most frequently reported TEAE (vomiting, upper respiratory tract infection, cough, and constipation) none were considered AVXS-101 related, with most events related to patients' underlying illness, not to study drug. CONCLUSIONS: Magnitude of the observed relative treatment effects indicates that AVXS-101 offers promising efficacy compared to nusinersen regarding EFS, reduced requirement for ventilation, and increased achievement of motor milestones.
A647Objectives: Osteoarthritis (OA) is the most common and costly bone and joint disease in the elderly. Recently, viscosupplementation, an intra-articular injection of artificial joint fluid in order to restore rheological properties affecting lubrication and shock absorption, has introduced as an alternative conservative treatment. To assess the effectiveness and cost-effectiveness of Hylan G-F 20 (Hylan) as a substitute for existing treatments for pain due to OA of the knee, other viscosupplementation devices, and/or as an adjunct to conventional therapy. MethOds: A Markov microsimulation model was developed to define a treatment pathway for OA of the knee, illustrate the current costs of treating patients with the condition, and demonstrate the potential savings associated with introduction of Hylan. A hypothetical cohort of patients categorized as having 2-3 or 4 degree of OA of the knee was followed over a 30-month time period. Results: When comparing intra-articular administration of Hylan, the use of NSAIDs and intra-articular administration of corticosteroids (GCS), rirost costs compared with the strategy of NSAIDs amounted to $192 rate per 1 patient. This increase in efficiency of 20% in favor of Hylan. Accordingly, the ratio ICER was $979 per patient, which is much below the threshold of "society's willingness to pay." Markov cycle for patients with OA of the knee of 4 degrees showed that use of Hylan is more effective in the end point of modeling the effectiveness of this strategy was 12% (compared to 0% in the policies of NSAIDs and corticosteroids). We calculated the total cost of the budget in the application of NSAIDs, GCS, and Hylan, after calculations found that the use of Gilan can save significant budget funds -up to $954582 (for 1,000 patients). cOnclusiOns: Hylan may delay the need for joint replacement in patients with OA of 4 degrees, suggest its use is justified from a clinical and economic standpoint as compared to the consideration of other treatment strategies.
A173 95% CI: 0.54 to 0.86). However, the total cost of treatment was higher for carbetocin compared with oxytocin, approximately 25.7 times, from the position of the perspective of Kazakhstan healthcare payer. The probability for carbetocin being cost-effective did not exceed 50% for any value of willingness to pay for effect. ConClusions: Our analysis failed to detect a significant difference with respect to postpartum hemorrhage, severe postpartum hemorrhage, mean estimated blood loss and adverse effects between carbetocin and oxytocin. Carbetocin does not seem to be a cost-effective strategy as compared with oxytocin for postpartum haemorrhage. Additional, higher-volume studies examining the clinical effect would be valuable.
Objectives: Italian recommendations for human papillomavirus (HPV) immunization currently consider females only. However, males can be vectors in viral transmission and at risk of infection. The BEST II study was designed to evaluate: the cost-effectiveness (CE) of different interventions targeting females as well as males; and the economic impact of vaccination on a wide range of HPV-induced diseases. MethOds: A dynamic Bayesian Markov model was developed to investigate the transmission between sexual partners and the cost-effectiveness of vaccination targeting female and male cohorts in comparison to screening and female cohorts only. A range of HPV-induced diseases was considered (cervical, vaginal, vulvar, anal, head and neck and penile cancer, the associated pre-cancerous stages and anogenital warts). The process of sexual mixing was calculated based on age, gender and sexual behavioural specific matrices to estimate th force of infection dynamically. Increased susceptibility to the virus, associated with early sexual début, a high number of partners, smoking and previous STDs, were included. We considered several scenarios; the baseline assumes universal vaccination to be implemented for 12-year-old females and males. The follow-up period was 55 years. Results: According to our preliminary analysis, universal vaccination resulted in incremental CE ratios (ICERs) corresponding to € 910 and € 5,770, when compared to screeningonly and female-only vaccination, respectively. We performed extensive sensitivity analysis, which confirmed the good CE profile of universal vaccination in Italy. cOnclusiOns: A universal HPV vaccination of male and female programme is more cost-effective than screening and female-only vaccination when accounting for all HPV-related diseases. Universal vaccination programme increase herd immunity and provide indirect protection to unvaccinated girls against HPV. The herd immunity plays a significant role in the economic evaluation of HPV immunization programmes. A universal vaccination may be further useful considering that males are both at risk of infection and vectors in viral transmission.
is associated with decreased quality of life, and poorer health outcomes. Therefore, there may be considerable gains in the adequate treatment of depression in oncology patients. We explored the cost-effectiveness of a collaborative care intervention specifically developed for the treatment of depression in cancer patients compared to usual practice. Methods: A cost-effectiveness analysis comparing a collaborative care intervention for depression management, Depression Care for People with Cancer (DCPC), in addition to usual care with usual care alone, based on data from the second Symptom Management Research Trials in Oncology (SMaRT-2). SMaRT-2 was a large (n= 500), multicentre study, in depressed patients with a relatively good cancer prognosis, in a secondary care setting. Outcomes included costs expressed as UK sterling in 2010-11 prices and health outcomes in quality-adjusted life-years (QALYs), estimated from a National Health Service and Personal Social Services perspective. Scenario analyses were performed to determine the impact on cost-effectiveness of alternative costing assumptions, and uncertainty was characterised through cost-effectiveness acceptability curves and probabilities of cost-effectiveness at key cost-effectiveness thresholds. Results: DCPC in addition to usual care was associated with greater costs, but also improved health outcomes. DCPC was found to be cost-effective at accepted cost-effectiveness thresholds. Results were robust across alternative scenarios, with probabilities of cost-effectiveness higher than 90% for cost-effectiveness thresholds ranging between £20,000-30,000 per QALY. ConClusions: Compared to usual care, DCPC in addition to usual care is likely to be cost-effective at current UK cost-effectiveness thresholds. This contributes to the growing evidence on the cost-effectiveness of collaborative care interventions for the treatment of comorbid depression. Future research will use a decision modelling approach to extrapolate trial-based results across a longer time horizon, and incorporate other relevant sources of evidence.
The persistence of PPI was defined as number of days to discontinuation of index PPI treatment without a gap of 30 or more days. Persistent PPI use for ≤ 8 weeks was classified as short term user and for > 8 weeks was classified as a long term PPI user. Descriptive statistics were performed to characterize the study population. Generalized linear models were used to analyze the cost difference and bootstrapping analysis was conducted to compute the 95% Confidence Interval (CI) as per percentile method. A statistical significance level of 0.05 was used in the study. SAS 9.3 software was used for statistical analysis. Results: The study population consisted of 75,503 patients with a GERD indication and incident PPI use. Majority of the patients were females (58.2%) and mean age of the cohort was 47.8 years. On an average, long term PPI users had higher all cause total costs
categorized into none (0), mild (1-3), moderate (4-6) or severe limitations (7 and up). Logistical regression was used to assess the association between functional limitations and healthcare utilization. Results: There was a total of 922 HF patients in the dataset. 251(31%) patients had none, 249(27%) had mild, 215(23%) had moderate, 207(19%) had severe functional limitations. For hospital stay, compared with those with no limitations, patients with mild (OR=1.6, 95% CI[1.1-2.5]), moderate (OR=1.6, 95% CI(1.0-2.6)], and severe limitations (OR=3.8 ,95% CI[2.5-5.7]) were more likely to be hospitalized at least once. For multiple hospital stays, patients with mild (OR=3.6, 95% CI[1.6-8.5]), moderate (OR=2.1, 95% CI(1.0-4.7)], and severe limitations (OR=3.6,95% CI[1.6-8.4]) were more likely to have $2 hospital admissions than those with no limitations. For outpatient visits, patients with mild (OR=2.0, 95% CI[1.1-3.6]), moderate (OR=2.5, 95% CI(1.3-4.8)], and severe limitations (OR=2.0,95% CI[1.1-3.8]) were more likely to have $4 outpatient visits than those with no limitations. Conclusions: Among older adults with HF, any degree of functional limitations is associated with higher utilization of healthcare. Future studies should investigate what aspects of functional limitations are predictors of higher utilization of healthcare and if any of these risk factors can be modified.
Objectives: Chronic HCV infection is associated with a significant health burden. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of direct-acting antivirals (DAAs) has dramatically changed hepatitis C treatment and sustained virologic response rates (SVR) of > 90% were observed in clinical trials. Especially interferon-free regimens allow a shorter treatment duration and show favorable toxicity profile. Nevertheless new treatment options were accompanied with higher pharmaceutical costs. The aim of the current study was to analyze outcomes and treatment costs in a realworld setting. MethOds: Data were derived from the German Hepatitis C-Registry (DHC-R). The DHC-R is a prospective, multicenter real-world registry study comprising approximately 10,500 patients. Patients are treated at the discretion of the physician. This analysis included all patients with HCV genotype (GT) 1 and 3 who initiated and finished treatment between 02/2014 and 02/2017 and were documented in the pharmacoeconomic substudy. Results: A total of 2,673 patients receiving antiviral treatment were analyzed; 88.0% had GT-1 and 12.0% GT-3 infection. Mean age was 54.6 years, 52.3% were male. Estimated mean duration of infection was 20.6 years. About half of the population (48.1%) was treatment-naïve and 30.2% had liver cirrhosis. 93.5% of all patients achieved SVR (GT-1: 94.0%, GT-3: 89.1%). Average total treatment costs were € 67,979 (€ 67,131 pharmaceutical costs, € 824 ambulatory care, € 24 hospital costs). Treatment costs were considerably lower in GT-1 compared to GT-3 patients (€ 65,650 vs. € 85,039). Average costs per SVR (cure) of € 69,841 for GT-1 and € 95,443 for GT-3 were calculated. cOnclusiOns: This analysis confirms high SVR rates for newly introduced DAAs in a real-world setting. Although costs for antiviral treatment have further increased, costs per SVR estimated are comparable to first generation DAAs. Detailed analyses stratified by treatment status, degree of cirrhosis and regimen should follow.
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