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van de Laar CJ, Janssen CA, Janssen M, Oude Voshaar MAH, AL MJ, van de Laar MAFJ. Model-based cost-effectiveness analyses comparing combinations of urate lowering therapy and anti-inflammatory treatment in gout patients. PLoS One 2022; 17:e0261940. [PMID: 35089941 PMCID: PMC8797232 DOI: 10.1371/journal.pone.0261940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives
To assess the cost-effectiveness of various combinations of urate lowering therapy (ULT) and anti-inflammatory treatment in the management of newly diagnosed gout patients, from the Dutch societal perspective.
Methods
A probabilistic patient-level simulation estimating costs and quality-adjusted life years (QALYs) comparing gout and hyperuricemia treatment strategies was performed. ULT options febuxostat, allopurinol and no ULT were considered. Flare treatments naproxen, colchicine, prednisone, and anakinra were considered. A Markov Model was constructed to simulate gout disease. Health states were no flare, and severe pain, mild pain, moderate pain, or no pain in the presence of a flare. Model input was derived from patient level clinical trial data, meta-analyses or from previously published health-economic evaluations. The results of probabilistic sensitivity analyses were presented using incremental cost-effectiveness ratios (ICERs), and summarized using cost-effectiveness acceptability curves (CEACs). Scenario analyses were performed.
Results
The ICER for allopurinol versus no ULT was €1,381, when combined with naproxen. Febuxostat yielded the highest utility, but also the highest costs (€4,385 vs. €4,063 for allopurinol), resulting in an ICER of €25,173 when compared to allopurinol. No ULT was not cost-effective, yielding the lowest utility. For the gout flare medications, comparable effects on utility were achieved. Combined with febuxostat, naproxen was the cheapest option (€4,404), and anakinra the most expensive (€4,651). The ICER of anakinra compared to naproxen was €818,504. Colchicine and prednisone were dominated by naproxen.
Conclusion
Allopurinol and febuxostat were both cost-effective compared to No ULT. Febuxostat was cost-effective in comparison with allopurinol at higher willingness-to-pay thresholds. For treating gout flares, colchicine, naproxen and prednisone offered comparable health economic implications, although naproxen was the favoured option.
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Affiliation(s)
| | - Carly A. Janssen
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Martijn A. H. Oude Voshaar
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Maiwenn J. AL
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mart A. F. J. van de Laar
- Transparency in Healthcare BV, Hengelo, the Netherlands
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
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2
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Rhon DI, Kim M, Asche CV, Allison SC, Allen CS, Deyle GD. Cost-effectiveness of Physical Therapy vs Intra-articular Glucocorticoid Injection for Knee Osteoarthritis: A Secondary Analysis From a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2142709. [PMID: 35072722 PMCID: PMC8787617 DOI: 10.1001/jamanetworkopen.2021.42709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Physical therapy and glucocorticoid injections are initial treatment options for knee osteoarthritis, but available data indicate that most patients receive one or the other, suggesting they may be competing interventions. The initial cost difference for treatment can be substantial, with physical therapy often being more expensive at the outset, and cost-effectiveness analysis can aid patients and clinicians in making decisions. OBJECTIVE To investigate the incremental cost-effectiveness between physical therapy and intra-articular glucocorticoid injection as initial treatment strategies for knee osteoarthritis. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation is a secondary analysis of a randomized clinical trial performed from October 1, 2012, to May 4, 2017. Health economists were blinded to study outcomes and treatment allocation. A randomized sample of patients seen in primary care and physical therapy clinics with a radiographically confirmed diagnosis of knee osteoarthritis were evaluated from the clinical trial with 96.2% follow-up at 1 year. INTERVENTIONS Physical therapy or glucocorticoid injection. MAIN OUTCOMES AND MEASURES The main outcome was incremental cost-effectiveness between 2 alternative treatments. Acceptability curves of bootstrapped incremental cost-effectiveness ratios (ICERs) were used to identify the proportion of ICERs under the specific willingness-to-pay level ($50 000-$100 000). Health care system costs (total and knee related) and health-related quality-of-life based on quality-adjusted life-years (QALYs) were obtained. RESULTS A total of 156 participants (mean [SD] age, 56.1 [8.7] years; 81 [51.9%] male) were randomized 1:1 and followed up for 1 year. Mean (SD) 1-year knee-related medical costs were $2113 ($4224) in the glucocorticoid injection group and $2131 ($1015) in the physical therapy group. The mean difference in QALY significantly favored physical therapy at 1 year (0.076; 95% CI, 0.02-0.126; P = .003). Physical therapy was the more cost-effective intervention, with an ICER of $8103 for knee-related medical costs, with a 99.2% probability that results fall below the willingness-to-pay threshold of $100 000. CONCLUSIONS AND RELEVANCE A course of physical therapy was cost-effective compared with a course of glucocorticoid injections for patients with knee osteoarthritis. These results suggest that, although the initial cost of delivering physical therapy may be higher than an initial course of glucocorticoid injections, 1-year total knee-related costs are equivalent, and greater improvement in QALYs may justify the initial higher costs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01427153.
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Affiliation(s)
- Daniel I. Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Minchul Kim
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria
| | - Carl V. Asche
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria
| | - Stephen C. Allison
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | - Chris S. Allen
- Department of Rehabilitation, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Gail D. Deyle
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
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3
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Hauptman M, Krase JM. Drug costs of Medicaid-covered therapies for pemphigus vulgaris treatment. Dermatol Online J 2020; 26:13030/qt9cr55716. [PMID: 33423416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023] Open
Abstract
Pemphigus vulgaris is the most common form of pemphigus affecting an estimated 30,000-40,000 people in the United States. Costs of systemic and immunoglobulin therapies for pemphigus vulgaris have remained persistently high. Herein, we address the current costs and changes in costs of immunosuppressive treatments, anti-inflammatory treatments, and immunoglobulin treatments covered by Medicaid for pemphigus vulgaris from 2013-2020.
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Affiliation(s)
| | - Jeffrey M Krase
- Division of Dermatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ.
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AlRuthia Y, Almadi M, Aljebreen A, Azzam N, Alsharif W, Alrasheed H, Almuaythir G, Saeed M, HajkhderMullaissa B, Alharbi O. The cost-effectiveness of biologic versus non-biologic treatments and the health-related quality of life among a sample of patients with inflammatory bowel disease in a tertiary care center in Saudi Arabia. J Med Econ 2020; 23:1102-1110. [PMID: 32619388 DOI: 10.1080/13696998.2020.1791889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/30/2022]
Abstract
AIMS This study's objectives were to examine and compare the cost-effectiveness of biologic and non-biologic therapies in the improvement of the health-related quality of life (HRQoL) of patients with inflammatory bowel disease (IBD) in Saudi Arabia. MATERIALS AND METHODS This retrospective cohort study analyzed data from the medical records of patients with IBD treated at a tertiary-care hospital in Riyadh, Saudi Arabia. Drug utilization costs and HRQoL scores were evaluated at baseline and after six months of treatment. Patients' HRQoL was measured using the Arabic version of the standardized EuroQol 5 Dimensional 3 Level (EQ-5D-3L) questionnaire with a visual analog scale (VAS). RESULTS Eighty-seven patients with Crohn's disease (CD) and 69 patients with ulcerative colitis (UC) were included in the study (N = 156), and 59 (37.82%) were treated with biologics. Similar effects of both types of medications were found on the HRQoL domains of mobility, usual activities, and pain and discomfort, while biologics outperformed non-biologics on the self-care domain. The mean utilization cost of a biologic-based treatment over a six-month period was SAR 25,690.46 (USD 6,850.79) higher than that of the non-biologic treatment (95% confidence interval (CI): 24,548.55-27,465.11), and the change in the ED-5D-3L VAS score from baseline to follow-up was 4.78 points (95% CI: 1.96-14.00). A probabilistic sensitivity analysis demonstrated that IBD therapy with biologic-based treatment is always more expensive, but also more effective in improving HRQoL 99.45% of the time. Adalimumab was found to be less cost effective than infliximab in the management of CD. LIMITATIONS Information bias cannot be ruled out, as this investigation was a retrospective cohort study with a relatively small sample that was not randomized. CONCLUSIONS The results of this analysis can serve as a foundation to introduce HRQoL-based recommendations for the use of biologics in the management of IBD in Saudi Arabia.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majid Almadi
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada
| | - Abdulrahman Aljebreen
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nahla Azzam
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Wejdan Alsharif
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hala Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghadah Almuaythir
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Maria Saeed
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Baraa HajkhderMullaissa
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Othman Alharbi
- Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Thompson KJ, Taylor CB, Venkatesh B, Cohen J, Hammond NE, Jan S, Li Q, Myburgh J, Rajbhandari D, Saxena M, Kumar A, Finfer SR. The cost-effectiveness of adjunctive corticosteroids for patients with septic shock. CRIT CARE RESUSC 2020; 22:191-199. [PMID: 32900325 PMCID: PMC10692584 DOI: 10.1016/s1441-2772(23)00386-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/06/2023]
Abstract
OBJECTIVE To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN Data linkage-based cost-effectiveness analysis. SETTING New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.
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Affiliation(s)
| | - Colman B Taylor
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Jeremy Cohen
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Sydney, NSW, Australia
| | - John Myburgh
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Manoj Saxena
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Ashwani Kumar
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Simon R Finfer
- The George Institute for Global Health, Sydney, NSW, Australia
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6
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Thompson KJ, Taylor CB, Venkatesh B, Cohen J, Hammond NE, Jan S, Li Q, Myburgh J, Rajbhandari D, Saxena M, Kumar A, Finfer SR. The cost-effectiveness of adjunctive corticosteroids for patients with septic shock. CRIT CARE RESUSC 2020; 22:191-199. [PMID: 32900325 PMCID: PMC10692584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN Data linkage-based cost-effectiveness analysis. SETTING New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.
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Affiliation(s)
| | - Colman B Taylor
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Jeremy Cohen
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Sydney, NSW, Australia
| | - John Myburgh
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Manoj Saxena
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Ashwani Kumar
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Simon R Finfer
- The George Institute for Global Health, Sydney, NSW, Australia
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Pouwels XGLV, Petersohn S, Carrera VH, Denniston AK, Chalker A, Raatz H, Armstrong N, Shah D, Witlox W, Worthy G, Noake C, Riemsma R, Kleijnen J, Joore MA. Fluocinolone Acetonide Intravitreal Implant for Treating Recurrent Non-infectious Uveitis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics 2020; 38:431-441. [PMID: 31701471 PMCID: PMC7176320 DOI: 10.1007/s40273-019-00851-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The National Institute for Health and Care Excellence (NICE) invited Alimera Sciences, the company manufacturing fluocinolone acetonide intravitreal implant (FAc) 0.19 mg (tradename ILUVIEN®), to submit evidence on the clinical and cost-effectiveness of FAc for treating recurrent non-infectious uveitis. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Centre + , was commissioned to act as the independent Evidence Review Group (ERG). This paper contains a summary of the clinical and cost-effectiveness evidence submitted by the company, the ERG's critique on the submitted evidence, and the guidance issued by the NICE Appraisal Committee (AC). The company submission (CS) was mainly informed by the PSV-FAI-001 trial in which FAc was compared with (limited) current practice [(L)CP], which was not considered to be representative of UK clinical practice by the ERG. There was no comparison of FAc to any treatment listed in the final scope, and especially to the dexamethasone intravitreal implant (dexamethasone), which was considered to be a relevant comparator by the AC. The primary outcome of the PSV-FAI-001 was recurrence of uveitis in the treated eye. Most of the events for the primary outcome were imputed during the PSV-FAI-001 trial, which probably led to an overestimation of the number of recurrences of disease, and a biased estimate of the relative effectiveness of FAc versus (L)CP. Finally, the place of FAc in the treatment pathway was not clearly defined by the company. Substantial uncertainty surrounded the cost-effectiveness results due to the shortcomings of the clinical evidence. Additionally, the quality of life of patients was not measured during the PSV-FAI-001 trial and long-term effectiveness data of FAc were lacking. The ERG adjusted several issues identified in the CS and added dexamethasone as a comparator in the decision analytic model. The ERG presented multiple analyses as base-cases because several elements of the assessment remained uncertain. The fully incremental ERG results ranged from dexamethasone (extendedly) dominating FAc (when assuming a hazard ratio of 1 or 0.7 for dexamethasone versus FAc) to an incremental cost-effectiveness ratio (ICER) of £30,153 per quality-adjusted life-year (QALY) gained for FAc versus (L)CP [when assuming a hazard ratio of 0.456 for dexamethasone versus (L)CP]. The ICER of FAc versus (L)CP ranged from £12,325 to £30,153 per QALY gained. After a second AC meeting where alternative company scenarios comparing FAc with dexamethasone were considered by the AC, the AC concluded that "the results of the company's analyses ranged from the fluocinolone acetonide implant being dominant (that is, it was more effective and costs less), to an ICER of £29,461 per QALY gained, and most of the ICERs were below £20,000 per QALY gained". Therefore, the AC recommended FAc as a cost-effective use of National Health Service (NHS) resources for treating recurrent non-infectious uveitis affecting the posterior segment of the eye in the final TA590 guidance (published July 2019).
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Affiliation(s)
| | - Svenja Petersohn
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | | | - Heike Raatz
- Kleijnen Systematic Reviews Ltd, York, UK
- European Centre of Pharmaceutical Medicine, Basel University, Basel, Switzerland
| | | | | | - Willem Witlox
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Caro Noake
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Tian M, Ticer T, Wang Q, Walker S, Pham A, Suh A, Busatto S, Davidovich I, Al-Kharboosh R, Lewis-Tuffin L, Ji B, Quinones-Hinojosa A, Talmon Y, Shapiro S, Rückert F, Wolfram J. Adipose-Derived Biogenic Nanoparticles for Suppression of Inflammation. Small 2020; 16:e1904064. [PMID: 32067382 DOI: 10.1002/smll.201904064] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/30/2019] [Indexed: 06/10/2023]
Abstract
Extracellular vesicles secreted from adipose-derived mesenchymal stem cells (ADSCs) have therapeutic effects in inflammatory diseases. However, production of extracellular vesicles (EVs) from ADSCs is costly, inefficient, and time consuming. The anti-inflammatory properties of adipose tissue-derived EVs and other biogenic nanoparticles have not been explored. In this study, biogenic nanoparticles are obtained directly from lipoaspirate, an easily accessible and abundant source of biological material. Compared to ADSC-EVs, lipoaspirate nanoparticles (Lipo-NPs) take less time to process (hours compared to months) and cost less to produce (clinical-grade cell culture facilities are not required). The physicochemical characteristics and anti-inflammatory properties of Lipo-NPs are evaluated and compared to those of patient-matched ADSC-EVs. Moreover, guanabenz loading in Lipo-NPs is evaluated for enhanced anti-inflammatory effects. Apolipoprotein E and glycerolipids are enriched in Lipo-NPs compared to ADSC-EVs. Additionally, the uptake of Lipo-NPs in hepatocytes and macrophages is higher. Lipo-NPs and ADSC-EVs have comparable protective and anti-inflammatory effects. Specifically, Lipo-NPs reduce toll-like receptor 4-induced secretion of inflammatory cytokines in macrophages. Guanabenz-loaded Lipo-NPs further suppress inflammatory pathways, suggesting that this combination therapy can have promising applications for inflammatory diseases.
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Affiliation(s)
- Ming Tian
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
- Department of Surgery, Surgical Lab, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, 68167, Germany
| | - Taylor Ticer
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Qikun Wang
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
- Department of Surgery, Surgical Lab, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, 68167, Germany
| | - Sierra Walker
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Anthony Pham
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Annie Suh
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Sara Busatto
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Irina Davidovich
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute (RBNI), Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Rawan Al-Kharboosh
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | | | - Baoan Ji
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Yeshayahu Talmon
- Department of Chemical Engineering and the Russell Berrie Nanotechnology Institute (RBNI), Technion-Israel Institute of Technology, Haifa, 3200003, Israel
| | - Shane Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Felix Rückert
- Department of Surgery, Surgical Lab, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, 68167, Germany
| | - Joy Wolfram
- Department of Biochemistry and Molecular Biology, Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, 32224, USA
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Moure-Fernandez A, Hollinghurst S, Carroll FE, Downing H, Young G, Brookes S, May M, El-Gohary M, Harnden A, Kendrick D, Lafond N, Little P, Moore M, Orton E, Thompson M, Timmins D, Wang K, Hay AD. Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care. BMJ Open 2020; 10:e033567. [PMID: 32075830 PMCID: PMC7045138 DOI: 10.1136/bmjopen-2019-033567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo. DESIGN Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work. SETTING Fifty-four National Health Service (NHS) general practices in England. PARTICIPANTS 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days. INTERVENTIONS 2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets. OUTCOME MEASURES Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up. RESULTS 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms. CONCLUSIONS The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms. TRIAL REGISTRATION NUMBERS EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.
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Affiliation(s)
- Aida Moure-Fernandez
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Fran E Carroll
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Harriet Downing
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Grace Young
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sara Brookes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Margaret May
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Magdy El-Gohary
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Anthony Harnden
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Natasher Lafond
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Paul Little
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Orton
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - David Timmins
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Abstract
Aims: To estimate annual cost per response (CPR) in the US and number needed to treat (NNT) among patients receiving guselkumab or adalimumab treatment for moderate-to-severe plaque psoriasis (PsO).Materials and methods: Results from VOYAGE 1, a double-blind, placebo-controlled, head-to-head, 48-week study of guselkumab compared with adalimumab in patients with moderate-to-severe PsO were used to estimate annual CPR for Psoriasis Area and Severity Index (PASI) 75, 90, and 100 responses. Drug dosing followed US label recommendations and drug costs were based on US annual wholesale acquisition costs. Number needed to treat (NNT) and annual CPR analyses were estimated, and week 48 response rates were assumed to be maintained for both the induction and maintenance years.Results: Week-48 PASI 90 response rates were 76.3% for guselkumab and 47.9% for adalimumab. The CPR for PASI 90 in the induction year for guselkumab was $113,861 vs $151,226 for adalimumab. Both drugs had lower CPRs for PASI 90 in the maintenance year: $85,395 for guselkumab and $140,424 for adalimumab for adalimumab. The NNT for a PASI 90 response was 1.3 for guselkumab and 2.1 for adalimumab; CPRs and NNT were also lower for guselkumab than for adalimumab for PASI 75 and PASI 100 for both induction and maintenance years.Limitations and conclusions: In this analysis, extrapolating 48-week results from a single head-to-head study, guselkumab was more cost-effective with lower NNT than adalimumab in both the induction and maintenance years for PASI 75, PASI 90, and PASI 100 responses.
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Affiliation(s)
- Amanda Teeple
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Erik Muser
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
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11
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Abstract
Aims: Non-adherence is associated with poor clinical outcomes among patients with asthma. While cost-effectiveness analysis (CEA) is increasingly used to inform value assessment of the interventions, most do not take into account adherence in the analyses. This study aims to: (1) Understand the extent of studies considering adherence as part of the economic analyses, and (2) summarize the methods of incorporating adherence in the economic models. Materials and methods: A literature search was performed from the inception to February 2018 using four databases: PubMed, EMBASE, NHS EED, and the Tufts CEA registry. Decision model-based CEA of asthma were identified. Outcomes of interest were the number of studies incorporating adherence in the economic models, and the incorporating methods. All data were extracted using a standardized data collection form. Results: From 1,587 articles, 23 studies were decision model-based CEA of asthma, of which four CEA (17.4%) incorporated adherence in the analyses. Only the method of incorporating adherence by adjusting treatment effectiveness according to adherence levels was demonstrated in this review. Two approaches were used to derive the associations between adherence and effectiveness. The first approach was to apply a mathematical formula, developed by an expert panel, and the second was to extrapolate the associations from previous published studies. The adherence-adjusted effectiveness was then incorporated in the economic models. Conclusions: A very low number of CEA of asthma incorporated adherence in the analyses. All the CEA adjusted treatment effectiveness according to adherence levels, applied to the economic models.
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Affiliation(s)
- Bunchai Chongmelaxme
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
| | - Nathorn Chaiyakunapruk
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
- b School of Pharmacy , Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia
- c Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster , Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia
- d School of Pharmacy , University of Wisconsin-Madison , Madison , WI , USA
| | - Piyameth Dilokthornsakul
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
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12
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Pöllinger B, Schmidt W, Seiffert A, Imhoff H, Emmert M. Costs of dose escalation among ulcerative colitis patients treated with adalimumab in Germany. Eur J Health Econ 2019; 20:195-203. [PMID: 29362899 DOI: 10.1007/s10198-017-0953-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/10/2016] [Accepted: 12/21/2017] [Indexed: 05/24/2023]
Abstract
AIMS We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation. METHODS The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010-2015) in adult UC patients undergoing adalimumab therapy. RESULTS A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease. CONCLUSION Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.
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Affiliation(s)
| | | | | | - Heidi Imhoff
- Market Access, MSD Sharp & Dohme GmbH, Haar, Germany
| | - Martin Emmert
- Versorgungsmanagement an der Friedrich-Alexander-Universität Erlangen-Nürnberg, Raum 5.255, Lange Gasse 20, 90403, Nuremberg, Germany.
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13
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Abstract
PURPOSE OF REVIEW Inflammation has been shown to be central to the development and progression of atherosclerosis. Despite detailed understanding of its central role and the cellular dynamics, which contribute to atherosclerotic inflammation, there has been slow progress in finding suitable agents to treat it. The recent CANTOS trial showed that the interleukin-1β inhibitor canakinumab can improve outcomes after acute coronary syndromes. Being a monoclonal antibody, it is expensive and inconvenient to administer for long-term treatment. This review summarizes recent work in finding effective, affordable alternatives to canakinumab. RECENT FINDINGS Statin drugs have anti-inflammatory properties but separating their LDL lowering effect from their anti-inflammatory effect has been difficult. Drugs acting on targets outside of the interleukin-1β (IL-1β) pathway have been tested without finding a suitable candidate. Following the proof of principle provided by the success of canakinumab, other candidates targeting the IL-1β pathway are undergoing detailed evaluation. The most likely candidates are low-dose methotrexate and low-dose colchicine. The potential mechanisms and ongoing clinical trials are described. SUMMARY Targeting the IL-1β pathway has already been successful with canakinumab but its expense and inconvenience of administration may limit its widespread uptake for controlling inflammation in atherosclerosis. Low-dose methotrexate and low-dose colchicine are affordable and more accessible alternatives, currently undergoing detailed evaluation for safety and efficacy in large randomized controlled trials.
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Affiliation(s)
- Peter L Thompson
- Heart Research Institute, Sir Charles Gairdner Hospital
- Harry Perkins Institute of Medical Research
- School of Medicine and Pharmacology, University of Western Australia
- GenesisCare, Perth, Australia
| | - S Mark Nidorf
- Harry Perkins Institute of Medical Research
- GenesisCare, Perth, Australia
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14
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Gherardi A, Roze S, Kuijvenhoven J, Ghatnekar O, Yip Sonderegger YL. Budesonide with multi-matrix technology as second-line treatment for ulcerative colitis: evaluation of long-term cost-effectiveness in the Netherlands. J Med Econ 2018; 21:869-877. [PMID: 29857775 DOI: 10.1080/13696998.2018.1484371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/11/2022]
Abstract
AIMS Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands. MATERIALS AND METHODS An eight-state Markov model with an 8 week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n = 598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and prednisolone) were selected based on current Dutch clinical practice. Treatment effects were evaluated by network meta-analysis using a Bayesian framework. Cost-effectiveness analysis was performed over a 5 year time horizon from a societal perspective, with costs, health-state and adverse event utilities derived from published sources. Outcomes were weighted by disease extent distribution and corresponding comparators. RESULTS Budesonide MMX was associated with comparable quality-adjusted life year (QALY) gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone. LIMITATIONS Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments. CONCLUSIONS In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.
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Affiliation(s)
| | | | | | - Ola Ghatnekar
- c Ferring International PharmaScience Center , Copenhagen , Denmark
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15
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Burns RM, Wolstenholme J, Jawad S, Williams N, Thompson M, Perera R, Hay AD, Heneghan C, Little P, Moore M, Hayward G. Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study. BMJ Open 2018; 8:e019184. [PMID: 29705751 PMCID: PMC5931286 DOI: 10.1136/bmjopen-2017-019184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat. DESIGN A UK-based, multicentre, two arm, individually randomised, double blind trial. SETTING AND POPULATION Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. INTERVENTION a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. MAIN OUTCOME Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective. RESULTS Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was -0.00005 (95% CI -0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was -£6440 (95% CI -£132 151 to £126 335) and the median ICER was -£304 (IQR-£5816 to £3877); suggesting considerable uncertainty. CONCLUSIONS AND RELEVANCE The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice. TRIAL REGISTRATION NUMBER ISRCTN17435450; Post-results.
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Affiliation(s)
- Richeal M Burns
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sena Jawad
- Department of Medicine, Imperial College London, Neonatal Data Analysis Unit, London, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Rafael Perera
- Primary Health Care, University of Oxford, Oxford, UK
| | - Alastair D Hay
- School of Social and Community Medicine, University of Bristol, Bristol, Bristol, UK
| | | | - Paul Little
- Southampton Medical School, University of Southampton, Southampton, UK
| | | | - Gail Hayward
- Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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16
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Chen X, Gautam S, Ruggieri A, Richards T, Devries A, Sylwestrzak G. Comparison of Specialty Medication Use for Common Chronic Inflammatory Diseases Among Health Exchange and Other Commercially Insured Members. J Manag Care Spec Pharm 2018; 24:12-19. [PMID: 29290173 PMCID: PMC10398125 DOI: 10.18553/jmcp.2018.24.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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 The Affordable Care Act of 2010 allows the purchase of health insurance through special marketplaces called "health exchanges." The majority of individuals enrolling in the exchanges were previously uninsured, older, and sicker than other commercially insured members. Early evidence also suggests that exchange plan members use more costly specialty drugs compared with other commercially insured members. OBJECTIVES To (a) examine patient characteristics and specialty drug use for common chronic inflammatory diseases (CIDs) among exchange plan members compared with other commercially insured members and (b) explore variations in specialty drug use within exchange plans by metal tiers (bronze, silver, gold, and platinum), as well as across local markets. METHODS This analysis included adults aged ≥ 18 years who were enrolled in exchange plans (exchange population) and other commercial health plans (nonexchange population). The primary outcome was the likelihood of using specialty drugs prescribed to treat common CIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriatic arthritis, and psoriasis. The adjusted likelihood of using CID specialty drugs was calculated from logistic regression controlling for prevalence of CIDs and other health risk factors. RESULTS A total of 931,384 exchange plan members and 2,682,855 nonexchange plan members were included in the analysis. Compared with the nonexchange population, the exchange population was older, more likely to be female, had more comorbid conditions, but filled fewer prescriptions. The 2 groups were similar in terms of CID prevalence. The observed likelihood of CID specialty drug use was 20.0% lower in the exchange versus the nonexchange populations (341 users per 100,000 exchange members vs. 427 users per 100,000 nonexchange members; P < 0.001). Within the exchange population, the observed likelihood of CID specialty drug use was 132 per 100,000 bronze plan members (69.1% lower than nonexchange); 326 per 100,000 silver plan members (23.5% lower than nonexchange); 579 per 100,000 gold plan members (35.6% higher than nonexchange); and 672 per 100,000 platinum plan members (57.5% higher than nonexchange). All differences were statistically significant at P < 0.001. There were also large differences by local market, ranging from 49.1% lower to 75.8% higher CID use in the exchange population than in the nonexchange population. After adjustment, the exchange population was 16.6% less likely to use CID specialty drugs than the nonexchange population (P < 0.001). Large variation in specialty drug use within the exchange plan metal tiers was reduced. After adjustment, the higher use of CID specialty drugs among the exchange population in certain local plans was no longer statistically significant. CONCLUSIONS Members insured through exchange plans were older and sicker than those with nonexchange plans, but they did not use more CID specialty drugs compared with the nonexchange population. Large variations were seen among the exchange plan metal tiers and by local markets, which were often related to the risk profiles of exchange plan enrollees. DISCLOSURES Funding for this study was provided by Anthem. Anthem had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Gautam, DeVries, and Sylwestrzak are employees of HealthCore, a wholly owned subsidiary of Anthem. Richards is an employee of Anthem. Ruggieri is a former employee of Anthem and a current employee of MedImpact Healthcare Systems. Study concept and design were contributed by Ruggieri, Richards, DeVries, and Sylwestrzak. Chen took the lead in data collection, along with Gautam. Data interpretation was performed by Chen, along with the other authors. The manuscript was written by Chen, Gautam, Sylwestrzak, and DeVries and revised by Chen, Gautam, and Sylwestrzak, along with the other authors.
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17
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Tappenden P, Carroll C, Stevens JW, Rawdin A, Grimm S, Clowes M, Kaltenthaler E, Ingram JR, Collier F, Ghazavi M. Adalimumab for Treating Moderate-to-Severe Hidradenitis Suppurativa: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics 2017; 35:805-815. [PMID: 28176188 DOI: 10.1007/s40273-017-0488-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As part of its single technology appraisal (STA) process, the UK National Institute for Health and Care Excellence (NICE) invited the manufacturer of adalimumab (AbbVie) to submit evidence on the clinical effectiveness and cost effectiveness of adalimumab for the treatment of moderate-to-severe hidradenitis suppurativa (HS). The appraisal assessed adalimumab as monotherapy in adult patients with an inadequate response to conventional systemic HS therapy. The School of Health and Related Research Technology Appraisal Group was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology based on the company's submission to NICE. The evidence was mainly derived from three randomised controlled trials comparing adalimumab with placebo in adults with moderate-to-severe HS. The clinical-effectiveness review found that significantly more patients achieved a clinical response in the adalimumab groups than in the control groups but that the treatment effect varied between trials and there was uncertainty regarding its impact on a range of other relevant outcomes as well as long-term efficacy. The company's submitted Markov model assessed the incremental cost effectiveness of adalimumab versus standard care for the treatment of HS from the perspective of the UK NHS and Personal Social Services (PSS) over a lifetime horizon. The original submitted model, including a patient access scheme (PAS), suggested that the incremental cost-effectiveness ratio (ICER) for adalimumab versus standard care was expected to be £16,162 per quality-adjusted life-year (QALY) gained. Following a critique of the model, the ERG's preferred base case, which corrected programming errors and structural problems surrounding discontinuation rules and incorporated a lower unit cost for HS surgery, resulted in a probabilistic ICER of £29,725 per QALY gained. Based on additional analyses undertaken by the company and the ERG following the publication of the appraisal consultation document (ACD), the Appraisal Committee concluded that the maximum possible ICER for adalimumab compared with supportive care was between £28,500 and £33,200 per QALY gained but was likely to be lower. The Appraisal Committee recommended adalimumab (with the PAS) for the treatment of active moderate-to-severe HS in adults whose disease has not responded to conventional systemic therapy.
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Affiliation(s)
- Paul Tappenden
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK.
| | - Christopher Carroll
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - John W Stevens
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - Andrew Rawdin
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - Sabine Grimm
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - Mark Clowes
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - Eva Kaltenthaler
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, England, UK
| | - John R Ingram
- Institute of Infection and Immunity, Cardiff University, Cardiff, UK
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18
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Null KD, Xu Y, Pasquale MK, Su C, Marren A, Harnett J, Mardekian J, Manuchehri A, Healey P. Ulcerative Colitis Treatment Patterns and Cost of Care. Value Health 2017; 20:752-761. [PMID: 28577692 DOI: 10.1016/j.jval.2017.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 09/12/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To examine treatment patterns, dosing, health care resource utilization, and cost of tumor necrosis factor inhibitors (TNFi), adalimumab (ADA) and infliximab (IFX), among patients enrolled in US Humana insurance plans who have been diagnosed with ulcerative colitis (UC). METHODS This retrospective cohort study identified the first pharmacy or medical claim for ADA or IFX (from January 1, 2007, to December 31, 2014) in patients with continuous enrollment for 6 months or more preindex and 12 months or more postindex, with one or more UC diagnosis claim 6 months pre- or postindex. TNFi discontinuation was defined as a therapy gap of 56 days or more for ADA and 112 days or more for IFX. TNFi switch was defined as nonindex TNFi initiation. Health care resource utilization and costs were characterized quarterly according to treatment patterns. RESULTS The study population comprised 295 patients: mean age 50.9 years, 50.5% females, and 61.7% in southern United States. At the index date, 17% of patients received ADA and 83% received IFX. Treatment discontinuation was observed in 52% of ADA and 45% of IFX users through 12 months postindex (mean time 19 and 22 weeks, respectively). Among discontinuers, 46% of ADA and 68% of IFX users did not restart/switch TNFi. ADA and IFX showed mean times to switch of 18 and 30 weeks, respectively. TNFi discontinuers had the lowest mean quarterly total health care cost ($3,935) versus patients who initiated/switched TNFi ($15,004). Nevertheless, discontinuers had higher UC-related hospitalization versus patients receiving therapy. CONCLUSIONS Approximately half of ADA and IFX users discontinued, with approximately half of discontinuers not restarting/switching therapies. Further investigation of treatment patterns and outcomes after TNFi discontinuation is required.
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Affiliation(s)
- Kyle D Null
- Comprehensive Health Insights, Humana, Louisville, KY, USA
| | - Yihua Xu
- Comprehensive Health Insights, Humana, Louisville, KY, USA
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Abstract
This article discusses the patent strategy underlying the world's best selling drug, AbbVie's Humira®. Despite a non-optimal starting position, AbbVie has established an extensive portfolio to fend off biosimilar competition. This article is the first part of a trilogy that discusses IP issues related to anti-Tumor Necrosis factor α (TNFα) biologics.
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MESH Headings
- Adalimumab/economics
- Adalimumab/therapeutic use
- Anti-Inflammatory Agents/economics
- Anti-Inflammatory Agents/therapeutic use
- Antirheumatic Agents/economics
- Antirheumatic Agents/therapeutic use
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/economics
- Arthritis, Psoriatic/immunology
- Arthritis, Psoriatic/pathology
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/economics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Biosimilar Pharmaceuticals/economics
- Biosimilar Pharmaceuticals/therapeutic use
- Colitis, Ulcerative/drug therapy
- Colitis, Ulcerative/economics
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/pathology
- Dissent and Disputes/history
- Dissent and Disputes/legislation & jurisprudence
- Drug Approval/legislation & jurisprudence
- Gene Expression
- History, 20th Century
- History, 21st Century
- Humans
- Intellectual Property
- Patents as Topic/ethics
- Patents as Topic/legislation & jurisprudence
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/genetics
- Tumor Necrosis Factor-alpha/immunology
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20
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Marsh JD, Birmingham TB, Giffin JR, Isaranuwatchai W, Hoch JS, Feagan BG, Litchfield R, Willits K, Fowler P. Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open 2016; 6:e009949. [PMID: 26758265 PMCID: PMC4716206 DOI: 10.1136/bmjopen-2015-009949] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the cost-effectiveness of arthroscopic surgery in addition to non-operative treatments compared with non-operative treatments alone in patients with knee osteoarthritis (OA). DESIGN, SETTING AND PARTICIPANTS We conducted an economic evaluation alongside a single-centre, randomised trial among patients with symptomatic, radiographic knee OA (KL grade ≥ 2). INTERVENTIONS Patients received arthroscopic debridement and partial resection of degenerative knee tissues in addition to optimised non-operative therapy, or optimised non-operative therapy only. MAIN OUTCOME MEASURES Direct and indirect costs were collected prospectively over the 2-year study period. The effectiveness outcomes were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality-adjusted life years (QALYs). Cost-effectiveness was estimated using the net benefit regression framework considering a range of willingness-to-pay values from the Canadian public payer and societal perspectives. We calculated incremental cost-effectiveness ratios and conducted sensitivity analyses using the extremes of the 95% CIs surrounding mean differences in effect between groups. RESULTS 168 patients were included. Patients allocated to arthroscopy received partial resection and debridement of degenerative meniscal tears (81%) and/or articular cartilage (97%). There were no significant differences between groups in use of non-operative treatments. The incremental net benefit was negative for all willingness-to-pay values. Uncertainty estimates suggest that even if willing to pay $400,000 to achieve a clinically important improvement in WOMAC score, or ≥$50,000 for an additional QALY, there is <20% probability that the addition of arthroscopy is cost-effective compared with non-operative therapies only. Our sensitivity analysis suggests that even when assuming the largest treatment effect, the addition of arthroscopic surgery is not economically attractive compared with non-operative treatments only. CONCLUSIONS Arthroscopic debridement of degenerative articular cartilage and resection of degenerative meniscal tears in addition to non-operative treatments for knee OA is not an economically attractive treatment option compared with non-operative treatment only, regardless of willingness-to-pay value. TRIAL REGISTRATION NUMBER NCT00158431.
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Affiliation(s)
- Jacquelyn D Marsh
- Faculty of Health Sciences; Bone and Joint Institute; Western University, London, Ontario, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences; Fowler Kennedy Sport Medicine Clinic; Bone and Joint Institute; Western University, London, Ontario, Canada
| | - J Robert Giffin
- Department of Surgery, Schulich School of Medicine and Dentistry; Fowler Kennedy Sport Medicine Clinic; Bone and Joint Institute; Western University, London, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California, Davis (UCD); Center for Healthcare Policy and Research, UCD; Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Brian G Feagan
- Departments of Medicine, and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry; Robarts Clinical Trials, Robarts Research Institute; Western University, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, Schulich School of Medicine and Dentistry; Fowler Kennedy Sport Medicine Clinic; Bone and Joint Institute; Western University, London, Ontario, Canada
| | - Kevin Willits
- Department of Surgery, Schulich School of Medicine and Dentistry; Fowler Kennedy Sport Medicine Clinic; Bone and Joint Institute; Western University, London, Ontario, Canada
| | - Peter Fowler
- Department of Surgery, Schulich School of Medicine and Dentistry; Fowler Kennedy Sport Medicine Clinic; Bone and Joint Institute; Western University, London, Ontario, Canada
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21
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Olivieri I, Cortesi PA, de Portu S, Salvarani C, Cauli A, Lubrano E, Spadaro A, Cantini F, Ciampichini R, Cutro MS, Mathieu A, Matucci-Cerinic M, Punzi L, Scarpa R, Mantovani LG. Long-term costs and outcomes in psoriatic arthritis patients not responding to conventional therapy treated with tumour necrosis factor inhibitors: the extension of the Psoriatic Arthritis Cost Evaluation (PACE) study. Clin Exp Rheumatol 2016; 34:68-75. [PMID: 26633622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/24/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Poor information on long-term outcomes and costs on tumour necrosis factor (TNF) inhibitors in psoriatic arthritis (PsA) are available. Our aim was to evaluate long-term costs and benefits of TNF- inhibitors in PsA patients with inadequate response to conventional treatment with traditional disease-modifying anti-rheumatic drugs (tDMARDs). METHODS Fifty-five out of 107 enrolled patients included in the study at one year, completed the 5-year follow-up period. These patients were enrolled in 8 of 9 centres included in the study at one year. Patients aged older than 18 years, with different forms of PsA and failure or intolerance to tDMARDs therapy were treated with anti-TNF agents. Information on resource use, health-related quality of life (HRQoL), disease activity, function and laboratory values were collected at baseline and through the 5 years of therapy. Costs (expressed in Euro 2011) and utility (measured by EQ-5D instrument) before TNF inhibitor therapy and after 1 and 5 years were compared. RESULTS The majority of patients (46 out of 55; 83.6%) had a predominant or exclusive peripheral arthritis and 16.4% had predominant or exclusive axial involvement. There was a statistically significant improvement of the most important clinical variables after 1 year of follow-up. These improvements were maintained also after 5 years. The direct costs increased by approximately €800 per patient-month after 1 year, the indirect costs decreased by €100 and the overall costs increased by more than €700 per patient-month due to the cost of TNF inhibitor therapy. Costs at 5 year were similar to the costs at 1 year. The HRQoL parameters showed the same trends of the clinical variables. EQ-5D VAS, EQ-5D utility and SF-36 PCS score showed a significant improvement after 1 year, maintained at 5 years. SF-36 MCS showed an improvement only at 5 years. CONCLUSIONS The results of our study suggest that TNF blockers have long-term efficacy. The higher cost of TNF inhibitor therapy was balanced by a significant improvement of HRQoL, stable at 5 years of follow-up. Our results need to be confirmed in larger samples of patients.
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Affiliation(s)
- Ignazio Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
| | - Paolo A Cortesi
- Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy
| | - Simona de Portu
- Department of Pharmaceutical Chemistry and Toxicology, University Federico II of Naples, Italy
| | - Carlo Salvarani
- Rheumatic Disease Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Alberto Cauli
- Rheumatology Unit II, University of Cagliari, Monserrato, Italy
| | - Ennio Lubrano
- Rheumatology Unit, Department of Healthy Sciences, University of Molise, Campobasso, Italy
| | - Antonio Spadaro
- Dipartimento di Clinica e Terapia Medica, Rheumatology Unit, Università di Roma 'La Sapienza', Rome, Italy
| | - Fabrizio Cantini
- Rheumatic Disease Unit, 2nd Division of Medicine, Prato Hospital, Prato, Italy
| | - Roberta Ciampichini
- Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy
| | - Maria Stefania Cutro
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy
| | | | | | - Leonardo Punzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Italy
| | - Raffaele Scarpa
- Rheumatology Research Unit, University Federico II of Naples, Italy
| | - Lorenzo G Mantovani
- Researh Centre on Public Health (CESP), University of Milan-Bicocca, and Fondazione Charta, Milan, Italy
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22
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Huoponen S, Blom M. A Systematic Review of the Cost-Effectiveness of Biologics for the Treatment of Inflammatory Bowel Diseases. PLoS One 2015; 10:e0145087. [PMID: 26675292 PMCID: PMC4682717 DOI: 10.1371/journal.pone.0145087] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/26/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Biologics are used for the treatment of inflammatory bowel diseases, Crohn´s disease and ulcerative colitis refractory to conventional treatment. In order to allocate healthcare spending efficiently, costly biologics for inflammatory bowel diseases are an important target for cost-effectiveness analyses. The aim of this study was to systemically review all published literature on the cost-effectiveness of biologics for inflammatory bowel diseases and to evaluate the methodological quality of cost-effectiveness analyses. METHODS A literature search was performed using Medline (Ovid), Cochrane Library, and SCOPUS. All cost-utility analyses comparing biologics with conventional medical treatment, another biologic treatment, placebo, or surgery for the treatment of inflammatory bowel diseases in adults were included in this review. All costs were converted to the 2014 euro. The methodological quality of the included studies was assessed by Drummond's, Philips', and the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Altogether, 25 studies were included in the review. Among the patients refractory to conventional medical treatment, the incremental cost-effectiveness ratio ranged from dominance to 549,335 €/Quality-Adjusted Life Year compared to the incremental cost-effectiveness ratio associated with conventional medical treatment. When comparing biologics with another biologic treatment, the incremental cost-effectiveness ratio ranged from dominance to 24,012,483 €/Quality-Adjusted Life Year. A study including both direct and indirect costs produced more favorable incremental cost-effectiveness ratios than those produced by studies including only direct costs. CONCLUSIONS With a threshold of 35,000 €/Quality-Adjusted Life Year, biologics seem to be cost-effective for the induction treatment of active and severe inflammatory bowel disease. Between biologics, the cost-effectiveness remains unclear.
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Affiliation(s)
- Saara Huoponen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Marja Blom
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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23
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Rencz F, Péntek M, Bortlik M, Zagorowicz E, Hlavaty T, Śliwczyński A, Diculescu MM, Kupcinskas L, Gecse KB, Gulácsi L, Lakatos PL. Biological therapy in inflammatory bowel diseases: Access in Central and Eastern Europe. World J Gastroenterol 2015; 21:1728-1737. [PMID: 25684937 PMCID: PMC4323448 DOI: 10.3748/wjg.v21.i6.1728] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/24/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Biological drugs opened up new horizons in the management of inflammatory bowel diseases (IBD). This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed. Moreover, we provide an estimation on prevalence of IBD as well as biological treatment rates. In all countries with the exception of Romania, lower biological treatment rates were observed in ulcerative colitis (UC) compared to Crohn’s disease despite the higher prevalence of UC. Great heterogeneity (up to 96-fold) was found in access to biologicals across the CEE countries. Poland, Bulgaria, Romania and the Baltic States are lagging behind Hungary, Slovakia and the Czech Republic in their access to biologicals. Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria, Latvia, Lithuania, and Poland, but association with other possible determinants (differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, and cost-effectiveness results) was not proven. We assume, nevertheless, that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD. In conclusion, access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors, drug prices or total health expenditure. Changes in reimbursement policy could contribute to better access to biologicals in some countries.
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MESH Headings
- Anti-Inflammatory Agents/adverse effects
- Anti-Inflammatory Agents/economics
- Anti-Inflammatory Agents/therapeutic use
- Biological Products/adverse effects
- Biological Products/economics
- Biological Products/therapeutic use
- Colitis, Ulcerative/diagnosis
- Colitis, Ulcerative/drug therapy
- Colitis, Ulcerative/economics
- Colitis, Ulcerative/epidemiology
- Colitis, Ulcerative/immunology
- Crohn Disease/diagnosis
- Crohn Disease/drug therapy
- Crohn Disease/economics
- Crohn Disease/epidemiology
- Crohn Disease/immunology
- Drug Costs
- Europe, Eastern/epidemiology
- Health Services Accessibility/trends
- Healthcare Disparities/trends
- Humans
- Insurance, Health, Reimbursement
- Practice Patterns, Physicians'/economics
- Practice Patterns, Physicians'/trends
- Prevalence
- Treatment Outcome
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24
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Murphy CL, Awan S, Sullivan MO, Chavrimootoo S, Bannon C, Martin L, Duffy T, Murphy E, Barry M. Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis. Ir Med J 2015; 108:19-21. [PMID: 25702349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.
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25
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Cutino A, Green K, Kendall R, Moore PT, Zachary C. Economic evaluation of a fluocinolone acetonide intravitreal implant for patients with DME based on the FAME study. Am J Manag Care 2015; 21:S63-S72. [PMID: 25734663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Diabetic macular edema (DME) is the most common cause of visual impairment in patients with diabetes. DME is a complex disease characterized by the deposition of fluid and proteins within the intraretinal layers, and the disease is recognized as being mediated by multiple cytokines, requiring a multifactorial therapeutic approach. Iluvien (fluocinolone acetonide intravitreal implant) 0.19 mg contains a corticosteroid, fluocinolone acetonide [FAc], and is indicated for the treatment of DME in patients who have been previously treated with a course of corticosteroids and did not have a clinically significant rise in intraocular pressure. METHODS A Markov model was constructed in Microsoft Excel with a 15-year time horizon comparing the healthcare and productivity costs with health outcomes from treatment. The model was structured around 13 best corrected visual acuity states using Early Treatment Diabetic Retinopathy Study scores. Observations and extrapolations from the Fluocinolone Acetonide for Diabetic Macular Edema study were applied to determine observed and ongoing treatment effects. RESULTS The expected incremental cost-effectiveness ratio for treatment with an FAc implant is $38,763, assuming 40% of patients are treated unilaterally; when 100% of patients receive unilateral treatment with an FAc implant, it is cost-saving. CONCLUSION Administering an FAc implant to patients with DME previously treated with a corticosteroid is a cost-effective treatment option for ophthalmologists.
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Affiliation(s)
| | | | | | | | - Christopher Zachary
- Alimera Sciences, 6120 Windward Parkway, Ste 290, Alpharetta, GA 30005. E-mail:
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26
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Costs of biologics for inflammatory conditions vary. Manag Care 2014; 23:53. [PMID: 25282867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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27
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Diamantopoulos A, Finckh A, Huizinga T, Sungher DK, Sawyer L, Neto D, Dejonckheere F. Tocilizumab in the treatment of rheumatoid arthritis: a cost-effectiveness analysis in the UK. Pharmacoeconomics 2014; 32:775-87. [PMID: 24854959 PMCID: PMC4113684 DOI: 10.1007/s40273-014-0165-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Since receiving a positive recommendation in England, Wales and Scotland, tocilizumab (TCZ) is one of the options available to clinicians for the treatment of rheumatoid arthritis (RA) patients in the UK. OBJECTIVE The objective of this study was to evaluate the cost effectiveness of adding TCZ to the current treatment sequence of RA patients from a UK payer's perspective over a patient lifetime horizon. METHODS An individual sampling model was developed to synthesise all clinical and economic inputs. Two scenarios were explored separately: patients contraindicated to methotrexate (MTX) and those MTX tolerant. For each scenario, the analysis compared three strategies. The standard of care (SoC) strategy included a sequence of the most commonly prescribed biologics; the other two comparator strategies considered the addition of TCZ to SoC at first line and second line. Patient characteristics were representative of UK patients. Treatment efficacy and quality-of-life evidence were synthesised from clinical trials and secondary sources. An analysis of a patient registry informed the model parameters regarding treatment discontinuation. The safety profile of all treatments in a given strategy was based on a network meta-analysis and literature review. Resource utilisation, treatment acquisition, administration, monitoring and adverse event treatment costs were considered. All costs reflect 2012 prices. Uncertainty in model parameters was explored by one-way and probabilistic sensitivity analysis. RESULTS In the MTX-contraindicated population, if TCZ was added to the SoC in first line, the estimated incremental cost-effectiveness ratio (ICER) was £7,300 per quality-adjusted life-year (QALY) gained; if added in second line, the estimated ICER was £11,400 per QALY. In the MTX-tolerant population, the estimated costs and QALYs of the TCZ strategy were similar to those of the SoC strategy. Sensitivity analysis showed that parameters that affect the treatment cost (such as patient weight) can have a noticeable impact on the overall cost-effectiveness results. The majority of the other sensitivity analyses resulted in modest changes to the ICER. CONCLUSION For the treatment of RA in MTX-tolerant and contraindicated patients, the addition of TCZ to the SoC was estimated to be a cost-effective strategy.
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MESH Headings
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/adverse effects
- Anti-Inflammatory Agents/economics
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/economics
- Arthritis, Rheumatoid/immunology
- Contraindications
- Cost-Benefit Analysis
- Drug Costs
- Drug Therapy, Combination
- Humans
- Interleukin-6/antagonists & inhibitors
- Methotrexate
- Models, Economic
- Quality of Life
- Surveys and Questionnaires
- Treatment Outcome
- United Kingdom
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Affiliation(s)
- Alex Diamantopoulos
- Symmetron Limited, Kinetic Centre, Theobald Street, Elstree, London, WD6 4PJ, UK,
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28
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Taxonera C, Olivares D, Mendoza JL, Díaz-Rubio M, Rey E. Need for infliximab dose intensification in Crohn’s disease and ulcerative colitis. World J Gastroenterol 2014; 20:9170-9177. [PMID: 25083091 PMCID: PMC4112868 DOI: 10.3748/wjg.v20.i27.9170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/24/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the need for infliximab dose intensification in two cohorts of patients with Crohn’s disease (CD) or ulcerative colitis (UC).
METHODS: Single centre, uncontrolled, observational study. Consecutive patients with CD and UC who responded to infliximab induction doses were included. Data collected in a prospectively maintained database were retrospectively analysed. Differences in the rates of dose intensification per patient-month and the intensification-free survival time were compared. We also evaluated the interval between the first infliximab induction dose and the first infliximab escalated dose. The weight-adjusted infliximab administration costs were also calculated.
RESULTS: Fifty nine patients with CD and 38 patients with UC were enrolled. The rate of intensification per patient-month was 3.9% for UC and 1.4% for CD (P = 0.005). The median time from baseline to intensification was significantly shorter in UC compared to CD [6.6 mo (IQR: 4.2-9.5 mo) vs 10.7 mo (IQR: 8.9-11.7 mo), P = 0.005]. In the survival analysis, the cumulative probability of avoiding infliximab dose intensification was significantly higher in CD (P = 0.002). In the multivariate analysis, disease (UC vs CD) was the only factor significantly associated with dose intensification. The infiximab administration costs during the first year were significantly higher for UC compared to CD (mean ± SD 234.9 ± 53.3 Euros/kg vs 212.3 ± 15.1 Euros/kg, P = 0.03).
CONCLUSION: The rate of infliximab dose intensification per patient-month is significantly higher in UC patients. The infliximab administration costs are also significantly higher in patients with UC.
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29
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Zalesak M, Greenbaum JS, Cohen JT, Kokkotos F, Lustig A, Neumann PJ, Pritchard D, Stewart J, Dubois RW. The value of specialty pharmaceuticals - a systematic review. Am J Manag Care 2014; 20:461-472. [PMID: 25180434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Novel specialty biopharmaceuticals hold promise for patients living with complex and chronic conditions. However, high research and development costs, special handling, and other necessary enhancements to patient support programs all contribute to frequently higher prices for these products. This study sought to assess the value of specialty pharmaceuticals through an examination of the clinical, functional, and economic benefits of these treatments for the top 3 disease areas by pharmaceutical spend: rheumatoid arthritis (RA), multiple sclerosis (MS), and breast cancer (BC). STUDY DESIGN Systematic literature review. METHODS A systematic review of market research and cost-effectiveness articles was conducted for each disease area to assess clinical, functional, and economic outcomes associated with specialty medicine treatments versus the previous standard of care. RESULTS All RA clinical (American College of Rheumatology) and functional (Health Assessment Questionnaire) outcome articles were classified as positive. The median cost-effectiveness ratio was $38,900 per quality-adjusted life year (QALY). All MS clinical outcome (relapse rate) articles were positive. The MS functional outcome (Expanded Disability Status Scale) findings were less conclusive. The median cost-effectiveness ratio was $248,000 per QALY. The majority of BC articles yielded statistically inconclusive results for survival. All functional outcome (Quality of Life Questionnaire- Core 30) articles were positive. The median cost-effectiveness ratio was $51,900 per QALY. CONCLUSIONS Novel specialty therapies hold promise for arresting disease progression and improving quality of life for the 3 conditions associated with the highest specialty pharmaceutical spend. These findings demonstrate a strong value proposition for specialty pharmaceuticals, and suggest even greater potential individual patient benefit with consideration of patient heterogeneity.
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30
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Sundberg T, Petzold M, Kohls N, Falkenberg T. Opposite drug prescription and cost trajectories following integrative and conventional care for pain--a case-control study. PLoS One 2014; 9:e96717. [PMID: 24827981 PMCID: PMC4020818 DOI: 10.1371/journal.pone.0096717] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/10/2014] [Indexed: 11/30/2022] Open
Abstract
Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.
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Affiliation(s)
- Tobias Sundberg
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
- * E-mail:
| | - Max Petzold
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Niko Kohls
- Division Integrative Health Promotion, University of Applied Sciences and Arts, Coburg, Germany
- Generation Research Program, Ludwig-Maximilians-University, Bad Tölz, Germany
- Brain, Mind & Healing Program, Samueli Institute, Alexandria, Virginia, United States of America
| | - Torkel Falkenberg
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Huddinge, Sweden
- I C – The Integrative Care Science Center, Järna, Sweden
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Rizzo G, Pugliese D, Armuzzi A, Coco C. Anti-TNF alpha in the treatment of ulcerative colitis: A valid approach for organ-sparing or an expensive option to delay surgery? World J Gastroenterol 2014; 20:4839-4845. [PMID: 24803795 PMCID: PMC4009515 DOI: 10.3748/wjg.v20.i17.4839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) is an inflammatory bowel disease affecting large bowel with variable clinical course. The history of disease has been modified by the introduction of biologic therapy, in particular Infliximab (IFX), that has demonstrated efficacy in inducing fast symptoms remission, promoting mucosal healing and maintaining long-term remission. However, surgery is still needed for UC patients: in case of failure of medical therapy and if acute complications or a malignancy occurred. Surgical treatment is associated with a short-term post-operative mortality and morbidity respectively of 0%-4% and 30%. In this study we systematically analyzed: the role of IFX in reducing the colectomy rate, the risk of post-operative morbidity in pre-operatively IFX-treated patients and the cost-effectiveness of IFX therapy. Four of 5 analyzed randomized controlled trials demonstrated that therapy with IFX significantly reduces the colectomy rate. Moreover, pre-operative treatment with IFX doesn’t seem to increase post-operative infectious complications. By an economic point of view, the cost-effectiveness of IFX-therapy was demonstrated for UC patients suffering from moderate to severe UC in a study based on a cost estimation of the National Health Service of England and Wales. However, the argument is debated.
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Park KT, Crandall WV, Fridge J, Leibowitz IH, Tsou M, Dykes D, Hoffenberg EJ, Kappelman MD, Colletti RB. Implementable strategies and exploratory considerations to reduce costs associated with anti-TNF therapy in inflammatory bowel disease. Inflamm Bowel Dis 2014; 20:946-51. [PMID: 24451222 PMCID: PMC3997595 DOI: 10.1097/01.mib.0000441349.40193.aa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A health care system is needed where care is based on the best available evidence and is delivered reliably, efficiently, and less expensively (best care at lower cost). In gastroenterology, anti-tumor necrosis factor agents represent the most effective medical therapeutic option for patients with moderate-to-severe inflammatory bowel disease (IBD), but are very expensive and account for nearly a quarter of the cost of IBD care, representing a major area of present and future impact in direct health care costs. The ImproveCareNow Network, consisting of over 55 pediatric IBD centers, seeks ways to improve the value of care in IBD, curtailing unnecessary costs and promoting better health outcomes through systematic and incremental quality improvement initiatives. This report summarizes the key evidence to facilitate the cost-effective use of anti-tumor necrosis factor agents for patients with IBD. Our review outlines the scientific rationale for initiating cost-reducing measures in anti-tumor necrosis factor use and focuses on 3 implementable strategies and 4 exploratory considerations through practical clinical guidelines, as supported by existing evidence. Implementable strategies can be readily integrated into today's daily practice, whereas exploratory considerations can guide research to support future implementation.
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Affiliation(s)
- KT Park
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Center for Health Policy/Primary Care Outcomes Research, Stanford University School of Medicine, Palo Alto, CA
| | - Wallace V. Crandall
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Jacqueline Fridge
- Northwest Pediatric Gastroenterology LLC, Randall Children’s Hospital, Portland, OR
| | - Ian H. Leibowitz
- Children’s Digestive Disease Program, Inova Fairfax Hospital for Children, Fairfax, VA
| | - Marc Tsou
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA
| | - Dana Dykes
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Edward J. Hoffenberg
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Denver School of Medicine, Denver, CO
| | - Michael D. Kappelman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Richard B. Colletti
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT
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Hatoum HT, Fierlinger AL, Lin SJ, Altman RD. Cost-effectiveness analysis of intra-articular injections of a high molecular weight bioengineered hyaluronic acid for the treatment of osteoarthritis knee pain. J Med Econ 2014; 17:326-37. [PMID: 24625229 DOI: 10.3111/13696998.2014.902843] [Citation(s) in RCA: 30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of bioengineered hyaluronic acid (BioHA, 1% sodium hyaluronate) intra-articular injections in treating osteoarthritis knee pain in poor responders to conventional care (CC) including non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. METHODS Two decision analytic models compared BioHA treatment with either continuation of patient's baseline CC with no assumption of disease progression (Model 1), or CC including escalating care costs due to disease progression (NSAIDs and analgesics, corticosteroid injections, and surgery; Model 2). Analyses were based on patients who received two courses of 3-weekly intra-articular BioHA (26-week FLEXX Trial + 26-week Extension Study). BioHA group costs included fees for physician assessment and injection regimen, plus half of CC costs. Cost-effectiveness ratios were expressed as averages and incremental costs per QALY. One-way sensitivity analyses used the 95% confidence interval (CI) of QALYs gained in BioHA-treated patients, and ±20% of BioHA treatment and CC costs. Probabilistic sensitivity analyses were performed for Model 2. RESULTS For 214 BioHA patients, the average utility gain was 0.163 QALYs (95% CI = -0.162 to 0.488) over 52 weeks. Model 1 treatment costs were $3469 and $4562 for the BioHA and CC groups, respectively; sensitivity analyses showed BioHA to be the dominant treatment strategy, except when at the lower end of the 95% CI. Model 2 annual treatment costs per QALY gained were $1446 and $516 for the BioHA and CC groups, respectively. Using CC as baseline strategy, the incremental cost-effectiveness ratio (ICER) of BioHA was $38,741/QALY gained, and was sensitive to response rates in either the BioHA or CC groups. CONCLUSION BioHA is less costly and more effective than CC with NSAIDs and analgesics, and is the dominant treatment strategy. Compared with escalating CC, the $38,741/QALY ICER of BioHA remains within the $50,000 per QALY willingness-to-pay threshold to adopt a new technology.
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Affiliation(s)
- Hind T Hatoum
- University of Illinois at Chicago , Chicago, IL , USA
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Gulácsi L, Rencz F, Péntek M, Brodszky V, Lopert R, Hevér NV, Baji P. Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries. Eur J Health Econ 2014; 15 Suppl 1:S27-S34. [PMID: 24832833 DOI: 10.1007/s10198-014-0591-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/31/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. AIM To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. METHODS Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. RESULTS Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). CONCLUSION While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.
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Affiliation(s)
- László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary,
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Roddy E, Zwierska I, Hay EM, Jowett S, Lewis M, Stevenson K, van der Windt D, Foster NE. Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial). BMC Musculoskelet Disord 2014; 15:81. [PMID: 24625273 PMCID: PMC3995668 DOI: 10.1186/1471-2474-15-81] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subacromial impingement syndrome is the most frequent cause of shoulder problems which themselves affect 1 in 3 adults. Management commonly includes exercise and corticosteroid injection. However, the few existing trials of exercise or corticosteroid injection for subacromial impingement syndrome are mostly small, of poor quality, and focus only on short-term results. Exercise packages tend to be standardised rather than individualised and progressed. There has been much recent interest in improving outcome from corticosteroid injections by using musculoskeletal ultrasound to guide injections. However, there are no high-quality trials comparing ultrasound-guided and blind corticosteroid injection in subacromial impingement syndrome. This trial will investigate how to optimise the outcome of subacromial impingement syndrome from exercise (standardised advice and information leaflet versus physiotherapist-led exercise) and from subacromial corticosteroid injection (blind versus ultrasound-guided), and provide long-term follow-up data on clinical and cost-effectiveness. METHODS/DESIGN The study design is a 2x2 factorial randomised controlled trial. 252 adults with subacromial impingement syndrome will be recruited from two musculoskeletal Clinical Assessment and Treatment Services at the primary-secondary care interface in Staffordshire, UK. Participants will be randomised on a 1:1:1:1 basis to one of four treatment groups: (1) ultrasound-guided subacromial corticosteroid injection and a physiotherapist-led exercise programme, (2) ultrasound-guided subacromial corticosteroid injection and an advice and exercise leaflet, (3) blind subacromial corticosteroid injection and a physiotherapist-led exercise programme, or (4) blind subacromial corticosteroid injection and an advice and exercise leaflet. The primary intention-to-treat analysis will be the mean differences in Shoulder Pain and Disability Index (SPADI) scores at 6 weeks for the comparison between injection interventions and at 6 months for the comparison between exercise interventions. Although independence of treatment effects is assumed, the magnitude of any interaction effect will be examined (but is not intended for the main analyses). Secondary outcomes will include comparison of long-term outcomes (12 months) and cost-effectiveness. A secondary per protocol analysis will also be performed. DISCUSSION This protocol paper presents detail of the rationale, design, methods and operational aspects of the SUPPORT trial. TRIAL REGISTRATION Current controlled trials ISRCTN42399123.
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Affiliation(s)
- Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
- Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-on-Trent ST6 7AG, UK
| | - Irena Zwierska
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
- Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-on-Trent ST6 7AG, UK
| | - Sue Jowett
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Kay Stevenson
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
- Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke-on-Trent ST6 7AG, UK
- Physiotherapy Department, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Danielle van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK
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Abstract
Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.
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Cawson MR, Mitchell SA, Knight C, Wildey H, Spurden D, Bird A, Orme ME. Systematic review, network meta-analysis and economic evaluation of biological therapy for the management of active psoriatic arthritis. BMC Musculoskelet Disord 2014; 15:26. [PMID: 24444034 PMCID: PMC3903562 DOI: 10.1186/1471-2474-15-26] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/22/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND An updated economic evaluation was conducted to compare the cost-effectiveness of the four tumour necrosis factor (TNF)-α inhibitors adalimumab, etanercept, golimumab and infliximab in active, progressive psoriatic arthritis (PsA) where response to standard treatment has been inadequate. METHODS A systematic review was conducted to identify relevant, recently published studies and the new trial data were synthesised, via a Bayesian network meta-analysis (NMA), to estimate the relative efficacy of the TNF-α inhibitors in terms of Psoriatic Arthritis Response Criteria (PsARC) response, Health Assessment Questionnaire (HAQ) scores and Psoriasis Area and Severity Index (PASI). A previously developed economic model was updated with the new meta-analysis results and current cost data. The model was adapted to delineate patients by PASI 50%, 75% and 90% response rates to differentiate between psoriasis outcomes. RESULTS All four licensed TNF-α inhibitors were significantly more effective than placebo in achieving PsARC response in patients with active PsA. Adalimumab, etanercept and infliximab were significantly more effective than placebo in improving HAQ scores in patients who had achieved a PsARC response and in improving HAQ scores in PsARC non-responders. In an analysis using 1,000 model simulations, on average etanercept was the most cost-effective treatment and, at the National Institute for Health and Care Excellence willingness-to-pay threshold of between £20,000 to £30,000, etanercept is the preferred option. CONCLUSIONS The economic analysis agrees with the conclusions from the previous models, in that biologics are shown to be cost-effective for treating patients with active PsA compared with the conventional management strategy. In particular, etanercept is cost-effective compared with the other biologic treatments.
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MESH Headings
- Adalimumab
- Anti-Inflammatory Agents/economics
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Monoclonal/economics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/economics
- Arthritis, Psoriatic/immunology
- Bayes Theorem
- Biological Products/economics
- Biological Products/therapeutic use
- Cost-Benefit Analysis
- Drug Costs
- Etanercept
- Humans
- Immunoglobulin G/economics
- Immunoglobulin G/therapeutic use
- Infliximab
- Models, Economic
- Quality-Adjusted Life Years
- Receptors, Tumor Necrosis Factor/therapeutic use
- Severity of Illness Index
- Surveys and Questionnaires
- Treatment Outcome
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Abstract
BACKGROUND Macular edema is the most common cause of vision loss among patients with diabetes. OBJECTIVE To determine the cost-effectiveness of different treatments of diabetic macular edema (DME). DESIGN Markov model. DATA SOURCES Published literature and expert opinion. TARGET POPULATION Patients with clinically significant DME. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION Laser treatment, intraocular injections of triamcinolone or a vascular endothelial growth factor (VEGF) inhibitor, or a combination of both. OUTCOME MEASURES Discounted costs, gains in quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS All treatments except laser monotherapy substantially reduced costs, and all treatments except triamcinolone monotherapy increased QALYs. Laser treatment plus a VEGF inhibitor achieved the greatest benefit, gaining 0.56 QALYs at a cost of $6975 for an ICER of $12 410 per QALY compared with laser treatment plus triamcinolone. Monotherapy with a VEGF inhibitor achieved similar outcomes to combination therapy with laser treatment plus a VEGF inhibitor. Laser monotherapy and triamcinolone monotherapy were less effective and more costly than combination therapy. RESULTS OF SENSITIVITY ANALYSIS VEGF inhibitor monotherapy was sometimes preferred over laser treatment plus a VEGF inhibitor, depending on the reduction in quality of life with loss of visual acuity. When the VEGF inhibitor bevacizumab was as effective as ranibizumab, it was preferable because of its lower cost. LIMITATION Long-term outcome data for treated and untreated diseases are limited. CONCLUSION The most effective treatment of DME is VEGF inhibitor injections with or without laser treatment. This therapy compares favorably with cost-effective interventions for other conditions. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Burisch J. Crohn's disease and ulcerative colitis. Occurrence, course and prognosis during the first year of disease in a European population-based inception cohort. Dan Med J 2014; 61:B4778. [PMID: 24393595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Inflammatory bowel diseases (IBD), consisting of Crohn's disease (CD) and ulcerative colitis (UC), are chronic immune mediated diseases of unknown aetiology. Traditionally, the highest occurrence of both UC and CD is found in North America and Europe, including Scandinavia and the United Kingdom, while the diseases remain rare in Eastern Europe. Until recently, few population-based cohort data were available on the epidemiology of IBD in Eastern Europe. However, recent studies from Hungary and Croatia have reported steep increases in IBD incidence that means they are now comparable with Western European countries. The reasons for these changes remain unknown but could include an increasing awareness of the diseases, better access to diagnostic procedures, methodological bias in previous studies from Eastern Europe, or real differences in environmental factors, lifestyle and genetic susceptibility. The aim of this thesis was to create a prospective European population-based inception cohort of incident IBD patients in order to investigate whether an East-West gradient in the incidence of IBD exists in Europe. Furthermore, we investigated possible differences throughout Europe during the first year subsequent to diagnosis in terms of clinical presentation, disease outcome, treatment choices, frequency of environmental risk factors, as well as patient-reported health-related quality of life (HRQoL) and quality of care (QoC). Finally, we assessed resource utilization during the initial year of disease in both geographic regions. A total number of 31 centres from 14 Western and 8 Eastern European countries covering a total background population of approximately 10.1 million participated in this study. During the inclusion period from 1 January to 31 December 2010 a total number of 1,515 patients aged 15 years or older were included in the cohort. Annual incidence rates were twice as high in Western Europe (CD: 6.3/100,000; UC: 9.8/100,000) compared to Eastern Europe (CD: 3.3/100,000; UC: 4.6/100,000), thus confirming a gradient in IBD incidence. The incidence gradient could not be explained by marked differences in environmental factors prior to IBD diagnosis. In fact, Eastern European patients had higher frequencies of dietary risk factors than Western European patients, while the remaining risk factors occurred just as frequently. Furthermore, the availability of diagnostic tools and the diagnostic strategy did not differ, and in fact was better in Eastern Europe in terms of the use of colonoscopies and diagnostic delay. In terms of socio-economic characteristics as well as clinical presentation at diagnosis Eastern and Western European IBD patients did not differ significantly. However, regarding treatment choices during the initial year of disease the use of biological therapy was significantly higher in Western Europe for both CD and UC, while Eastern European centres used 5-ASA more often in CD and UC. In both regions patients were treated earlier and more frequently with immunomodulators compared to previous cohorts. But despite these differences in treatment, disease course - including hospitalisation and surgery rates during the first year of disease - were similar in both regions and the majority of patients were in clinical remission at follow-up. Finally, generic and disease-specific HRQoL improved in all IBD patients and at twelve months follow-up the majority of patients had a good disease-specific HRQoL score. Differences in how, and from whom, patients received disease-specific education and information were noted between the geographic regions; for instance IBD specialist nurses were not used in Eastern European IBD centres. Expenses for the cohort during the initial year of disease exceeded four million Euros with most money spent on diagnostics and surgery. Biological therapy accounted for one fourth costs in Western European CD patients. Long-term follow-up of the EpiCom cohort is needed in order to assess whether the earlier and more frequent treatment with immunomodulators and biologicals observed in this study will change the natural disease course and phenotypes over time or merely postpone outcomes such as surgery. Furthermore, the question of if and how differences in treatment choices between Eastern and Western Europe impact on the disease course requires long-term follow-up.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, Herlev University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.
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Wielage RC, Myers JA, Klein RW, Happich M. Cost-effectiveness analyses of osteoarthritis oral therapies: a systematic review. Appl Health Econ Health Policy 2013; 11:593-618. [PMID: 24214160 DOI: 10.1007/s40258-013-0061-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Cost-effectiveness analyses (CEAs) have been performed for oral non-disease-altering osteoarthritis (OA) treatments for well over a decade. During that period the methods for performing these analyses have evolved as pharmacoeconomic methods have advanced, new treatments have been introduced, and the knowledge of associated adverse events (AEs) has improved. OBJECTIVE The objective of this systematic review was to trace the development of CEAs for oral non-disease-altering treatments in OA. METHODS A systematic search for CEAs of OA oral treatments was performed of the English-language medical literature using the following databases: PubMed, EMBASE, MEDLINE In-Process, EconLit, and Cochrane. Key requirements for inclusion were that the population described patients with OA or arthritis and that the analysis reported at least one incremental cost-effectiveness ratio. Each identified publication was assessed for inclusion. Thirteen characteristics and all AEs appearing in each included CEA were extracted and organized. Reference lists from these CEAs were also searched. A chronology of key CEAs in the field was compiled, noting the characteristics that advanced the state of the art in modeling oral OA treatments. RESULTS Thirty publications of 28 CEAs were identified and evaluated. Developments in CEAs included an expanded set of comparators that broadened from non-steroidal anti-inflammatory drugs (NSAIDs) only to NSAIDs plus gastroprotective agents, cyclooxygenase-2 inhibitors, and opioids. In turn, AEs expanded from gastrointestinal (GI) events to also include cardiovascular (CV) and neurological events. Efficacy, which initially was presumed to be equivalent for all treatments, evolved to treatment-specific efficacies. Decision-tree analyses were generally replaced by Markov models or, occasionally, stochastic or discrete event simulation. Finally, outcomes have progressed from GI-centric measures to also include quality-adjusted life-years. CONCLUSION Methods used by CEAs of oral non-disease-altering OA treatments have evolved in response to changing treatments with different safety profiles and efficacies as well as technical advances in the application of decision science to health care.
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Affiliation(s)
- Ronald C Wielage
- Medical Decision Modeling Inc., 8909 Purdue Road, Suite #550, Indianapolis, IN, 46268, USA,
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Moverley AR, Coates LC, Helliwell PS. Can biologic therapies be withdrawn or tapered in psoriatic arthritis? Clin Exp Rheumatol 2013; 31:S51-S53. [PMID: 24129138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 06/02/2023]
Abstract
There is a paucity of data on tapering and withdrawing therapy in psoriatic arthritis but advances in treatment and outcome measures suggest it is now time to be looking more closely at this. Several highly effective therapies are available providing the opportunity to achieve low disease activity. However, these therapies are associated with a marked increase in direct costs and patients are exposed to potentially life threatening adverse events. In addition to effective therapies the science of outcome assessment means that there are now suitable validated criteria for low disease activity which will allow both treat-to-target and a suitable measure of continuing low disease. Given these conditions, suitably designed randomized controlled trials of treatment withdrawal are now needed. Such studies will allow us to determine disease characteristics predictive of flare upon treatment withdrawal. In this way identifying which patients can successfully stop therapy will allow a more personalized approach to treatment decisions in PsA and will minimise risks and costs associated with ongoing therapy.
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Affiliation(s)
- Anna R Moverley
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Losina E, Daigle ME, Reichmann WM, Suter LG, Hunter DJ, Solomon DH, Walensky RP, Jordan JM, Burbine SA, Paltiel AD, Katz JN. Disease-modifying drugs for knee osteoarthritis: can they be cost-effective? Osteoarthritis Cartilage 2013; 21:655-67. [PMID: 23380251 PMCID: PMC3670115 DOI: 10.1016/j.joca.2013.01.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/15/2012] [Accepted: 01/25/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Disease-modifying osteoarthritis drugs (DMOADs) are under development. Our goal was to determine efficacy, toxicity, and cost thresholds under which DMOADs would be a cost-effective knee OA treatment. DESIGN We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare guideline-concordant care to strategies that insert DMOADs into the care sequence. The guideline-concordant care sequence included conservative pain management, corticosteroid injections, total knee replacement (TKR), and revision TKR. Base case DMOAD characteristics included: 50% chance of suspending progression in the first year (resumption rate of 10% thereafter) and 30% pain relief among those with suspended progression; 0.5%/year risk of major toxicity; and costs of $1,000/year. In sensitivity analyses, we varied suspended progression (20-100%), pain relief (10-100%), major toxicity (0.1-2%), and cost ($1,000-$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization. RESULTS Base case DMOADs added 4.00 quality-adjusted life years (QALYs) and $230,000 per 100 persons, with an ICER of $57,500/QALY. DMOADs reduced need for TKR by 15%. Cost-effectiveness was most sensitive to likelihoods of suspended progression and pain relief. DMOADs costing $3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20% and 70%. At a cost of $5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%. CONCLUSIONS Cost, suspended progression, and pain relief are key drivers of value for DMOADs. Plausible combinations of these factors could reduce need for TKR and satisfy commonly cited cost-effectiveness criteria.
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Affiliation(s)
- Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Meghan E. Daigle
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - William M. Reichmann
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Lisa G. Suter
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - David J. Hunter
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Daniel H. Solomon
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Rochelle P. Walensky
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Joanne M. Jordan
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Sara A. Burbine
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - A. David Paltiel
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, MED, SAB, WMR, JNK), Division of Infectious Disease (RPW), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, DHS, JNK), Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA (EL, DHS, RPW, JNK); Boston University School of Public Health, Boston, MA (EL, WMR); Yale University, New Haven, CT (LGS, ADP); University of Sydney, Sydney Australia (DJH); Massachusetts General Hospital, Boston, MA (RPW); Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC (JMJ)
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Abudagga A, Sun SX, Tan H, Solem CT. Exacerbations among chronic bronchitis patients treated with maintenance medications from a US managed care population: an administrative claims data analysis. Int J Chron Obstruct Pulmon Dis 2013; 8:175-85. [PMID: 23589684 PMCID: PMC3624965 DOI: 10.2147/copd.s40437] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) exacerbations are the leading cause of hospital admission and death among chronic bronchitis (CB) patients. This study estimated annual COPD exacerbation rates, related costs, and their predictors among patients treated for CB. METHODS This was a retrospective study using claims data from the HealthCore Integrated Research Database (HIRD(SM)). The study sample included CB patients aged ≥ 40 years with at least one inpatient hospitalization or emergency department visit or at least two office visits with CB diagnosis from January 1, 2004 to May 31, 2011, at least two pharmacy fills for COPD medications during the follow-up year, and ≥2 years of continuous enrollment. COPD exacerbations were categorized as severe or moderate. Annual rates, costs, and predictors of exacerbations during follow-up were assessed. RESULTS A total of 17,382 individuals treated for CB met the selection criteria (50.6% female; mean ± standard deviation age 66.7 ± 11.4 years). During the follow-up year, the mean ± standard deviation number of COPD maintenance medication fills was 7.6 ± 6.3; 42.6% had at least one exacerbation and 69.5% of patients with two or more exacerbations during the 1 year prior to the index date (baseline period) had any exacerbation during the follow-up year. The mean ± standard deviation cost per any exacerbation was $269 ± $748 for moderate and $18,120 ± $31,592 for severe exacerbation. The number of baseline exacerbations was a significant predictor of the number of exacerbations and exacerbation costs during follow-up. CONCLUSION Exacerbation rates remained high among CB patients despite treatment with COPD maintenance medications. New treatment strategies, designed to reduce COPD exacerbations and associated costs, should focus on patients with high prior-year exacerbations.
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Herndon JB, Mattke S, Evans Cuellar A, Hong SY, Shenkman EA. Anti-inflammatory medication adherence, healthcare utilization and expenditures among Medicaid and children's health insurance program enrollees with asthma. Pharmacoeconomics 2012; 30:397-412. [PMID: 22268444 DOI: 10.2165/11586660-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Underuse of controller therapy among Medicaid-enrolled children is common and leads to more emergency department (ED) visits and hospitalizations. However, there is little evidence about the relationship between medication adherence, outcomes and costs once controller therapy is initiated. OBJECTIVE This study examined the relationship between adherence to two commonly prescribed anti-inflammatory medications, inhaled corticosteroids (ICS) and leukotriene inhibitors (LI), and healthcare utilization and expenditures among children enrolled in Medicaid and the Children's Health Insurance Program in Florida and Texas in the US. METHODS The sample for this retrospective observational study consisted of 18,456 children aged 2-18 years diagnosed with asthma, who had been continuously enrolled for 24 months during 2004-7 and were on monotherapy with ICS or LI. State administrative enrolment files were linked to medical claims data. Children were grouped into three adherence categories based on the percentage of days per year they had prescriptions filled (medication possession ratio). Bivariate and multivariable regression analyses that adjusted for the children's demographic and health characteristics were used to examine the relationship between adherence and ED visits, hospitalizations, and expenditures. RESULTS Average adherence was 20% for ICS-treated children and 28% for LI-treated children. Children in the highest adherence category had lower odds of an ED visit than those in the lowest adherence category (p<0.001). We did not detect a statistically significant relationship between adherence and hospitalizations; however, only 3.7% of children had an asthma-related hospitalization. Overall asthma care expenditures increased with greater medication adherence. CONCLUSIONS Although greater adherence was associated with lower rates of ED visits, higher medication expenditures outweighed the savings. The overall low adherence rates suggest that quality improvement initiatives should continue to target adherence regardless of the class of medication used. However, low baseline hospitalization rates may leave little opportunity to significantly decrease costs through better disease management, without also decreasing medication costs.
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Affiliation(s)
- Jill Boylston Herndon
- Institute for Child Health Policy and Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL 32610-0147, USA
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Von Voshaar T, Behr J, Brüggenjürgen B, Deimling A, Krüger M, Virchow C, Wiens C. [On general practitioners' care of patients with asthma]. MMW Fortschr Med 2012; 154 Suppl 1:1-7. [PMID: 23427362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED This review offers readers new aspects for the guideline-compliant care of asthma patients. Here, attention is focused on illustrating the bottlenecks in the administration of good and practicable therapeutic care and listing these as "major challenges for GPs". The interdisciplinary team of authors - consisting of three hospital-based pulmonologists, one pulmonologist in private practice, one internist in general practice, one pharmacist and one health economist discussed aspects of asthma therapy relevant in clinical practice. RESULTS AND CONCLUSIONS Practicable results for the reader included an asthma pentagram, a graphic depicting the links and interactions between diagnosis, symptom management, communication, application and costs. From this emerged a consensus on four recommendations that can help GPs improve their care of their patients: (1) Whenever possible, have a specialist verifythe diagnosis. (2) Practice inhalation techniques with the patient and check up on their technique at regular intervals. (3) Monitor and fine-tune the therapeutic goals set down together with the patient. (4) Clearly define the (patient's) responsibilities and who is organizing care (communication between GP-specialist-patient-pharmacist-family members).
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Affiliation(s)
- T Von Voshaar
- Med. Klinik III, Pneumologie, Allergologie, Zentrum für Schlafund Beatmungsmedizin.
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Knight C, Mauskopf J, Ekelund M, Singh A, Yang S, Boggs R. Cost-effectiveness of treatment with etanercept for psoriasis in Sweden. Eur J Health Econ 2012; 13:145-56. [PMID: 21380772 DOI: 10.1007/s10198-010-0293-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/22/2010] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness, from a Swedish societal perspective, of intermittent use of etanercept (Enbrel) with interruptions of use after 24 weeks compared to continuous use of adalimumab (Humira) as well as non-systemic standard of care in patients with moderate to severe psoriasis. METHODS A Markov decision-tree model was constructed from clinical trials results. Patients starting etanercept, adalimumab, or non-systemic therapy moved through the model's 10-years horizon. Model input parameters included clinical response rates. Outcome measures included direct and indirect costs and quality-adjusted life-years (QALYs). RESULTS The incremental total (direct and indirect) costs per QALY were 1,559,939 kr (<euro>165,354) for adalimumab 40 mg every other week, compared with intermittent once-weekly Enbrel 50 mg, and 93,629 kr (<euro>9,925) for once-weekly intermittent etanercept 50 mg compared with non-systemic standard of care. CONCLUSIONS This analysis showed that, with a 470,000 kr (<euro>50,000) per QALY willingness-to-pay threshold, once-weekly etanercept 50 mg, used intermittently, is a cost-effective treatment for moderate to severe psoriasis compared with adalimumab and non-systemic standard of care.
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Affiliation(s)
- Christopher Knight
- RTI Health Solutions, Velocity House Business and Conference Centre, Sheffield, UK.
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Topical therapy for scalp psoriasis in adults. Drug Ther Bull 2012; 50:33-6. [PMID: 22419755 DOI: 10.1136/dtb.2012.02.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An estimated 2% of the UK population has psoriasis. For many patients this affects the scalp. Particular challenges in managing scalp psoriasis include choosing an appropriate treatment option, difficulties of applying topical treatments and deciding how to treat severe disease. Moreover, there is a lack of good-quality evidence on which to base treatment decisions. Here, we offer some practical advice, taking into account the available evidence.
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Carter CT, Leher H, Smith P, Smith DB, Waters HC. Impact of persistence with infliximab on hospitalizations in ulcerative colitis. Am J Manag Care 2011; 17:385-392. [PMID: 21756009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess infliximab infusion patterns in ulcerative colitis (UC) and assess the impact of persistence with infliximab maintenance therapy on UC-related hospitalizations, lengths of stay, and inpatient costs. STUDY DESIGN Retrospective analysis of medical claims for UC patients newly initiating infliximab treatment. METHODS Patients were aged >18 years and had 2 UC diagnosis codes, an infliximab index date between September 1, 2005, and January 31, 2008, and continuous enrollment for >12 months before and >14 months after the index date. Infliximab induction (first 56 days postindex) and maintenance (>56 days and <12 months postinduction) patterns were evaluated. Of patients with maintenance treatment, persistence was defined as a medication possession ratio (MPR) of >80%, and this group was compared with those without persistence (<80% MPR). RESULTS Overall, 420 patients were included in the analysis; 84.3% (n = 354) continued to maintenance therapy. Maintenance infusion patterns were consistent with recommended prescribing information. A smaller proportion of patients with maintenance therapy persistence required hospitalization compared with patients without persistence (3.0% vs 20.4%; P <.001). Hospitalized patients with maintenance therapy persistence had significantly lower mean inpatient costs ($14,243 vs $32,745; P = .046), with a trend toward shorter mean lengths of stay (6.67 vs 9.71 days; P = .147) than patients without persistence. CONCLUSIONS Infliximab maintenance therapy persistence in UC was associated with significantly fewer hospitalizations. Once hospitalized, patients with therapeutic persistence had significantly decreased inpatient costs.
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Affiliation(s)
- Chureen T Carter
- Centocor Ortho Biotech Services, LLC, 800 Ridgeview Dr., Horsham, PA 19044, USA.
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