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Tužil J, Mlčoch T, Jirčíková J, Závada J, Nekvindová L, Svoboda M, Uher M, Křístková Z, Vencovský J, Pavelka K, Doležal T. Short-term response in new users of anti-TNF predicts long-term productivity and non-disability: analysis of Czech ATTRA ankylosing spondylitis biologic registry. Expert Opin Biol Ther 2019; 20:183-192. [PMID: 31736377 DOI: 10.1080/14712598.2020.1694900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/14/2022]
Abstract
Objectives: To assess the role of short-term response to first anti-TNF in long-term prediction of disability.Methods: In nationwide registry ATTRA, we identified ankylosing spondylitis patients starting anti-TNF between 01/2003 and 12/2016. Full disability and work impairment (WI; WPAI questionnaire) were predicted via the Cox- and lagged-parameter mixed-effect regression.Results: 2,274 biologicals-naïve patients newly indicated to anti-TNF were prospectively followed (6,333 patient-years; median follow-up 1.9 years). Reaching BASDAI < 4 (77.4%) and ASDAS-CRP < 2.1 (61.1%) after 3 months of anti-TNF both decreased the risk of future disability by ≈2.5-fold. ASDAS-CRP < 2.1 predicted non-disability better than BASDAI < 4 & CRP < 5 mg/L (p = 0.032). BASDAI < 4 & CRP < 5 mg/L was comparable to BASDAI < 4 (p = 0.941) and to BASDAI change by >50% or by >2 points (p = 0.902). ASDAS-CRP change >1.1 and >2.0 both failed to predict non-disability. Once on anti-TNF therapy, the strongest predictor of WI was Pain (SF36). Yearly increase in indirect costs remains below €3,000 in those reaching ASDAS-CRP < 2.1.Conclusions: Low disease activity measured by ASDAS-CRP ≤ 2.1 should be used to measure the outcome of new anti-TNF therapy. Continuous WI could be decreased through pain management.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Lucie Nekvindová
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Michal Uher
- Faculty of Medicine of the Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic
| | - Zlatuše Křístková
- Institute of Biostatistics and Analyses, Ltd., Spinoff company of the Faculty of Medicine of the Masaryk University, Brno, Czech Republic
| | - Jiří Vencovský
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.,Institute of Rheumatology, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Mlčoch T, Klimeš J, Fila L, Vávrová V, Skalická V, Turnovec M, Krulišová V, Jirčíková J, Zemková D, Dědečková KV, Bílková A, Frühaufová V, Homola L, Friedmannová Z, Drnek R, Dřevínek P, Doležal T, Macek M. Cost-of-illness analysis and regression modeling in cystic fibrosis: a retrospective prevalence-based study. Eur J Health Econ 2017; 18:73-82. [PMID: 26743971 DOI: 10.1007/s10198-015-0759-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/14/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Economic data pertaining to cystic fibrosis (CF), is limited in Europe generally, and completely lacking in Central and Eastern Europe. We performed an analysis of all direct costs associated with CF relative to key disease features and laboratory examinations. METHODS A retrospective prevalence-based cost-of-illness (COI) study was performed in a representative cohort of 242 CF patients in the Czech Republic, which represents about 65 % of all Czech CF patients. Medical records and invoices to health insurance companies for reference year 2010 were analyzed. RESULTS The mean total health care costs were €14,486 per patient, with the majority of the costs going towards medicinal products and devices (€10,321). Medical procedures (€2676) and inpatient care (€1829) represented a much smaller percentage of costs. A generalized linear model showed that the strongest cost drivers, for all cost categories, were associated with patient age and lung disease severity (assessed using the FEV1 spirometric parameter), when compounded by chronic Pseudomonas aeruginosa airway infections. Specifically, maximum total costs are around the age 16 years; a FEV1 increase of 1 % point represented a cost decrease of: 0.9 % (medicinal products), 1.7 % (total costs), 2.8 % (procedures) and 7.0 % (inpatient care). CONCLUSIONS COI analysis and regression modeling using the most recent data available can provide a better understanding of the overall economic CF burden. A comparison of our results with other methodologically similar studies demonstrates that although overall costs may differ, FEV1 can nonetheless be utilized as a generally transferrable indicator of the relative economic impact of CF.
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Affiliation(s)
- Tomáš Mlčoch
- Institute of Health Economics and Technological Assessment, Prague, Czech Republic
| | - Jiří Klimeš
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University in Prague, Prague, Czech Republic
| | - Libor Fila
- Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Věra Vávrová
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Veronika Skalická
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Marek Turnovec
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Úvalu 84, 15006, Prague 5, Czech Republic
| | - Veronika Krulišová
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Úvalu 84, 15006, Prague 5, Czech Republic
| | - Jitka Jirčíková
- Institute of Health Economics and Technological Assessment, Prague, Czech Republic
| | - Dana Zemková
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Klára Vilimovská Dědečková
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Alena Bílková
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | | | - Lukáš Homola
- Department of Children's Infectious Diseases, Faculty of Medicine of Masaryk University, University Hospital, Brno, Czech Republic
| | - Zuzana Friedmannová
- Division of Health Insurance, University Hospital Motol, Prague, Czech Republic
| | - Radovan Drnek
- Division of Health Insurance, University Hospital Motol, Prague, Czech Republic
| | - Pavel Dřevínek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Tomáš Doležal
- Institute of Health Economics and Technological Assessment, Prague, Czech Republic
| | - Milan Macek
- Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Úvalu 84, 15006, Prague 5, Czech Republic.
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