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Wahlberg K, Winblad B, Cole A, Herring WL, Ramsberg J, Torontali I, Visser PJ, Wimo A, Wollaert L, Jönsson L. People get ready! A new generation of Alzheimer's therapies may require new ways to deliver and pay for healthcare. J Intern Med 2024; 295:281-291. [PMID: 38098165 DOI: 10.1111/joim.13759] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The development of disease-modifying therapies (DMTs) for Alzheimer's disease (AD) has progressed over the last decade, and the first-ever therapies with potential to slow the progression of disease are approved in the United States. AD DMTs could provide life-changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies' actual clinical value. This perspective article discusses, from the broad perspective of various health systems and stakeholders, how we can overcome these challenges and improve society's readiness for AD DMTs. We propose that innovative payment models such as performance-based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost-effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e. healthcare vs. societal) and ethical questions in terms of treatment eligibility criteria.
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Affiliation(s)
- Karin Wahlberg
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | | | - William L Herring
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | | | - Pieter-Jelle Visser
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Department of Psychiatry, Maastricht University, Maastricht, The Netherlands
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | | | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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Callahan LF, Samsell B, DiBenedetti D, Frangiosa T, Slota C, Biggar V, Paulsen R, Lappin D, Herring WL, Romano C. Evaluating Elements of the Care Partner Experience in Individuals Who Care for People with Alzheimer's Disease Across the Severity Spectrum. Neurol Ther 2024; 13:53-67. [PMID: 37889399 PMCID: PMC10787717 DOI: 10.1007/s40120-023-00558-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Non-professional care partners play an important and often evolving role in the care of persons living with Alzheimer's disease (PLWAD). We investigated two elements of the care partner experience, namely time and strain incurred by care partners providing care to PLWAD across the severity spectrum. METHODS Data gathered from the Alzheimer's Disease Patient and Caregiver Engagement (AD PACE) What Matters Most (WMM) study series were analyzed to determine how much time care partners spent providing care to PLWAD based on where the care recipients lived. Additionally, quantitative assessments of weekly hours providing care and the strain experienced by care partners were conducted using the UsAgainstAlzheimer's A-LIST Insights Series survey, which included the Modified Caregiver Strain Index (MCSI). Finally, a targeted literature review was conducted to contextualize findings and characterize the existing literature landscape. RESULTS Care partners in the AD PACE WMM studies (n = 139) spent significantly more hours providing care for recipients who lived with someone (mean ± standard deviation [SD], 57.3 ± 44.3 h/week) than for recipients who lived alone (26.0 ± 12.0 h/week) (P = 0.0096) or lived in assisted living/nursing home (23.6 ± 14.4 h/week) (P = 0.0002). In the A-LIST Insights Series survey, care partners provided an overall mean (± SD) 58.1 ± 53.0 h of direct care each week, with caregiving hours increasing with increasing severity of AD/AD-related dementias (AD/ADRD). Additionally, care partners for recipients with mild (n = 14), moderate (n = 111), and severe AD/ADRD (n = 91) had overall mean MCSI scores of 9.0 ± 3.8 (range 2-14), 13.3 ± 4.8 (range 4-23), and 17.5 ± 5.3 (range 4-26), respectively, with higher scores suggesting greater care partner strain. CONCLUSIONS Persons living with AD require increasing levels of care along the spectrum of disease, and even individuals with early disease need care from partners. Early interventions that slow progression of AD and programs that improve family function may have beneficial impact on the experiences of care partners for recipients with mild, moderate, or severe AD.
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Affiliation(s)
| | - Brian Samsell
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | | | | | | | - William L Herring
- RTI Health Solutions, Research Triangle Park, NC, USA
- Karolinska Institute, Stockholm, Sweden
| | - Carla Romano
- RTI Health Solutions, Research Triangle Park, NC, USA.
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Paret K, Beyhaghi H, Herring WL, Mauskopf J, Shane LG, Rousculp MD. Going Forward: Potential Impact of Protein-Based COVID-19 Vaccination Coverage on Population Outcomes and Costs in the United States. Vaccines (Basel) 2024; 12:74. [PMID: 38250887 PMCID: PMC10819070 DOI: 10.3390/vaccines12010074] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Policymakers in the United States (US) recommend coronavirus disease 2019 (COVID-19) vaccination with a monovalent 2023-2024 vaccine formulation based on the Omicron XBB.1.5 variant. We estimated the potential US population-level health and economic impacts of increased COVID-19 vaccine coverage that might be expected with the availability of a protein-based vaccine with simpler storage requirements in addition to messenger ribonucleic acid (mRNA) vaccines. A Markov model was developed to estimate 1-year COVID-19-related costs, cases, hospitalizations, and deaths with and without the availability of a protein-based vaccine option. The model population was stratified by age and risk status. Model inputs were sourced from published literature or derived from publicly available data. Our model estimated that a five-percentage-point increase in coverage due to the availability of a protein-based vaccine option would prevent over 500,000 cases, 66,000 hospitalizations, and 3000 COVID-19-related deaths. These clinical outcomes translated to 42,000 quality-adjusted life years (QALYs) gained and an incremental cost-effectiveness ratio of USD 16,141/QALY from a third-party payer perspective. In sensitivity analyses, outcomes were most sensitive to COVID-19 incidence and severity across age groups. The availability of a protein-based vaccine option in the US could reduce hospitalizations and deaths and is predicted to be cost-effective.
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Affiliation(s)
- Kyle Paret
- RTI Health Solutions, Research Triangle Park, NC 27709, USA; (K.P.); (W.L.H.); (J.M.)
| | | | - William L. Herring
- RTI Health Solutions, Research Triangle Park, NC 27709, USA; (K.P.); (W.L.H.); (J.M.)
- Karolinska Institute, 17177 Stockholm, Sweden
| | - Josephine Mauskopf
- RTI Health Solutions, Research Triangle Park, NC 27709, USA; (K.P.); (W.L.H.); (J.M.)
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Spelman T, Herring WL, Acosta C, Hyde R, Jokubaitis VG, Pucci E, Lugaresi A, Laureys G, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Ozakbas S, Alroughani R, Kalincik T, Duquette P, Girard M, Petersen T, Patti F, Csepany T, Granella F, Grand'Maison F, Ferraro D, Karabudak R, Jose Sa M, Trojano M, van Pesch V, Van Wijmeersch B, Cartechini E, McCombe P, Gerlach O, Spitaleri D, Rozsa C, Hodgkinson S, Bergamaschi R, Gouider R, Soysal A, Castillo-Triviño, Prevost J, Garber J, de Gans K, Ampapa R, Simo M, Sanchez-Menoyo JL, Iuliano G, Sas A, van der Walt A, John N, Gray O, Hughes S, De Luca G, Onofrj M, Buzzard K, Skibina O, Terzi M, Slee M, Solaro C, Oreja-Guevara, Ramo-Tello C, Fragoso Y, Shaygannejad V, Moore F, Rajda C, Aguera Morales E, Butzkueven H. Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom. J Med Econ 2024; 27:109-125. [PMID: 38085684 DOI: 10.1080/13696998.2023.2293379] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
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Affiliation(s)
- T Spelman
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - W L Herring
- Health Economics, RTI Health Solutions, NC, USA
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - C Acosta
- Value and Access, Biogen, Baar, Switzerland
| | - R Hyde
- Medical, Biogen, Baar, Switzerland
| | - V G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - E Pucci
- Neurology Unit, AST-Fermo, Fermo, Italy
| | - A Lugaresi
- Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - T Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Duquette
- CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | - T Petersen
- Aarhus University Hospital, Arhus C, Denmark
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Italy
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - M Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - M Trojano
- School of Medicine, University of Bari, Bari, Italy
| | - V van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Belgium
| | - B Van Wijmeersch
- University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
| | | | - P McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - O Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - C Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - S Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - R Gouider
- Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Castillo-Triviño
- Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain
| | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | - J Garber
- Westmead Hospital, Sydney, Australia
| | - K de Gans
- Groene Hart Ziekenhuis, Gouda, Netherlands
| | - R Ampapa
- Nemocnice Jihlava, Jihlava, Czech Republic
| | - M Simo
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - J L Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
- Biocruces-Bizkaia Health Research Institute, Spain
| | - G Iuliano
- Ospedali Riuniti di Salerno, Salerno, Italy
| | - A Sas
- Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
| | - A van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - N John
- Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - O Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | - S Hughes
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G De Luca
- MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - K Buzzard
- Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - O Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - M Slee
- Flinders University, Adelaide, Australia
| | - C Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitation, ML Novarese Hospital Moncrivello
| | - Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
| | - C Ramo-Tello
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Y Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - F Moore
- Department of Neurology, McGill University, Montreal, Canada
| | - C Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - E Aguera Morales
- Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Li X, Hodgson D, Flaig J, Kieffer A, Herring WL, Beyhaghi H, Willem L, Jit M, Bilcke J, Beutels P. Cost-Effectiveness of Respiratory Syncytial Virus Preventive Interventions in Children: A Model Comparison Study. Value Health 2023; 26:508-518. [PMID: 36442831 DOI: 10.1016/j.jval.2022.11.014] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Model-based cost-effectiveness analyses on maternal vaccine (MV) and monoclonal antibody (mAb) interventions against respiratory syncytial virus (RSV) use context-specific data and produce varied results. Through model comparison, we aim to characterize RSV cost-effectiveness models and examine drivers for their outputs. METHODS We compared 3 static and 2 dynamic models using a common input parameter set for a hypothetical birth cohort of 100 000 infants. Year-round and seasonal programs were evaluated for MV and mAb interventions, using available evidence during the study period (eg, phase III MV and phase IIb mAb efficacy). RESULTS Three static models estimated comparable medically attended (MA) cases averted versus no intervention (MV, 1019-1073; mAb, 5075-5487), with the year-round MV directly saving ∼€1 million medical and €0.3 million nonmedical costs, while gaining 4 to 5 discounted quality-adjusted life years (QALYs) annually in <1-year-olds, and mAb resulting in €4 million medical and €1.5 million nonmedical cost savings, and 21 to 25 discounted QALYs gained. In contrast, both dynamic models estimated fewer MA cases averted (MV, 402-752; mAb, 3362-4622); one showed an age shift of RSV cases, whereas the other one reported many non-MA symptomatic cases averted, especially by MV (2014). These differences can be explained by model types, assumptions on non-MA burden, and interventions' effectiveness over time. CONCLUSIONS Our static and dynamic models produced overall similar hospitalization and death estimates, but also important differences, especially in non-MA cases averted. Despite the small QALY decrement per non-MA case, their larger number makes them influential for the costs per QALY gained of RSV interventions.
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Affiliation(s)
- Xiao Li
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - David Hodgson
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Julien Flaig
- Epidemiology and Modeling of Infectious Diseases (EPIMOD), Lyon, France
| | - Alexia Kieffer
- Health Economics and Value Assessment, Sanofi, Lyon, France
| | - William L Herring
- RTI Health Solutions, Research Triangle Park, NC, USA; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Lander Willem
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mark Jit
- Center of Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, England, UK
| | - Joke Bilcke
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Herring WL, Gould IG, Wittrup-Jensen V, Ertle J, Kuti E, Wolowacz S. Evaluation of emerging NASH therapies: the impact of treatment efficacy profiles on long-term health outcomes. J Comp Eff Res 2022; 11:1349-1363. [PMID: 36317935 DOI: 10.2217/cer-2021-0194] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Evaluations of nonalcoholic steatohepatitis (NASH) treatments require predicting lifetime outcomes from short-term clinical trials. Materials & methods: A Markov model with NASH fibrosis stages F0-F3, NASH resolution, compensated cirrhosis (F4/CC), and liver-related complication (LRC) states was developed using literature-based standard of care (SoC) data. Hypothetical efficacy profiles were defined affecting resolution (100%-increase), fibrosis improvement (100% increase), or fibrosis worsening (50% decrease). Results: For the SoC, 10-year LRC rates increased with baseline fibrosis stage (F1: 3.0%; F2: 9.8%; F3: 27.2%; F4/CC: 64.9%). The fibrosis worsening profile reduced predicted 10-year LRC rates (F1: 1.9%; F2: 6.5%; F3: 19.1%; F4/CC: 55.0%) more than the resolution and fibrosis improvement profiles (F1: 2.6%/2.6%; F2: 8.5%/8.3%; F3: 23.3%/23.0%; F4/CC: NA/59.0%). Scenario analyses considered alternative SoC progression, treatment efficacy and treatment-stopping rules. Conclusion: Potential NASH efficacy profiles have differing impacts on predicted long-term outcomes, providing insights for future stakeholders.
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Affiliation(s)
- William L Herring
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Ian Gopal Gould
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Villum Wittrup-Jensen
- Boehringer Ingelheim International GmbH, Binger Strasse 17, Ingelheim am Rhein, 55216, Germany
| | - Judith Ertle
- Boehringer Ingelheim International GmbH, Binger Strasse 17, Ingelheim am Rhein, 55216, Germany
| | - Effie Kuti
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, Ridgefield, CT 06877, USA
| | - Sorrel Wolowacz
- RTI Health Solutions, Towers Business Park, Wilmslow Road, Manchester, M20 2RY, UK
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7
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Handels RL, Green C, Gustavsson A, Herring WL, Winblad B, Wimo A, Sköldunger A, Karlsson A, Anderson R, Belger M, Brück C, Espinosa R, Hlávka JP, Jutkowitz E, Lin P, Mendez ML, Mar J, Shewmaker P, Spackman E, Tafazzoli A, Tysinger B, Jönsson L. Cost‐effectiveness models for Alzheimer's disease and related dementias: IPECAD modeling workshop cross‐comparison challenge. Alzheimers Dement 2022; 19:1800-1820. [PMID: 36284403 PMCID: PMC10126209 DOI: 10.1002/alz.12811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/14/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The credibility of model-based economic evaluations of Alzheimer's disease (AD) interventions is central to appropriate decision-making in a policy context. We report on the International PharmacoEconomic Collaboration on Alzheimer's Disease (IPECAD) Modeling Workshop Challenge. METHODS Two common benchmark scenarios, for the hypothetical treatment of AD mild cognitive impairment (MCI) and mild dementia, were developed jointly by 29 participants. Model outcomes were summarized, and cross-comparisons were discussed during a structured workshop. RESULTS A broad concordance was established among participants. Mean 10-year restricted survival and time in MCI in the control group ranged across 10 MCI models from 6.7 to 9.5 years and 3.4 to 5.6 years, respectively; and across 4 mild dementia models from 5.4 to 7.9 years (survival) and 1.5 to 4.2 years (mild dementia). DISCUSSION The model comparison increased our understanding of methods, data used, and disease progression. We established a collaboration framework to assess cost-effectiveness outcomes, an important step toward transparent and credible AD models.
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Affiliation(s)
- Ron L.H. Handels
- Maastricht University Department of Psychiatry and Neuropsychology Alzheimer Centre Limburg School for Mental Health and Neurosciences Maastricht The Netherlands
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Colin Green
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Health Economics Group University of Exeter College of Medicine and Health University of Exeter Exeter UK
| | - Anders Gustavsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Quantify Research Hantverkargatan 8 Stockholm Sweden
| | | | - Bengt Winblad
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Wimo
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Anders Sköldunger
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
| | - Andreas Karlsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Solna Sweden
| | - Robert Anderson
- Care Policy Evaluation Centre London School of Economics London UK
| | | | - Chiara Brück
- Erasmus MC University Medical Center Department of Public Health Rotterdam The Netherlands
| | | | - Jakub P. Hlávka
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Eric Jutkowitz
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
- Providence Veterans Affairs (VA) Medical Center Center of Innovation in Long Term Services and Supports Providence Rhode Island USA
| | - Pei‐Jung Lin
- Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston Massachusetts USA
| | - Mauricio Lopez Mendez
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Javier Mar
- Osakidetza Basque Health Service Debagoiena Integrated Health Organisation Research Unit Arrasate‐Mondragón Spain
- Biodonostia Health Research Institute Donostia‐San Sebastián Spain
| | - Peter Shewmaker
- Department of Health Services Policy & Practice, Brown University School of Public Health Providence Rhode Island USA
| | - Eldon Spackman
- University of Calgary Department of Community Health Sciences Calgary Canada
- O'Brien Institute of Public Health Alberta Canada
| | | | - Bryan Tysinger
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics Los Angeles California USA
| | - Linus Jönsson
- Karolinska Institutet Department for Neurobiology, Care Sciences and Society Center for Alzheimer Research Division of Neurogeriatrics Solna Sweden
- H. Lundbeck A/S Valby Denmark
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Spelman T, Herring WL, Zhang Y, Tempest M, Pearson I, Freudensprung U, Acosta C, Dort T, Hyde R, Havrdova E, Horakova D, Trojano M, De Luca G, Lugaresi A, Izquierdo G, Grammond P, Duquette P, Alroughani R, Pucci E, Granella F, Lechner-Scott J, Sola P, Ferraro D, Grand'Maison F, Terzi M, Rozsa C, Boz C, Hupperts R, Van Pesch V, Oreja-Guevara C, van der Walt A, Jokubaitis VG, Kalincik T, Butzkueven H. Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Patients with Inadequate Response to Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis in the United Kingdom. Pharmacoeconomics 2022; 40:323-339. [PMID: 34921350 PMCID: PMC8866337 DOI: 10.1007/s40273-021-01106-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with highly active relapsing-remitting multiple sclerosis inadequately responding to first-line therapies (interferon-based therapies, glatiramer acetate, dimethyl fumarate, and teriflunomide, known collectively as "BRACETD") often switch to natalizumab or fingolimod. OBJECTIVE The aim was to estimate the comparative effectiveness of switching to natalizumab or fingolimod or within BRACETD using real-world data and to evaluate the cost-effectiveness of switching to natalizumab versus fingolimod using a United Kingdom (UK) third-party payer perspective. METHODS Real-world data were obtained from MSBase for patients relapsing on BRACETD in the year before switching to natalizumab or fingolimod or within BRACETD. Three-way-multinomial-propensity-score-matched cohorts were identified, and comparisons between treatment groups were conducted for annualised relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M). Results were applied in a cost-effectiveness model over a lifetime horizon using a published Markov structure with health states based on the Expanded Disability Status Scale. Other model parameters were obtained from the UK MS Survey 2015, published literature, and publicly available UK sources. RESULTS The MSBase analysis found a significant reduction in ARR (rate ratio [RR] = 0.64; 95% confidence interval [CI] 0.57-0.72; p < 0.001) and an increase in CDI6M (hazard ratio [HR] = 1.67; 95% CI 1.30-2.15; p < 0.001) for switching to natalizumab compared with BRACETD. For switching to fingolimod, the reduction in ARR (RR = 0.91; 95% CI 0.81-1.03; p = 0.133) and increase in CDI6M (HR = 1.30; 95% CI 0.99-1.72; p = 0.058) compared with BRACETD were not significant. Switching to natalizumab was associated with a significant reduction in ARR (RR = 0.70; 95% CI 0.62-0.79; p < 0.001) and an increase in CDI6M (HR = 1.28; 95% CI 1.01-1.62; p = 0.040) compared to switching to fingolimod. No evidence of difference in CDW6M was found between treatment groups. Natalizumab dominated (higher quality-adjusted life-years [QALYs] and lower costs) fingolimod in the base-case cost-effectiveness analysis (0.453 higher QALYs and £20,843 lower costs per patient). Results were consistent across sensitivity analyses. CONCLUSIONS This novel real-world analysis suggests a clinical benefit for therapy escalation to natalizumab versus fingolimod based on comparative effectiveness results, translating to higher QALYs and lower costs for UK patients inadequately responding to BRACETD.
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Affiliation(s)
- Timothy Spelman
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | | | - Yuanhui Zhang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | - Carlos Acosta
- Value and Market Access, Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland.
| | - Thibaut Dort
- Value and Market Access, Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland
| | | | - Eva Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital and Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital and Charles University, Prague, Czech Republic
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata Hospital, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Pierre Grammond
- Centre de Réadaptation Déficience Physique Chaudière-Appalache, Lévis, Canada
| | | | | | | | | | | | - Patrizia Sola
- Azienda Ospedaliero Universitaria Policlinico/OCB, Neurology Unit, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
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Herring WL, Gould IG, Fillit H, Lindgren P, Forrestal F, Thompson R, Pemberton-Ross P. Predicted Lifetime Health Outcomes for Aducanumab in Patients with Early Alzheimer's Disease. Neurol Ther 2021; 10:919-940. [PMID: 34426940 PMCID: PMC8571451 DOI: 10.1007/s40120-021-00273-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a chronic and progressive neurodegenerative disease that places a substantial burden on patients and caregivers. Aducanumab is the first AD therapy approved by the US Food and Drug Administration to reduce a defining pathophysiological feature of the disease, brain amyloid plaques. In the phase 3 clinical trial EMERGE (NCT02484547), aducanumab reduced clinical decline in patients with mild cognitive impairment (MCI) due to AD and mild AD dementia and confirmed amyloid pathology. METHODS We used a Markov modeling approach to predict the long-term clinical benefits of aducanumab for patients with early AD based on EMERGE efficacy data. In the model, patients could transition between AD severity levels (MCI due to AD; mild, moderate, and severe AD dementia) and care settings (community vs. institution) or transition to death. The intervention was aducanumab added to standard of care (SOC), and the comparator was SOC alone. Data sources for base-case and scenario analyses included EMERGE, published National Alzheimer's Coordinating Center analyses, and other published literature. RESULTS Per patient over a lifetime horizon, aducanumab treatment corresponded to 0.65 incremental patient quality-adjusted life-years (QALYs) and 0.09 fewer caregiver QALYs lost compared with patients treated with SOC. Aducanumab treatment translated to a lower lifetime probability of transitioning to AD dementia, a lower lifetime probability of transitioning to institutionalization (25.2% vs. 29.4%), delays in the median time to transition to AD dementia (7.50 vs. 4.92 years from MCI to moderate AD dementia or worse), and an incremental median time in the community of 1.32 years compared with SOC. CONCLUSION The model predicted long-term benefits of aducanumab treatment in patients with MCI due to AD and mild AD dementia and their caregivers. The predicted outcomes provide a foundation for healthcare decision-makers and policymakers to understand the potential clinical and socioeconomic value of aducanumab.
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Affiliation(s)
| | | | - Howard Fillit
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Alzheimer's Drug Discovery Foundation, New York, NY, USA
| | - Peter Lindgren
- The Swedish Institute for Health Economics, Stockholm, Sweden
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Patterson BJ, Buck PO, Curran D, Van Oorschot D, Carrico J, Herring WL, Zhang Y, Stoddard JJ. Estimated Public Health Impact of the Recombinant Zoster Vaccine. Mayo Clin Proc Innov Qual Outcomes 2021; 5:596-604. [PMID: 34195552 PMCID: PMC8240325 DOI: 10.1016/j.mayocpiqo.2021.03.006] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To investigate the potential public health impact of adult herpes zoster (HZ) vaccination with the adjuvanted recombinant zoster vaccine (RZV) in the United States in the first 15 years after launch. METHODS We used a publicly available model accounting for national population characteristics and HZ epidemiological data, vaccine characteristics from clinical studies, and anticipated vaccine coverage with RZV after launch in 2018. Two scenarios were modeled: a scenario with RZV implemented with 65% coverage after 15 years and a scenario continuing with zoster vaccine live (ZVL) with coverage increasing 10% over the same period. We estimated the numbers vaccinated, and the clinical outcomes and health care use avoided yearly, from January 1, 2018, to December 31, 2032. We varied RZV coverage and investigated the associated impact on HZ cases, complications, and health care resource use. RESULTS With RZV adoption, the numbers of individuals affected by HZ was predicted to progressively decline with an additional 4.6 million cumulative cases avoided if 65% vaccination with RZV was reached within 15 years. In the year 2032, it was predicted that an additional 1.3 million physicians' visits and 14.4 thousand hospitalizations could be avoided, compared with continuing with ZVL alone. These numbers could be reached 2 to 5 years earlier with 15% higher RZV vaccination rates. CONCLUSION Substantial personal and health care burden can be alleviated when vaccination with RZV is adopted. The predicted numbers of HZ cases, complications, physicians' visits, and hospitalizations avoided, compared with continued ZVL vaccination, depends upon the RZV vaccination coverage achieved.
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Affiliation(s)
| | - Philip O. Buck
- GSK, US Health Outcomes & Epidemiology, Philadelphia, PA
| | | | | | - Justin Carrico
- RTI Health Solutions, Health Economics, Research Triangle, NC
| | | | - Yuanhui Zhang
- RTI Health Solutions, Health Economics, Research Triangle, NC
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Patterson BJ, Herring WL, Van Oorschot D, Curran D, Carrico J, Zhang Y, Ackerson BK, Bruxvoort K, Sy LS, Tseng HF. Incremental clinical and economic impact of recombinant zoster vaccination: real-world data in a budget impact model. J Manag Care Spec Pharm 2020; 26:1567-1575. [PMID: 33043821 PMCID: PMC10391059 DOI: 10.18553/jmcp.2020.20251] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2017, the FDA approved the adjuvanted recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in immunocompetent adults aged 50 years and older. RZV joined zoster vaccine live (ZVL) as U.S.-marketed vaccines against HZ. The Advisory Committee on Immunization Practices preferentially recommended use of RZV over ZVL. In order to inform population-based decision makers (PBDMs) about the incremental clinical and economic impact of RZV adoption, budget impact (BI) models may be used. Populating such models with national data can inform PBDMs about the incremental value of RZV adoption nationally; however, heterogeneity across health plans requires the inclusion of plan-specific data to ensure the relevance of modeling outcomes for plan-specific decision makers. OBJECTIVE To investigate the clinical and economic outcomes associated with the adoption of RZV in nationally representative populations with commercial and Medicare coverage and to demonstrate the effect of the heterogeneity of health plans using real-world data from a large, integrated delivery network (IDN). METHODS We used a publicly available BI model. The model accounts for national and IDN-collected population characteristics (size, age distribution) and epidemiological data (incidence of HZ and complications, HZ recurrence rate), vaccine characteristics from randomized controlled trials and observational studies (efficacy, waning, second dose compliance for RZV, adverse event rate), national costs (vaccine, direct medical for HZ, complications, and vaccine adverse events), and current and anticipated vaccine coverage. We assessed incremental clinical (HZ cases and complications) and economic (per-member-per-month [PMPM] costs) impact at 5-year to 15-year time horizons, comparing scenarios where RZV is solely implemented with one where only ZVL is utilized. RESULTS Following the adoption of RZV, the incremental HZ cases avoided over 5 and 15 years were estimated to be 1,800 and 15,000 for a commercial plan, 3,800 and 21,000 for a Medicare plan, and 8,600 and 71,000 for a specific IDN. The incremental PMPM budget impact over the same time horizons was estimated to be $0.42 and $0.31, respectively, for a commercial plan, $0.35 and $0.10 for a Medicare plan, and $0.39 and $0.25 for a specific IDN. The differences in results across plans resulted from the population age distribution, the vaccine copay (applied in the Medicare scenario only), the vaccine coverage in the plan, and other plan-specific factors affecting disease epidemiology and costs per case of HZ. CONCLUSIONS Model projections indicated that RZV adoption avoided HZ cases and related complications, with the PMPM budget impact dependent on plan-specific factors. As health gains increased over time, the incremental costs incurred were found to decrease as the shorter-term costs of adopting the new vaccine were increasingly offset by the longer-term benefits of vaccination. DISCLOSURES GlaxoSmithKline Biologicals SA funded this study (GSK study identifier: HO-17-18378) and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also paid all costs associated with the development and publication of this manuscript. Patterson, Van Oorschot, and Curran are employees of the GSK group of companies and hold shares in the GSK group of companies. Herring, Carrico, and Zhang are employees of RTI Health Solutions, which received funding via a contractual agreement with the GSK group of companies to perform the work contributing to this research. Ackerson, Bruxvoort, Sy, and Tseng are employees of Kaiser Permanente Southern California, which was contracted by the GSK group of companies for the conduct of this study and were members of the KPSC study team. Ackerson, Bruxvoort, Sy, and Tseng report research contracts with the following pharmaceutical companies unrelated to this study: Dynavax (Ackerson, Bruxvoort, and Sy); the GSK group of companies (Ackerson, Bruxvoort, Sy, and Tseng); Novavax (Ackerson, Sy, and Tseng); and Seqirus (Ackerson, Bruxvoort, Sy, and Tseng). Tseng reports having served as a paid consultant for the GSK group of companies. The authors declare no other financial and nonfinancial relationships and activities. Findings from this study were presented at AMCP Nexus 2019; October 29-November 1, 2019; National Harbor, MD.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lina S Sy
- Kaiser Permanente Southern California, Pasadena
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Herring WL, Mauskopf JM. Persistent challenges in Alzheimer’s disease modeling: Pragmatic solutions to inform the road forward. Alzheimers Dement 2020. [DOI: 10.1002/alz.041141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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