV, Grigoriadi NE, Korotayeva TV. Efficacy of the combined therapy with etanercept and methotrexat at the female patient with generalized pustular psoriasis and arthritis psoriasis after the therapeutic failure of two the TNF-α receptor inhibitors. Case study. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-6-94-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the clinical observation effectiveness of TNF-a inhibitor etanercept in patients with generalized pustular psoriasis and PsA, resistant to treatment by other drugs of this class. It presents the current recommendations for the management of patients with pustular psoriasis.
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Strand V, Husni E, Griffith J, Zhou ZY, Signorovitch J, Ganguli A. Economic Evaluation of Timely Versus Delayed Use of Tumor Necrosis Factor Inhibitors for Treatment of Psoriatic Arthritis in the US. Rheumatol Ther 2016; 3:305-322. [PMID: 27747584 PMCID: PMC5127966 DOI: 10.1007/s40744-016-0042-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The present study aimed to evaluate clinical outcomes and costs associated with timely versus delayed use of tumor necrosis factor inhibitors (TNFis) among patients with moderately to severely active psoriatic arthritis (PsA) with and without moderate/severe psoriasis (Ps) from a US payer's perspective. METHODS An economic model evaluated PsA patients initially treated with a TNFi (timely TNFi use) or apremilast (delayed TNFi use). Patients without joint (American College of Rheumatology 20%, [ACR20]) improvement either switched TNFis or initiated one. ACR20 responses were evaluated for all patients and skin responses by Psoriasis Area Severity Index 75% (PASI75) for those with concomitant PsA and Ps. Published randomized controlled trials and publicly available databases provided model inputs. Effectiveness measures included 1-year responses and number needed to treat (NNT). Direct costs, costs per responder, and incremental costs per responder were calculated. RESULTS After 1 year, timely TNFi-treated patients had higher ACR20 responses (70.4% vs. 59.6%) and lower NNTs (1.42 vs. 1.68) compared with delayed use. Among PsA + Ps patients, timely TNFi use was associated with higher ACR20 + PASI75 responses (41.0% vs. 30.0%) and lower NNTs (2.44 vs. 3.33). Cost per ACR20 responder was higher ($56,492 vs. $52,835) among PsA patients without Ps; with concomitant Ps, cost per ACR20 + PASI75 responder was lower for timely TNFi use ($100,954 vs. $111,686). Incremental costs per responder for timely versus delayed TNFi were $76,823 in PsA and $71,791 in PsA and Ps. CONCLUSION Timely use of TNFis is a cost-effective strategy for the management of PsA based on improvements in both joint and/or skin disease. FUNDING AbbVie Inc.
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Sideris E, Corbett M, Palmer S, Woolacott N, Bojke L. The Clinical and Cost Effectiveness of Apremilast for Treating Active Psoriatic Arthritis: A Critique of the Evidence. PHARMACOECONOMICS 2016; 34:1101-1110. [PMID: 27272887 DOI: 10.1007/s40273-016-0419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As part of the National Institute for Health and Clinical Excellence (NICE) single technology appraisal (STA) process, the manufacturer of apremilast was invited to submit evidence for its clinical and cost effectiveness for the treatment of active psoriatic arthritis (PsA) for whom disease-modifying anti-rheumatic drugs (DMARDs) have been inadequately effective, not tolerated or contraindicated. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This paper provides a description of the ERG review of the company's submission, the ERG report and submission and summarises the NICE Appraisal Committee's subsequent guidance (December 2015). In the company's initial submission, the base-case analysis resulted in an incremental cost-effectiveness ratio (ICER) of £14,683 per quality-adjusted life-year (QALY) gained for the sequence including apremilast (positioned before tumour necrosis factor [TNF]-α inhibitors) versus a comparator sequence without apremilast. However, the ERG considered that the base-case sequence proposed by the company represented a limited set of potentially relevant treatment sequences and positions for apremilast. The company's base-case results were therefore not a sufficient basis to inform the most efficient use and position of apremilast. The exploratory ERG analyses indicated that apremilast is more effective (i.e. produces higher health gains) when positioned after TNF-α inhibitor therapies. Furthermore, assumptions made regarding a potential beneficial effect of apremilast on long-term Health Assessment Questionnaire (HAQ) progression, which cannot be substantiated, have a very significant impact on results. The NICE Appraisal Committee (AC), when taking into account their preferred assumptions for HAQ progression for patients on treatment with apremilast, placebo response and monitoring costs for apremilast, concluded that the addition of apremilast resulted in cost savings but also a QALY loss. These cost savings were not high enough to compensate for the clinical effectiveness that would be lost. The AC thus decided that apremilast alone or in combination with DMARD therapy is not recommended for treating adults with active PsA that has not responded to prior DMARD therapy, or where such therapy is not tolerated.
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Affiliation(s)
- Eleftherios Sideris
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
| | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
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Corbett M, Soares M, Jhuti G, Rice S, Spackman E, Sideris E, Moe-Byrne T, Fox D, Marzo-Ortega H, Kay L, Woolacott N, Palmer S. Tumour necrosis factor-α inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review and economic evaluation. Health Technol Assess 2016; 20:1-334, v-vi. [PMID: 26847392 DOI: 10.3310/hta20090] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tumour necrosis factor (TNF)-α inhibitors (anti-TNFs) are typically used when the inflammatory rheumatologic diseases ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-AxSpA) have not responded adequately to conventional therapy. Current National Institute for Health and Care Excellence (NICE) guidance recommends treatment with adalimumab, etanercept and golimumab in adults with active (severe) AS only if certain criteria are fulfilled but it does not recommend infliximab for AS. Anti-TNFs for patients with nr-AxSpA have not previously been appraised by NICE. OBJECTIVE To determine the clinical effectiveness, safety and cost-effectiveness within the NHS of adalimumab, certolizumab pegol, etanercept, golimumab and infliximab, within their licensed indications, for the treatment of severe active AS or severe nr-AxSpA (but with objective signs of inflammation). DESIGN Systematic review and economic model. DATA SOURCES Fifteen databases were searched for relevant studies in July 2014. REVIEW METHODS Clinical effectiveness data from randomised controlled trials (RCTs) were synthesised using Bayesian network meta-analysis methods. Results from other studies were summarised narratively. Only full economic evaluations that compared two or more options and considered both costs and consequences were included in the systematic review of cost-effectiveness studies. The differences in the approaches and assumptions used across the studies, and also those in the manufacturer's submissions, were examined in order to explain any discrepancies in the findings and to identify key areas of uncertainty. A de novo decision model was developed with a generalised framework for evidence synthesis that pooled change in disease activity (BASDAI and BASDAI 50) and simultaneously synthesised information on function (BASFI) to determine the long-term quality-adjusted life-year and cost burden of the disease in the economic model. The decision model was developed in accordance with the NICE reference case. The model has a lifetime horizon (60 years) and considers costs from the perspective of the NHS and personal social services. Health effects were expressed in terms of quality-adjusted life-years. RESULTS In total, 28 eligible RCTs were identified and 26 were placebo controlled (mostly up to 12 weeks); 17 extended into open-label active treatment-only phases. Most RCTs were judged to have a low risk of bias overall. In both AS and nr-AxSpA populations, anti-TNFs produced clinically important benefits to patients in terms of improving function and reducing disease activity; for AS, the relative risks for ASAS 40 ranged from 2.53 to 3.42. The efficacy estimates were consistently slightly smaller for nr-AxSpA than for AS. Statistical (and clinical) heterogeneity was more apparent in the nr-AxSpA analyses than in the AS analyses; both the reliability of the nr-AxSpA meta-analysis results and their true relevance to patients seen in clinical practice are questionable. In AS, anti-TNFs are approximately equally effective. Effectiveness appears to be maintained over time, with around 50% of patients still responding at 2 years. Evidence for an effect of anti-TNFs delaying disease progression was limited; results from ongoing long-term studies should help to clarify this issue. Sequential treatment with anti-TNFs can be worthwhile but the drug survival response rates and benefits are reduced with second and third anti-TNFs. The de novo model, which addressed many of the issues of earlier evaluations, generated incremental cost-effectiveness ratios ranging from £19,240 to £66,529 depending on anti-TNF and modelling assumptions. CONCLUSIONS In both AS and nr-AxSpA populations anti-TNFs are clinically effective, although more so in AS than in nr-AxSpA. Anti-TNFs may be an effective use of NHS resources depending on which assumptions are considered appropriate. FUTURE WORK RECOMMENDATIONS Randomised trials are needed to identify the nr-AxSpA population who will benefit the most from anti-TNFs. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010182. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Gurleen Jhuti
- Centre for Health Economics, University of York, York, UK
| | - Stephen Rice
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | | | | | - Dave Fox
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Helena Marzo-Ortega
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Lesley Kay
- Division of Rheumatic and Musculoskeletal Disease, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
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Fong W, Holroyd C, Davidson B, Armstrong R, Harvey N, Dennison E, Cooper C, Edwards CJ. The effectiveness of a real life dose reduction strategy for tumour necrosis factor inhibitors in ankylosing spondylitis and psoriatic arthritis. Rheumatology (Oxford) 2016; 55:1837-42. [PMID: 27354684 DOI: 10.1093/rheumatology/kew269] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine feasibility of TNF inhibitor (TNFi) dose reduction for severe AS and PsA patients. METHODS A retrospective study in a real-world setting. Criteria for dose reduction of TNFi included BASDAI < 4 for ⩾6 months in AS; or DAS28-ESR ⩽ 3.2 for ⩾6 months in PsA. TNFi dose was reduced by one-third. Patients who flared (BASDAI > 4 in AS or DAS28-ESR > 3.2 in PsA) were re-escalated to standard treatment dose. RESULTS Twenty-six per cent (33/125) of AS and 18% (15/83) of PsA patients fulfilled criteria and underwent TNFi dose reduction. Fifty-eight per cent (19/33) of AS and 60% (9/15) of PsA patients maintained TNFi dose reduction for mean (s.d) of 1.0 (0.8) years. Reinstating standard dose of TNFi recaptured low disease activity in all patients who failed dose reduction within 24 weeks, with no statistically significant difference in mean BASDAI compared with those maintaining TNFi dose reduction in AS at 24 weeks [mean (s.d) BASDAI 2.4 (1.1) vs 1.9 (1.5), respectively (P = 0.229)]; however in PsA, those who failed dose reduction had higher disease activity compared with patients maintained on TNFi dose reduction at 24 weeks [mean (s.d) DAS28-ESR 2.7 (0.6) vs 1.3 (0.5), respectively (P ⩽ 0.001)]. In PsA, a lower DAS28-ESR prior to dose reduction of TNFi was associated with more successful dose reduction. CONCLUSIONS In a real-world setting, 60% of individuals with severe AS and PsA who achieve low disease activity can successfully reduce the dose of TNFi therapy by a third for a mean of 1 year.
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Affiliation(s)
- Warren Fong
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Chris Holroyd
- Department of Rheumatology MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | - Nick Harvey
- Department of Rheumatology MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Elaine Dennison
- Department of Rheumatology MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- Department of Rheumatology MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK Department of Rheumatology
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Prinz J, Puig L, Girolomoni G. Treatment of psoriasis with etanercept: the typical patient profile. J Eur Acad Dermatol Venereol 2016; 30:1092-9. [DOI: 10.1111/jdv.13662] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/22/2016] [Indexed: 01/06/2023]
Affiliation(s)
- J.C. Prinz
- Department of Dermatology University of Munich Munich Germany
| | - L. Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona Catalonia Spain
| | - G. Girolomoni
- Section of Dermatology Department of Medicine University of Verona Piazzale A. Stefani, Verona Italy
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O'Connor J, Rice S, Smith A, Rodgers M, Lopez RR, Craig D, Woolacott N. The Clinical and Cost Effectiveness of Ustekinumab for the Treatment of Psoriatic Arthritis: A Critique of the Evidence. PHARMACOECONOMICS 2016; 34:337-348. [PMID: 26818809 DOI: 10.1007/s40273-015-0350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The National Institute for Health and Care Excellence (NICE) invited the manufacturer of ustekinumab (Janssen) to submit evidence for the clinical and cost effectiveness of ustekinumab for the treatment of active psoriatic arthritis (PsA) as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination and the Centre for Health Economics Technology Appraisal Group at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the ERG review of the manufacturer's evidence submission, and summarises the NICE Appraisal Committee's final guidance (TA340) issued in June 2015. The manufacturer presented evidence on ustekinumab for two patient populations: (1) a tumour necrosis factor-α (TNFα)-inhibitor-naïve population who had not previously received any TNFα inhibitors (biologics); and (2) a TNFα-inhibitor-exposed population who had previously received at least one TNFα inhibitor. The clinical evidence for ustekinumab was derived from two randomised controlled trials (PSUMMIT 1 and 2), in which a total of 927 patients who had not responded to previous disease-modifying antirheumatic drug therapies received ustekinumab 45 mg, ustekinumab 90 mg, or placebo. These data suggested that ustekinumab is more effective than placebo over 16-24 weeks in terms of both joint and skin response. In the absence of head-to-head comparisons between different biologics (ustekinumab, golimumab, etanercept, adalimumab and infliximab), the manufacturer conducted a network meta-analysis to estimate the relative efficacy of treatments for the TNFα-inhibitor-naïve population. Results of this analysis were marked as academic in confidence and are therefore not reported. For the TNFα-inhibitor-exposed population, the clinical analysis was limited to ustekinumab versus conventional management only, and was based on a subgroup of 180 patients from the PSUMMIT 2 trial. The ERG raised concerns relating to the lack of data on the long-term efficacy of ustekinumab, the limited data available for the exposed population, and the lack of consideration of the sequential use of treatments. Based on the manufacturer's original model, the ERG found ustekinumab to be dominated by golimumab in the anti-TNF-inhibitor-naïve population, and had an incremental cost-effectiveness ratio (ICER) of £29,843/quality-adjusted life-years versus conventional management in the exposed population. The ERG's analyses highlighted the fact that there is significant uncertainty around the model results. In addition, the ERG's exploratory cost-effectiveness analysis, which incorporated the sequential use of TNFα inhibitors, suggested that ustekinumab would not be cost effective if it were used as second-line treatment. The initial NICE recommendations asserted that ustekinumab was not recommended for treating active PsA. However, the manufacturer submitted a post-consultation model that included a Patient Access Scheme (PAS), halving the unit cost of ustekinumab 90 mg to £2147 (the same as a 45 mg dose). The NICE final recommendations were that, dependent on the inclusion of the PAS, ustekinumab is recommended as an option, along or in combination with methotrexate, for treating active PsA in adults only when treatment with TNFα inhibitors is contraindicated but would otherwise be considered, or the person has previously had treatment with one or more TNFα inhibitors, which has failed.
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Affiliation(s)
- Joanne O'Connor
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK.
| | - Stephen Rice
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | - Alison Smith
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | | | - Dawn Craig
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, Heslington, York, UK
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Betts KA, Griffith J, Friedman A, Zhou ZY, Signorovitch JE, Ganguli A. An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis. Curr Med Res Opin 2016; 32:721-9. [PMID: 26743448 DOI: 10.1185/03007995.2016.1140026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. METHODS A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. RESULTS Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. CONCLUSION Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.
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Lorenzin M, Ortolan A, de Hooge M, Frallonardo P, Piccoli A, Cozzi F, Oliviero F, Punzi L, Ramonda R. Lengthening the time intervals between doses of biological agents in psoriatic arthritis patients: A single-center retrospective study. Int J Immunopathol Pharmacol 2015; 28:479-87. [DOI: 10.1177/0394632015599446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Anti-tumor necrosis factor (TNF) alpha therapy has changed the course of psoriatic arthritis (PsA), but clinical experience about lengthening of time intervals between drug administrations is still limited. The aims of the study were to evaluate: (1) the long-term efficacy (over a 4-year period) of etanercept/adalimumab in a subset of PsA patients who did not require switches; and (2) the progressive lengthening of time intervals between treatments in patients who achieved minimal disease activity (MDA). PsA outpatients attending the Rheumatology Clinic-University of Padova who took a single anti-TNF agent (etanercept/adalimumab) for a 4-year period were studied. Therapy efficacy was assessed using clinical, biochemical, and disease activity (DA) indexes. The intervals between treatments were empirically and progressively lengthened after MDA was reached and maintained. One hundred and forty-one patients (mean age, 51.22 ± 12.34 years; mean disease duration, 12.1 ± 8.42 years) treated with etanercept/adalimumab (47.5% and 52.5%, respectively) were studied. DA indexes showed a marked, persistent improvement in all the patients throughout 4 years. The interval between injections could be extended in 46.1% of the patients (35% for adalimumab, 58% for etanercept) without provoking relapses. The mean therapy interval at the end of the study period was 3.12 weeks for adalimumab 40 mg (with respect to 2 weeks) and 2.75 weeks for etanercept 25 mg (with respect to 0.5 weeks). The new therapy timetable also led to cost savings. In conclusion, lengthening the time intervals between injections of anti-TNF agents in PsA patients who reach MDA is safe, effective, cost-effective, and facilitates patient compliance.
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Affiliation(s)
- Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Manouk de Hooge
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Paola Frallonardo
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Antonio Piccoli
- Nephrology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED-University of Padova, Padova, Italy
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Effect of TNF-α inhibitors on transcriptional levels of pro-inflammatory interleukin-33 and Toll-like receptors-2 and -9 in psoriatic plaques. Exp Ther Med 2015; 10:1573-1577. [PMID: 26622528 DOI: 10.3892/etm.2015.2688] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 01/24/2023] Open
Abstract
Tumor necrosis factor (TNF)-α inhibitors are considered to be effective in the treatment of psoriatic plaques, although the precise therapeutic pathway is not clear. Pro-inflammatory molecules, such as Toll-like receptor (TLR)-2 and -9 and interleukin (IL)-33, a member of the IL-1 receptor/TLR superfamily, have been found to be expressed in psoriatic plaques. The aim of the present study was to investigate whether TNF-α inhibitor treatment has an effect on the expression of IL-33 and TLR-2 and -9 in psoriatic plaques. Seventeen patients with psoriatic plaques were treated with a TNF-α inhibitor (etanercept or infliximab) for 12 weeks in an open-label study, and the transcriptional levels of IL-33 and TLR-2 and -9 were determined by reverse transcription-quantitative polymerase chain reaction in paired biopsies of psoriatic plaques obtained at baseline (B) and following the 12 weeks of treatment (P). The psoriasis area severity index (PASI) score was also determined. At B, elevated IL-33 and TLR-2 mRNA levels were observed in all cases, while TLR-9 showed elevated mRNA levels in 76% of cases. At P, reductions in the mRNA levels of IL-33, TLR-2 and TLR-9 were observed, with TLR-2 and -9 levels exhibiting significant reductions (P<0.0001, Wilcoxon signed-rank test). PASI scores were significantly reduced by the treatment (P<0.0001, Wilcoxon signed-rank test) and the changes in PASI scores exhibited a significant positive Pearson's correlation with the P/B mRNA expression ratios of TLR-2 or -9 in males (P<0.05), particularly in the etanercept group (P<0.0001). The findings support the efficacy of anti-TNF-α treatment on the innate immune response in psoriatic skin, with a focus on TLR-2 and -9 inhibition, suggesting their role in the pathogenic mechanism of plaque psoriasis, which may be associated with gender.
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45
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Oliveira MDFSPD, Rocha BDO, Duarte GV. Psoriasis: classical and emerging comorbidities. An Bras Dermatol 2015; 90:9-20. [PMID: 25672294 PMCID: PMC4323693 DOI: 10.1590/abd1806-4841.20153038] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/28/2013] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association
of psoriasis with arthritis, depression, inflammatory bowel disease and
cardiovascular diseases. Recently, several other comorbid conditions have been
proposed as related to the chronic inflammatory status of psoriasis. The
understanding of these conditions and their treatments will certainly lead to better
management of the disease. The present article aims to synthesize the knowledge in
the literature about the classical and emerging comorbidities related to
psoriasis.
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46
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Boehncke WH, Qureshi A, Merola JF, Thaçi D, Krueger GG, Walsh J, Kim N, Gottlieb AB. Diagnosing and treating psoriatic arthritis: an update. Br J Dermatol 2015; 170:772-86. [PMID: 24266754 DOI: 10.1111/bjd.12748] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 12/14/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis of uncertain pathogenesis, affecting approximately one in four patients with psoriasis. Onset of psoriasis typically precedes the development of PsA. Therefore, the dermatologist is ideally positioned to recognize the early signs and symptoms of PsA for diagnosis and subsequent treatment. The role of the dermatologist in early diagnosis and treatment is essential for preventing pain and functional disabilities, as well as the joint deterioration that accompanies progressive forms of PsA. Diagnosis of PsA is a key aspect of the clinical decision process for the dermatologist, as psoriasis plus PsA requires a different therapeutic approach from that required for psoriasis alone. Furthermore, PsA is associated with an increased risk of cardiovascular comorbidities that present significant health concerns. In this review, the pathogenesis and comorbidities of PsA are discussed. In addition, screening and imaging tools that aid in the diagnosis of PsA, as well as tools used for efficacy assessment, are reviewed. Available therapies are presented, with a focus on targeted biologics and emerging treatments.
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Affiliation(s)
- W H Boehncke
- Geneva University Hospital, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland
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47
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Etanercept en el tratamiento de la artritis psoriásica. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:252-9. [DOI: 10.1016/j.ad.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/07/2014] [Accepted: 09/14/2014] [Indexed: 12/20/2022] Open
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48
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Puig L, López-Ferrer A, Laiz A. Etanercept in the Treatment of Psoriatic Arthritis. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lis K, Kuzawińska O, Bałkowiec-Iskra E. Tumor necrosis factor inhibitors - state of knowledge. Arch Med Sci 2014; 10:1175-85. [PMID: 25624856 PMCID: PMC4296073 DOI: 10.5114/aoms.2014.47827] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/25/2013] [Accepted: 07/21/2013] [Indexed: 12/14/2022] Open
Abstract
Tumor necrosis factor (TNF) is considered a major proinflammatory cytokine, affecting various aspects of the immune reaction. All five TNF inhibitors currently available on the market (i.e., etanercept, infliximab, adalimumab, certolizumab and golimumab) are top sellers, although indicated only in autoimmune diseases, including rheumatoid arthritis, Crohn's disease and psoriasis. This article briefly discusses the background and place for TNF inhibitors in modern therapy. The main safety aspects of TNF inhibitor administration are described in particular, with special consideration of the available meta-analyses. Finally, perspectives on the next-generation TNF inhibitors and their use in the clinic are given.
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Affiliation(s)
- Krzysztof Lis
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Olga Kuzawińska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Bałkowiec-Iskra
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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50
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Villacorta R, Hay JW, Messali A. Novel methods of measuring clinical outcomes from psoriasis and psoriatic arthritis clinical trials. Expert Rev Pharmacoecon Outcomes Res 2014; 14:545-58. [PMID: 24820676 DOI: 10.1586/14737167.2014.917970] [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: 11/08/2022]
Abstract
Numerous instruments exist that measure the clinical and health related quality of life impact of psoriasis and psoriatic arthritis (PsA) in clinical trials. However, many of these instruments are not typically used in economic evaluations to inform decision problems facing health care decision makers. This study reviews the current state of psoriasis and PsA health outcome measures and evaluates their limitations in cost-effectiveness analyses (CEAs). We highlight the health related quality of life and clinical outcome measures that are typically used in CEAs, with special focus on studies with quality adjusted life years as a primary outcome measure. Despite the high prevalence of psoriasis and PsA health outcome measures in clinical trials, only a few are used in CEAs. The methods by which utilities are estimated from these measures vary across cost-effectiveness studies. These differences should be considered when conducting cost-effectiveness research in psoriasis and PsA.
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Affiliation(s)
- Reginald Villacorta
- University of Southern California, Leonard D. Schaeffer Center for Health Policy and Economics, 3335 S. Figueroa St., Unit A, University Park Campus, UGW-Unit A, Los Angeles, CA 90089-7273, USA
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