Targeting outcome expectancy and external barriers with multifaceted, ongoing interventions may improve guideline adherence. Pulmonologists are clearly looking for empirical evidence that these medications benefit their patients over the long-term and offset patient treatment burden with improved health.

After crizotinib monotherapy, most patients either received radiotherapy only or discontinued antineoplastic treatment altogether. OS after discontinuing crizotinib was poor and shorter among those with brain metastases than without, and among those without subsequent antineoplastic treatment than with. Patients who continued antineoplastic treatment incurred substantial healthcare costs.

third agent being dexamethasone for all regimens. Only cost inputs differed between the two country analyses. RESULTS: NEPA was dominant against all four comparators in Germany, being the cheapest with a total cost of 81.49V and the most effective with a total QALDs of 4.272. The total differential costs were +35.45V, +37.38V, +68.77V and +6.89V; the total differential QALDs were respectively -0.0004, -0.0001, -0.0004 and -0.0006 and the proportions of CINV-free patients at 5 days was 83.0% for NEPA and 79.4%, 83.0%, 79.1% and 75.5% for APR+OND, APR+PAL, FOS+GRA and ROL+GRA respectively. NEPA was also dominant against all three comparators in Greece, with a total cost of 85.00V. The differential total costs were +10.46V, +27.07V and +23.

clinical data, modeling approaches, and value perspective. To facilitate transparency, debate and collaboration among diverse stakeholders, the model consists of the following components: Modifiable R and C++ source code available in a GitHub repository; an R-package to run the model for custom analyses; a webbased user interface for full control over the model without the need to be wellversed in the programming language; and a general audience web-application allowing those who are not experts in modeling or health economics to interact with the model, and contribute to the discussion of value assessment. Model input parameters were estimated based on currently available evidence, synthesized with Bayesian meta-analysis techniques. RESULTS: The model was used to evaluate the impact of uncertainty in clinical evidence, multiple competing model structures, decision framework of choice (i.e. cost-effectiveness analysis or multicriteria decision analysis), and perspective (healthcare or limited societal) on estimates of value for currently recommended treatment sequences for patients with metastatic EGFR+ NSCLC. CONCLUSIONS: In order for a cost-effectiveness model to remain relevant over time it needs to evolve along with the clinical evidence and scientific insights. The OSVP EGFR+ NSCLC facilitates iterative development and collaboration between multiple clinical and methodological experts with the ultimate aim of having a transparent model useful and acceptable for many stakeholders.OBJECTIVES: Tisagenlecleucel, a CD19-directed genetically modified autologous Tcell immunocellular therapy is pending regulatory approval for the treatment of pediatric and young adult patients with relapsed or refractory (r/r) B-cell acute lymphoblastic leukemia (pALL). The current study assessed the cost-utility of tisagenlecleucel in comparison with salvage chemotherapy for the treatment of r/r B-cell pALL from a Canadian societal perspective. METHODS: The model included three health states: event free survival (EFS), progressive disease, and death. Using the partitioned survival model approach, the proportions of patients in each health state were determined by the area under the curves based on the fitted overall survival (OS) and EFS trial curves. The model used literature of ALL long-term survivors to inform the mortality risk after year 5 and conservatively assumed no difference in mortality risk across treatments. A 70-year time horizon was used to capture all the relevant costs and benefits associated with the treatments. Both costs and benefits were discounted at 1.5% per year. The model comparator was salvage chemotherapy. Costs, health state utility and treatment-related disutility inputs were obtained from Canada-specific databases and literature RESULTS: Tisagenlecleucel was associated with incremental life year (LY) gains of 13.46 years, incremental quality-adjusted life years (QALYs) gains of 11.74 years and an incremental cost of $135,758 when compared to salvage chemotherapy. The incremental cost-effectiveness rati...

A23942.3% reported having both NT and EM symptoms, 32.7% reported either symptom, and 25.0% reported neither symptom. Mean (±SD) age was 60.2 (±8.0) years and the majority of respondents were female (60.5%), white (91.6%), and former/current smokers (87.1%). Among respondents with NT symptoms, the most commonly reported symptom was coughing (72.9%), followed by wheezing (69.2%), and shortness of breath (61.4%). 77.7% of respondents with NT symptoms reported sleep disturbance and 59.1% felt anxious due to NT symptoms. Among respondents with EM symptoms, the most frequently reported symptom was coughing (74.5%), followed by shortness of breath (73.9%), and bringing up phlegm or mucus (69.6%). Of respondents with EM symptoms, 60.4% reported morning activity limitation and 54.3% felt anxious due to EM symptoms. CONCLUSIONS: NT/EM symptoms are highly prevalent in the COPD population, especially cough and wheezing. The presence of these symptoms interferes with patients' sleep, anxiety, and morning activities.

No abstract

OBJECTIVES:To determine the effect of enrollment in a prescription drug plan on use of controller medications in patients with persistent asthma. METHODS: The study used a retrospective, cross sectional research design. The data source utilized was the 2008 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the non-institutionalized, civilian U.S. population. Analysis was restricted to asthma patients who reported use of more than 3 canisters of rescue inhalers in a three-month period. Controller medication use was self-reported by MEPS respondants. Descriptive statistics was used to describe the sample and their controller medication use. A logistic regression model was used to assess the effect of prescription drug coverage based on the type of prescription drug plan on the controller medication use while adjusting for age, gender, race, ethnicity, income and perceived health status. All analyses were carried out using SASv.9.1. RESULTS: Forty-two percent of respondents had prescription drug coverage while 67% reported use of controller medications. In the regression model, controller medication use was found to be similar amongst patients with prescription drug coverage and patients without coverage (68%, 66%, respectively). Patients with prescription drug coverage were less likely to use controller medications than those who did not have coverage, although this effect was not significant (OR ϭ 0.53,CI:0.28-1.01). Patients with Medicare (OR ϭ 4.35, CI:1.61-11.75), Medicaid (OR ϭ 5.44, CI:2.23-13.24) or Veterans Affairs (OR ϭ 12.82, CI:3.21-51.16) prescription coverage were more likely to use controller medications when compared with patients in other types of plans. Both pediatric patients (OR ϭ 5.51, CI:1.27-23.88) and patients with excellent perceived health status (OR ϭ 5.10, CI:2.04-12.76) had a higher likelihood of using controller medications. CONCLUSIONS: Enrollment in a prescription drug plan did not show a significant impact on use of controller medications. However, enrollment in Medicare, Medicaid or Veterans Affairs prescription plans increased likelihood of controller medication use in this patient cohort.

No abstract