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Nolla JM, Martín E, Llamas P, Manero J, Rodríguez de la Serna A, Fernández-Miera MF, Rodríguez M, López JM, Ivanova A, Aragón B. An estimate of the cost of administering intravenous biological agents in Spanish day hospitals. Ther Clin Risk Manag 2017; 13:325-334. [PMID: 28356746 PMCID: PMC5360410 DOI: 10.2147/tcrm.s112062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To estimate the unit costs of administering intravenous (IV) biological agents in day hospitals (DHs) in the Spanish National Health System. Patients and methods Data were obtained from 188 patients with rheumatoid arthritis, collected from nine DHs, receiving one of the following IV therapies: infliximab (n=48), rituximab (n=38), abatacept (n=41), or tocilizumab (n=61). The fieldwork was carried out between March 2013 and March 2014. The following three groups of costs were considered: 1) structural costs, 2) material costs, and 3) staff costs. Staff costs were considered a fixed cost and were estimated according to the DH theoretical level of activity, which includes, as well as personal care of each patient, the DH general activities (complete imputation method, CIM). In addition, an alternative calculation was performed, in which the staff costs were considered a variable cost imputed according to the time spent on direct care (partial imputation method, PIM). All costs were expressed in euros for the reference year 2014. Results The average total cost was €146.12 per infusion (standard deviation [SD] ±87.11; CIM) and €29.70 per infusion (SD ±11.42; PIM). The structure-related costs per infusion varied between €2.23 and €62.35 per patient and DH; the cost of consumables oscillated between €3.48 and €20.34 per patient and DH. In terms of the care process, the average difference between the shortest and the longest time taken by different hospitals to administer an IV biological therapy was 113 minutes. Conclusion The average total cost of infusion was less than that normally used in models of economic evaluation coming from secondary sources. This cost is even less when the staff costs are imputed according to the PIM. A high degree of variability was observed between different DHs in the cost of the consumables, in the structure-related costs, and in those of the care process.
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Affiliation(s)
- Joan Miquel Nolla
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona
| | | | - Pilar Llamas
- Hospital Universitario Fundación Jiménez Díaz, Madrid
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Montes A, Perez-Pampin E, Navarro-Sarabia F, Moreira V, de la Serna AR, Magallares B, Vasilopoulos Y, Sarafidou T, Fernández-Nebro A, Ordóñez MDC, Narváez J, Cañete JD, Marquez A, Pascual-Salcedo D, Joven B, Carreira P, Moreno-Ramos MJ, Caliz R, Ferrer MA, Garcia-Portales R, Blanco FJ, Magro C, Raya E, Valor L, Alegre-Sancho JJ, Balsa A, Martin J, Plant D, Isaacs J, Morgan AW, Barton A, Wilson AG, Gómez-Reino JJ, Gonzalez A. Rheumatoid arthritis response to treatment across IgG1 allotype - anti-TNF incompatibility: a case-only study. Arthritis Res Ther 2015; 17:63. [PMID: 25885039 PMCID: PMC4411723 DOI: 10.1186/s13075-015-0571-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/20/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction We have hypothesized that incompatibility between the G1m genotype of the patient and the G1m1 and G1m17 allotypes carried by infliximab (INX) and adalimumab (ADM) could decrease the efficacy of these anti-tumor necrosis factor (anti-TNF) antibodies in the treatment of rheumatoid arthritis (RA). Methods The G1m genotypes were analyzed in three collections of patients with RA totaling 1037 subjects. The first, used for discovery, comprised 215 Spanish patients. The second and third were successively used for replication. They included 429 British and Greek patients and 393 Spanish and British patients, respectively. Two outcomes were considered: change in the Disease Activity Score in 28 joint (ΔDAS28) and the European League Against Rheumatism (EULAR) response criteria. Results An association between less response to INX and incompatibility of the G1m1,17 allotype was found in the discovery collection at 6 months of treatment (P = 0.03). This association was confirmed in the replications (P = 0.02 and 0.08, respectively) leading to a global association (P = 0.001) that involved a mean difference in ΔDAS28 of 0.4 units between compatible and incompatible patients (2.3 ± 1.5 in compatible patients vs. 1.9 ± 1.5 in incompatible patients) and an increase in responders and decrease in non-responders according to the EULAR criteria (P = 0.03). A similar association was suggested for patients treated with ADM in the discovery collection, but it was not supported by replication. Conclusions Our results suggest that G1m1,17 allotypes are associated with response to INX and could aid improved therapeutic targeting in RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0571-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariana Montes
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
| | - Eva Perez-Pampin
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
| | | | - Virginia Moreira
- Rheumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | | | - Berta Magallares
- Rheumatology Unit, Hospital Santa Creu e San Pau, Barcelona, Spain.
| | - Yiannis Vasilopoulos
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
| | - Theologia Sarafidou
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
| | - Antonio Fernández-Nebro
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - María Del Carmen Ordóñez
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain.
| | - Juan D Cañete
- Rheumatology Unit, Hospital Clinic, Barcelona, Spain.
| | - Ana Marquez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
| | - Dora Pascual-Salcedo
- Department of Immunology, Instituto de Investigación Hospital Universitario La Paz, Hospital La Paz, Madrid, Spain.
| | - Beatriz Joven
- Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain.
| | | | | | - Rafael Caliz
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Miguel Angel Ferrer
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | - Francisco J Blanco
- Rheumatology Department, Instituto de Investigacion Biomedica-Complejo Hospitalario Universitario A Coruna, A Coruna, Spain. .,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Cesar Magro
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain.
| | - Enrique Raya
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain.
| | - Lara Valor
- Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | - Alejandro Balsa
- Department of Rheumatology, Instituto de Investigación Hospital Universitario La Paz, Hospital Universitario La Paz, Madrid, Spain.
| | - Javier Martin
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
| | - Darren Plant
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - John Isaacs
- Musculoskeletal Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle, UK. .,National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, Newcastle, UK.
| | - Ann W Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, St. James's University Hospital, University of Leeds, Leeds, UK. .,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Anne Barton
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. .,Arthritis Research UK-Centre for Genetics and Genomics, The University of Manchester, Manchester, UK.
| | | | | | - Juan J Gómez-Reino
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. .,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Antonio Gonzalez
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. .,Laboratorio Investigacion 10, Hospital Clinico Universitario de Santiago, Edificio de consultas, planta -2 Travesia de Choupana, sn, Santiago de Compostela, 15706, Spain.
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Zarco P, González CM, Rodríguez de la Serna A, Peiró E, Mateo I, Linares L, Calvo J, Cea-Calvo L, Arteaga MJ, Vanaclocha F, Marín-Jiménez I, García-Vicuña R. Extra-articular disease in patients with spondyloarthritis. Baseline characteristics of the spondyloarthritis cohort of the AQUILES study. ACTA ACUST UNITED AC 2014; 11:83-9. [PMID: 25441489 DOI: 10.1016/j.reuma.2014.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the prevalence of extra-articular disease (uveitis, psoriasis and inflammatory bowel disease [IBD]), in a cohort of patients with spondyloarthritis (SpA). PATIENTS AND METHODS AQUILES is an observational, prospective and multicentric study of three cohorts of patients with one of the following immune-mediated inflammatory diseases (IMID): SpA, psoriasis, or IBD. In the present cohort, patients ≥18 years of age with SpA were enrolled from Rheumatology clinics. The main objective was to assess the coexistence of these diseases and of uveitis, based on the patients' clinical history up to the study entry. RESULTS A total of 601 patients with SpA (men: 63.1%; women: 36.9%) were enrolled. The specific diagnoses were: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated spondyloarthritis (16.1%), enteropathic arthritis (2.5%), and others (1.3%). In 43.6% (95% CI: 39.7-47.6) of the patients, at least one of the three abovementioned diseases was encountered, predominantly psoriasis (prevalence 27.8%, 95% CI: 24.4-31.5), uveitis (13.6%, CI 95%: 11.1-16.6) and IBD (5.1%, 95% CI: 3.7-7.2). In patients with ankylosing spondylitis the proportion of other disease was 25.3% (IBD: 3.9%, psoriasis: 5.4%, uveitis: 19.0%) whilst it was 94.7% in psoriatic arthritis, due to the presence of psoriasis (94.0%). The coexistence of these diseases was associated with age, female gender and the presence of other extra-articular manifestations associated with SpA. CONCLUSIONS Extra-articular disease in patients with SpA is common and, in this study, it was associated to age, female gender and the presence of other SpA-related extra-articular manifestations.
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Affiliation(s)
- Pedro Zarco
- Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, España.
| | | | | | - Enriqueta Peiró
- Hospital Marqués de Valdecilla, Santander, Cantabria, España
| | | | | | - Jerusalem Calvo
- Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba/Universidad de Córdoba, Córdoba, España
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Peñacoba Toribio P, Córica Albani ME, Mayos Pérez M, Rodríguez de la Serna A. Rituximab in the treatment of shrinking lung syndrome in systemic lupus erythematosus. ACTA ACUST UNITED AC 2013; 10:325-7. [PMID: 24315464 DOI: 10.1016/j.reuma.2013.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/18/2013] [Accepted: 09/26/2013] [Indexed: 11/27/2022]
Abstract
Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus. We report the case of a patient with non-responding SLS (neither to glucocorticoids nor immunosupresors), who showed remarkable improvement after the onset of treatment with rituximab. Although there is a little evidence, treatment with rituximab could be proposed in SLS when classical treatment fails.
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Affiliation(s)
| | - María Emilia Córica Albani
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Mercedes Mayos Pérez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CibeRes), Universidad Autónoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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