Background Determining the best treatment path for Crohn’s Disease (CD) patients following loss of response (LoR) to a tumour necrosis factor inhibitor (TNFi) is challenging for clinicians. This study seeks to provide real-world evidence on treatment failure, treatment discontinuation and corticosteroid-free drug survival in CD patients with LoR to a first TNFi, switching to another TNFi compared to a non-TNFi biologic. Methods Adult CD-patients without biologics therapy in the last 6 months who started treatment with adalimumab or infliximab and switched due to LoR to another biologic between 01/10/2014–31/12/2018 were identified from German claims data (AOK PLUS). The identified patients were classified as either within-class switchers (WCS) (if they switched to adalimumab or infliximab) or outside-class switchers (OCS) (if they switched to vedolizumab or ustekinumab). The date of first treatment switch was set as the index date. Patients were followed for at least one year after treatment switch. To compare WCS and OCS, baseline covariate adjustment through inverse probability of treatment weighting (IPTW) of the propensity scores was conducted. Time-to-event analyses were performed using Cox Proportional Hazard regressions adjusted for an indicator of primary non-response and secondary LoR (if the first switch happened within or after 6 months from the initial TNFi). Results 112 patients (53 WCS and 59 OCS) were identified. Upon IPTW, 43 WCS and 54 OCS satisfying the common support assumption were included for comparative analyses with adjustment for primary non-response and secondary LoR. WCS were significantly more likely to receive corticosteroid therapy, more likely to fail and to discontinue the treatment they had switched to; and more likely to switch again to another biologic compared to OCS (Figure 1). Having switched due to primary non-response or due to secondary LoR was not significantly associated with any outcome. Figure 1: Kaplan-Meier curves and Cox proportional hazard models adjusted for an indicator variable of primary non-response/secondary loss of response Abbreviations: CD, Crohn’s disease; CI, confidence interval; HR, hazard ratio Conclusion Whilst small sample size is a limitation, these results suggest that following loss of response to a TNFi, patients may benefit from switching to vedolizumab or ustekinumab rather than switching to a different TNFi.
Improving treatment continuity and adherence to antipsychotic therapy in schizophrenia is a major challenge. The 3-monthly long-acting therapy of paliperidone palmitate (PP3M) has the longest dosing interval available compared to other antipsychotics whilst having the same active ingredient, as the existing 1-monthly long-acting therapy (PP1M). This study assessed the cost-effectiveness of PP3M versus PP1M in patients with schizophrenia in the UK. MethOds: A Markov model with monthly cycles encompassed a first treatment line (PP3M or PP1M) followed by a period off-treatment, and then a follow-up therapy (a mix of treatments reflecting UK practice). At each cycle, patients could either remain in stable disease, experience a relapse, experience temporary or permanent adverse events, or die. Relapse and adverse event rates were based on a non-inferiority head-to-head trial and were set equal in both arms; first line treatment discontinuation of PP1M was based on UK real-world evidence and assumed equivalent for PP3M. Accounting for differences in drug exposure length between PP1M and PP3M, a time-dependent relapse rate was applied during the period off-treatment. The benefits of a reduced administration frequency were reflected in the stable state utility for PP3M by applying an increment to the PP1M baseline utility. The perspective of the UK National Health Service was adopted throughout a two-year time horizon. Costs and effects were discounted at an annual rate of 3.5%. Results: PP3M is dominant compared to PP1M, showing cost savings (£ -638) and an increase in QALYs (+0.069). Cost savings were driven by reductions in relapse and administration costs for PP3M, whilst QALY gains were derived from the reduced administration frequency. Results robustness was demonstrated via sensitivity and scenario analyses. cOnclusiOns: The introduction of PP3M to the UK setting constitutes an improvement, bringing savings and QoL benefits to the current LAI-based standard of care for schizophrenia patients.
A4410.18 over 30 years. ConClusions: The use of cabozantinib represents an efficient option in England versus nivolumab with numerically better efficacy and lower cost. Treatment with cabozantinib was more costly but also more effective than treatment with axitinib or everolimus. These conclusions held true across a range of scenarios and sensitivity analyses, including one-way and probabilistic analyses. PCN163 Cost-EffECtivENEss of ibrutiNib iN PatiENts with rElaPsEd or rEfraCtory (rr) ChroNiC lymPhoCytiC lEukaEmia (Cll) iN ENglaNd
Objectives: Stratified breast cancer screening describes the using of individual risk information to cluster women into groups who would overall benefit from intensified screening and groups who would overall benefit from reduced screening. Recent economic evaluations applied decision analytical modeling to test new methods of stratified mammography screening for women over 50 years. One major assumption in recent models is that women adhere fully to recommended screening protocols. In Germany, screening adherence is at 54%. Accordingly, full adherence is more the exception than the rule. We evaluate stratified breast cancer screening for the general population using both, full adherence and non-adherence, assumptions. MethOds: A micro-simulation Markov model is adapted to the German context. Model validation is based on the AdViSHE tool. German register and published data are used for parameters of cancer incidence, treatment and survival. Annual, biennial and triennial routine screening are compared against five strategies using different combination of three risk factor to stratify screening frequencies. As suggested in the German HTA procedure, all strategies are evaluated using efficiency frontiers. We evaluated three outcome variables (mortality reduction, QALY and false positive results) under the assumption of full adherence and an average adherence rate of 54%. Results: Under the full adherence assumption, four of five stratified strategies and all routine strategies lie on the efficiency frontiers. Only one stratified strategies is dominated. Under the non-adherence assumption, biennial routine screening and two more stratified screening are dominated in mortality reduction and QALYs. Depending on the willingness-to-pay, one of the two remaining stratified screening should be selected as efficient alternatives to biennial routine screening. cOnclusiOns: Routine and stratified screening strategies are found to be sensitive to non-adherence. The choice which strategy to recommend is affected by non-adherence. In the context of low screening adherence, routine mammography screening is not an efficient strategy.
A 3 4 7 -A 7 6 6 A733 above was applied to the R-chemotherapy arm. Given the limited R-chemotherapy evidence and the immaturity of the available ibrutinib overall survival (OS) data, post-progression survival (PPS) was assumed equal in the two arms. OS was the sum of PFS + PPS. Utility data were taken from the pooled ibrutinib dataset and a utility decrement for patients while receiving chemotherapy was applied as per expert opinion4. Results: Estimated outcomes for ibrutinib were 2.28 life years (LYs) and 1.59 QALYs per patient. R-chemotherapy resulted in 1.04 LYs and 0.65 QALYs using the fist method and 1.26 LYs and 0.77 QALYs using the second method. ConClusions: The limited evidence available in R/R MCL inhibits a direct comparison between ibrutinib and R-chemotherapy. Modelled estimates using available data indicate that ibrutinib offers a large QALY and LY benefit versus R-chemotherapy.
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