Objective: To estimate the cost-effectiveness of Cladribine Tablets in the treatment of relapsing multiple sclerosis (RMS) with high disease activity compared with fingolimod, from the perspective of the National Health System (NHS) in Spain. Methods: A Markov model was developed. The annual transition probabilities, were adjusted to patients with RMS with high disease activity. The effect of the treatments compared on the Expanded Disability Status Scale (EDSS) was modeled by hazard ratios for the confirmed progression of disability. The annual relapse rate and the probability of suffering adverse reactions were obtained from a meta-analysis and the literature. The derived costs were calculated from Spanish unit costs. The utilities were obtained from the CLARITY clinical trial and the literature. Deterministic and probabilistic sensitivity analyzes were performed. Results: Cladribine tablets was the dominant treatment: lower costs (−86,536 €) and more effective (+1.11 quality-adjusted life years-QALYs) compared to fingolimod. The probability that Cladribine Tablets was costeffective compared to fingolimod ranged between 94.6% and 96.1% for willingness to pay from € 20,000 to € 30,000 per QALY gained. Conclusions: Cladribine Tablets is a cost-effective treatment, compared to fingolimod, for the treatment of RMS with high disease activity. Expert Opinion: According to the present study, compared to fingolimod, treatment with Cladribine Tablets of relapsing multiple sclerosis with high disease activity is an option that could generate savings for the Spanish National Health System, with a considerable gain in QALYs. Cladribine Tablets is considered cost-effective and dominant (less costs and more effectiveness) than fingolimod treatment option in this population.
Este artículo presenta los resultados del uso de laboratorios remotos aplicados a la formación e-learning en ingeniería y ciencias básicas en tiempos del COVID-19. La investigación se llevó acabo porque el coronavirus afectó el sector educación especialmente en la formación de las áreas experimentales donde requieren manipular variables físicas. Los resultados evidenciaron que los estudiantes percibieron una sensación de inmersión en un laboratorio real a pesar de que la experimentación fue mediante la web.
OBJECTIVES: AbobotulinumtoxinA (aboBoNT-A), an injectable form of botulinum toxin type A, is approved for use in adults with upper limb spasticity (ULS). A costeffectiveness model was developed to estimate the costs and health outcomes associated with treatment with aboBoNT-A in Sweden compared to best supportive care (BSC) only in patients with ULS. METHODS: A health state transition model assessed accumulated life-time costs, life years and quality adjusted life years (QALY). Health states were based on disease severity, defined according to the Disability Assessment Scale (DAS). Transition probabilities between health states were derived from changes in DAS scores observed in pivotal randomized and open-label extension clinical studies of aboBoNT-A during the first year, and extrapolated over the remaining time horizon. Costs included country-specific data on intervention cost, other health care costs as well as informal care costs. Data on utility was based both on SF-36 data from the pivotal clinical study, mapped to utilities, and from literature sources. The base case analysis applied a conservative approach assuming no difference in health care costs, other than for drug acquisition and injections. RESULTS: AboBoNT-A-treated patients were associated with~78,000 SEK higher costs and accrued 0.44 more QALYs per patient, compared to BSC. Hence, treatment of ULS with aboBoNT-A resulted in a base case incremental cost per QALY gained of about 177,000 SEK (~18,600 EUR). The result was sensitive to utility weights, discontinuation rates and initial health state distribution. CONCLUSIONS: Results indicates that, based on existing evidence and country-specific treatment costs, the management of ULS in Sweden with abo-BoNT-A is likely to be a cost-effective treatment option compared to BSC, with a cost per QALY gained within an acceptable limit. More data on real-life use of aboBoNT-A and its long-term impact on utility and health care costs would increase the certainty of these findings.
Discussion/conclusions• DTDS is a rare disorder that should be considered in the differential diagnosis of genetic parkinsonism of juvenile-onset. Affected individuals show hyperkinesia with orolingual and limb dyskinesia, dystonia, and chorea with parkinsonian features. • Atypical onset in adolescence or adulthood has been described.• SLC6A3 encodes the dopamine transporter (DAT) that is expressed predominantly within the substantia nigra and in the midbrain, which has a crucial role in mediating reuptake and homeostasis of dopamine.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.