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Romero Jiménez RM, Herranz Pinto P, Campos Domínguez M, Aceituno Mata S, Bellmunt A, Prades M, Arumi D, Hernández-Martín I, Herrera-Lasso V, Llevat N, De Lossada Juste A, Rebollo Laserna FJ. Cost-Effectiveness Analysis of Abrocitinib Compared with Other Systemic Treatments for Severe Atopic Dermatitis in Spain. Pharmacoecon Open 2024; 8:291-302. [PMID: 38236526 PMCID: PMC10884369 DOI: 10.1007/s41669-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a chronic, inflammatory skin disease characterized by itchy, painful, and dry skin. Despite the great number of available therapies, economic evaluations are still needed to provide evidence on their cost efficiency. This research aimed to evaluate the cost effectiveness of the Janus kinase (JAK) inhibitor abrocitinib (200 mg) compared with dupilumab (300 mg), tralokinumab (300 mg), baricitinib (2 and 4 mg), and upadacitinib (15 and 30 mg) for the treatment of patients with severe AD from the Spanish National Health System (NHS) perspective. METHODS A hybrid model consisting of a decision tree linked to a Markov model was developed to estimate costs, quality-adjusted life-years (QALYs), total years in response and incremental cost-per-QALY gained (willingness-to-pay [WTP] threshold: €25,000/QALY). Adults with severe AD entered the decision tree and response (75% reduction in baseline Eczema Area and Severity Index score, EASI-75) was considered at 16 and 52 weeks. After this time, patients entered the Markov model (remainder of the 10-year time horizon), which consisted of three health states: maintenance with active therapy, subsequent treatment, or death. All costs were presented in 2022 euros (€). Additionally, cost per number-needed-to-treat (NNT) was calculated for abrocitinib and dupilumab based on a head-to-head post-hoc analysis. RESULTS Abrocitinib 200 mg was dominant (i.e., lower incremental costs and higher incremental benefit) compared with all studied alternatives (dupilumab 300 mg, tralokinumab 300 mg, baricitinib 2 and 4 mg, upadacitinib 15 and 30 mg) with a QALYs gain of 0.49, 0.60, 0.64, 0.43, 0.45, and 0.08, respectively, and per-person costs savings of €22,097, €24,140, €14,825, €7,116, €12,805, and €45,189, respectively. Considering the WTP threshold, abrocitinib was dominant or cost effective compared with all alternatives for most simulations. Additionally, abrocitinib was dominant compared with all alternatives when evaluating the cost effectiveness over a 5-year time horizon. NNT showed that abrocitinib was dominant versus dupilumab. CONCLUSIONS The results of the study show that abrocitinib is a cost-effective therapy compared with other JAK inhibitors and biological therapies from the Spanish NHS perspective.
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Affiliation(s)
| | | | | | | | - Alba Bellmunt
- Outcomes'10 S.L., Castellón de la Plana, Castellón, Spain
| | - Miriam Prades
- Outcomes'10 S.L., Castellón de la Plana, Castellón, Spain
| | - Daniel Arumi
- Pfizer SLU, Av. de Europa, 20, B, 28028, Alcobendas, Madrid, Spain
| | | | | | - Noelia Llevat
- Pfizer SLU, Av. de Europa, 20, B, 28028, Alcobendas, Madrid, Spain
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Agache I, Akdis CA, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Chu DK, Del Giacco S, Eiwegger T, Flood B, Firinu D, Gern JE, Hamelmann E, Hanania N, Hernández-Martín I, Knibb R, Mäkelä M, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park HS, Pérez de Llano L, Pfaar O, Quirce S, Sastre J, Shamji M, Schwarze J, Palomares O, Jutel M. EAACI Biologicals Guidelines-Recommendations for severe asthma. Allergy 2020. [PMID: 32484954 DOI: 10.1111/all.14425.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine-Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, ON, Canada
| | - Breda Flood
- European Federation of Allergy and Airway Diseases, Brussels, Belgium
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - James E Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Eckard Hamelmann
- Children's Center Bethel, Evangelical Hospital Bethel, University of Bielefeld, Bielefeld, Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Rebeca Knibb
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University, Ajou, Korea
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.,Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain
| | - Marek Jutel
- Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.,ALL-MED" Medical Research Institute, Wroclaw, Poland
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Loli-Ausejo D, Hernández-Martín I, Cabañas R, Entrala A, Gutiérrez-Alvariño M, Martínez-Sánchez N, Caballero T. Tranexamic Acid Plus Bemiparin Sodium as Long- Term Prophylaxis in a Patient With FXII-HAE During Pregnancy: A Case Report. J Investig Allergol Clin Immunol 2020; 30:464-465. [PMID: 32490821 DOI: 10.18176/jiaci.0585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D Loli-Ausejo
- Allergy Department, La Paz University Hospital, Madrid, Spain
| | | | - R Cabañas
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network on Rare Diseases - U754 (CIBERER), Madrid, Spain
| | - A Entrala
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | | | - N Martínez-Sánchez
- Obstetrics and Gynecology Department, High Risk Pregnancy Unit, Autoimmune Diseases and Pregnancy clinic, La Paz University Hospital, Madrid, Spain
| | - T Caballero
- Allergy Department, La Paz University Hospital, Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Biomedical Research Network on Rare Diseases - U754 (CIBERER), Madrid, Spain
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Tomás-Pérez M, Hernández-Martín I, Fernández de Alba-Porcel I, Pagola MJ, Carretero P, Domínguez-Ortega J, Lluch-Bernal MM, Caballero ML, Quirce S. [Allergy to vegetables belonging to the Solanaceae family]. ACTA ACUST UNITED AC 2020; 66:322-328. [PMID: 31606016 DOI: 10.29262/ram.v66i3.608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although cross-reactivity with other plant-based foods and latex has been described, allergies to potatoes and tomatoes are uncommon. OBJECTIVE To study the different sensitization patterns in patients who are allergic to potatoes and/or tomatoes. METHODS Skin prick tests were carried out with fresh foods and extracts, specific IgE determination and allergen detection by SDS-PAGE and IgE-Immunoblotting with both raw and heated potato and tomato extracts. RESULTS In 10 patients, two thermostable allergens to potato extract were detected; the first one with a molecular weight that is compatible with Sola t 1 (43 kDa, patatin) and the second one with a molecular weight of 14-22 kDa, which could correspond to the allergens Sola t 4 (16 kDa) and Sola t 2 and Sola t 3 (21 kDa); in two patients who are allergic to potatoes and two patients who are allergic to tomatoes, a thermostable allergen that is compatible to Sola I 2 (50 kDa) was detected. The patient had presented oral allergy syndrome with some types of potatoes and showed higher IgE reactivity to two thermostable potato allergens. CONCLUSIONS The allergen sensitization patterns were similar in all the patients that had been studied, regardless of the symptoms. A new allergen involved in the allergy to solanaceae plants has been detected.
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Agache I, Beltran J, Akdis C, Akdis M, Canelo-Aybar C, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Hernández-Martín I, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park HS, Pérez de Llano L, Posso M, Rocha C, Quirce S, Sastre J, Shamji M, Song Y, Steiner C, Schwarze J, Alonso-Coello P, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020. [PMID: 32034960 DOI: 10.1111/all.14221.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five biologicals have been approved for severe eosinophilic asthma, a well-recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6-11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV1 , without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug-related adverse events (AE) and drug-related serious AE (low to very low certainty of evidence). The incremental cost-effectiveness ratio per quality-adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV1 . More data on long-term safety are needed together with more efficacy data in the paediatric population.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Jessica Beltran
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, Canada
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Second Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University, Suwon, Korea
| | | | - Margarita Posso
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- Universidad Autónoma de Madrid Facultad de Medicina, Madrid, Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.,Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Yang Song
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Corinna Steiner
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain
| | - Marek Jutel
- Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.,"ALL-MED" Medical Research Institute, Wroclaw, Poland
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Falces-Romero I, Hernández-Martín I, Fiandor A, Rico-Nieto A. Alergia a antibióticos: perspectiva desde un hospital de tercer nivel. Enferm Infecc Microbiol Clin 2019; 37:350-351. [DOI: 10.1016/j.eimc.2018.09.004] [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] [Received: 09/11/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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