No abstract

Aims: Although the benefit of first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) over chemotherapy in EGFR mutation-positive (EGFRm) non-smallcell lung cancer (NSCLC) has been demonstrated in clinical trials, the optimal treatment sequence remains unclear. The objective of our study was to evaluate the cost-effectiveness of dacomitinib in Sweden versus afatinib and osimertinib in first-line treatment of EGFRm NSCLC. Materials and methods: A partitioned survival model was developed with three health states: progression-free, post-progression, and death. Progression-free and overall survival curves were used to inform movements between states. Clinical data were taken from randomized trials, compared via a network meta-analysis (NMA). Utility data were taken from published studies and costs from national Swedish sources. The model used a 15-year time horizon and a Swedish healthcare payer perspective. Sensitivity and scenario analyses were performed. Results: The base-case analysis showed that dacomitinib accrued a total of 2.10 qualityadjusted life years (QALYs) at a total cost of Swedish krona (SEK) 874,615. The incremental cost-effectiveness ratio (ICER) for dacomitinib versus afatinib was SEK 461,556 per QALY gained. The ICER of osimertinib versus dacomitinib, where the small QALY gains of the former came at a high additional cost, was SEK 11,444,709. Deterministic and probabilistic sensitivity analyses confirmed robustness of these results; changes to drug and medical resource use costs and overall survival had the greatest impact on ICER estimates. Limitations: This model is subject to uncertainty associated with extrapolating long-term A c c e p t e d M a n u s c r i p t treatment effects from shorter trial follow-up periods, although this would also be a limitation when using direct comparison or time-dependent hazard ratios. The NMA was limited by the use of indirect comparison although sensitivity analyses supported the robustness of our findings. Conclusions: Our model demonstrated dacomitinib is cost-effective for first-line EGFRm NSCLC treatment in Sweden versus afatinib and osimertinib.

A611within and between the MTM members and controls were measured (differencein-differences (DID) analysis). Results: 2382 patients (MTM group: n= 201, mean age= 75,44%male; control group: n= 2181,mean age= 74,48%male) in the diabetes cohort and 9751 patients (MTM group: n= 563, mean age= 76,39% male; control group: n= 9188, mean age= 75,40% male) in the hypertension cohort were included. For patients in diabetes cohort, the MTM group had pre-post increase in PDC by 5.19% (P= 0.05), while the control group had decrease of 2.82% (P< 0.01) (DID= 8.03%; P= 0.003). For patients in hypertension cohort, the MTM group had pre-post increase in PDC by 17.33% (P< 0.01), while the control group had increase of 9.64% (P< 0.01) (DID= 7.67%; P< 0.01). The PDC finding was confirmed with regression analyses with propensity score adjustment showing the MTM groups had a significant increase in pre-post PDC for hypertension, as compared with the control group, while controlling for baseline characteristics (P= 0.01). ConClusions: This study found that the pharmacist-managed MTM program significantly increased medication adherence in Medicare MAPD patients with hypertension, as compared with a control group.

Prevalence of opioid-related side effects among patients with CNCP who initiated opioids was substantially higher based on patient survey than from charts or claims. Opioid-related side effects were associated with significantly higher healthcare costs.

Employees with DC had substantially higher comorbidity rates, utilization, and direct and indirect costs compared with demographically matched controls.