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Derks TGJ, Venema A, Köller C, Bos E, Overduin RJ, Stolwijk NN, Hofbauer P, Bolhuis MS, van Eenennaam F, Groen H, Hollak CEM, Wortmann SB. Repurposing empagliflozin in individuals with glycogen storage disease Ib: A value-based healthcare approach and systematic benefit-risk assessment. J Inherit Metab Dis 2024; 47:244-254. [PMID: 38185897 DOI: 10.1002/jimd.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Off-label repurposing of empagliflozin allows pathomechanism-based treatment of neutropenia/neutrophil-dysfunction in glycogen storage disease type Ib (GSDIb). From a value-based healthcare (VBHC) perspective, we here retrospectively studied patient-reported, clinical and pharmacoeconomic outcomes in 11 GSDIb individuals before and under empagliflozin at two centers (the Netherlands [NL], Austria [AT]), including a budget impact analysis, sensitivity-analysis, and systematic benefit-risk assessment. Under empagliflozin, all GSDIb individuals reported improved quality-of-life-scores. Neutrophil dysfunction related symptoms allowed either granulocyte colony-stimulating factor cessation or tapering. Calculated cost savings per patient per year ranged between € 6482-14 190 (NL) and € 1281-41 231 (AT). The budget impact analysis estimated annual total cost savings ranging between € 75 062-225 716 (NL) and € 37 697-231 790 (AT), based on conservative assumptions. The systematic benefit-risk assessment was favorable. From a VBHC perspective, empagliflozin treatment in GSDIb improved personal and clinical outcomes while saving costs, thereby creating value at multiple pillars. We emphasize the importance to reimburse empagliflozin for GSDIb individuals, further supported by the favorable systematic benefit-risk assessment. These observations in similar directions in two countries/health care systems strongly suggest that our findings can be extrapolated to other geographical areas and health care systems.
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Affiliation(s)
- Terry G J Derks
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annieke Venema
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clara Köller
- University Children's Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Eline Bos
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben J Overduin
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nina N Stolwijk
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Hofbauer
- Department of Production, Landesapotheke Salzburg, Hospital Pharmacy, Salzburg, Austria
| | - Mathieu S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fred van Eenennaam
- The Decision Group, Amsterdam, The Netherlands
- Erasmus School of Accounting & Assurance, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - Carla E M Hollak
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia B Wortmann
- University Children's Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Pediatrics, Amalia Children's Hospital, Nijmegen, The Netherlands
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Boxhammer E, Paar V, Jirak P, Köller C, Demirel O, Eder S, Reiter C, Kammler J, Kellermair J, Hammerer M, Blessberger H, Steinwender C, Hoppe UC, Lichtenauer M. Main pulmonary artery diameter in combination with cardiovascular biomarkers: new possibilities to identify pulmonary hypertension in patients with severe aortic valve stenosis. Minerva Med 2023; 114:802-814. [PMID: 35822856 DOI: 10.23736/s0026-4806.22.08167-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Echocardiography is currently the noninvasive method of choice to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery pressure (sPAP). However, radiological options are also available by determining the main pulmonary artery (MPA) diameter in the setting of CT angiography. The aim of the present study was to compare cardiovascular biomarkers with the MPA diameter to allow other ways of detecting PH in patients with severe AS. METHODS One hundred ninety-four patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) were included in this study and were divided into two groups based on the CT-angiographically determined MPA diameter. In accordance with ESC guidelines, a cut-off value of 29 mm was determined in this study, with the absence of PH defined by an MPA diameter <29 mm (N79/194) and the presence of PH defined by an MPA diameter ≥29 mm (115/194). Immediately before interventional aortic valve replacement, blood samples were drawn from the subjects and relevant cardiovascular biomarkers such as BNP, cTnI, GDF-15, H-FABP, IGF-BP2 and suPAR were assessed. RESULTS Patients with an MPA diameter ≥29 mm had significantly higher BNP (P=0.004), cTnI (P=0.039) and H-FABP (P=0.015) plasma levels, whereas GDF-15 (P=0.140), IGF-BP2 (P=0.088) and suPAR (P=0.140) showed no significant differences. In addition, cut-off values were calculated to predict an MPA diameter ≥29 mm. Significant results were shown with 1634.00 pg/mL for BNP (P=0.004), with 16.50 pg/mL for cTnI (P=0.039) and with 1.16 ng/mL for H-FABP (P=0.016). In a combined biomarker analysis, the 2-way combination of BNP and IGF-BP2 (AUC 0.671; 95%CI 0.538-0.805; P=0.023) and the 3-way combination of BNP, H-FABP and IGF-BP2 (AUC 0.685; 95%CI 0.551-0.818; P=0.015) showed the best results. Biomarker follow-up at 3 and 12 months after TAVR did not require additional information gain. Regarding 1-year survival, no significant difference could be detected between patients with an MPA diameter<29 mm compared to patients with ≥29 mm (log-rank test: P=0.262). CONCLUSIONS The MPA diameter remains a controversial parameter for the detection of PH in patients with severe AS. Standing on its own, this non-invasive parameter may not be precise enough to detect PH accurately. Combining this parameter with several biomarkers did not provide significant additional information.
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Affiliation(s)
- Elke Boxhammer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Peter Jirak
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Clara Köller
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ozan Demirel
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sarah Eder
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University of Linz, Linz, Austria
| | - Jürgen Kammler
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University of Linz, Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University of Linz, Linz, Austria
| | - Matthias Hammerer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University of Linz, Linz, Austria
| | - Clemens Steinwender
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
- Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University of Linz, Linz, Austria
| | - Uta C Hoppe
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria -
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Boxhammer E, Köller C, Paar V, Fejzic D, Rezar R, Reiter C, Kammler J, Kellermair J, Hammerer M, Blessberger H, Steinwender C, Hoppe UC, Lichtenauer M. Systolic Pulmonary Artery Pressure and Cardiovascular Biomarkers—New Non-Invasive Ways to Detect Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing TAVR? Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2307224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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