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From both perspectives of the US payer and society, T-DM1 is not cost-effective when comparing to the LC combination therapy at a willingness-to-pay threshold of $150,000/QALY. T-DM1 might have a better chance to be cost-effective compared to capecitabine monotherapy from the US societal perspective.

Replenishing low vitamin D in patients with statin-induced myopathy appears to be an effective strategy in improving medication adherence and subsequently preventing cardiovascular and mortality events.

BACKGROUND: Ankylosing spondylitis (AS) is a form of rheumatic disease caused by chronic inflammation of the axial skeleton. Patients with AS experience significant functional limitations and reduced quality of life. Consequently, AS imposes a substantial economic burden on society due to productivity loss and work disability. Biologics, including tumor necrosis factor (TNF) inhibitors and human anti-interleukin-17A monoclonal antibody (IL-17A) agents, are effective treatment strategies in relieving symptoms and slowing down disease progression. Currently, 5 TNF inhibitors and 2 IL-17A antibody agents are approved by the FDA for the management of AS. Of these agents, there is no clear preferred agent in initial biologic therapy, although an IL-17A antibody agent or alternative TNF inhibitor agent is recommended after failure of the initial TNF inhibitor therapy. OBJECTIVE: To assess cost-effectiveness of treatment strategies with biologics, TNF inhibitor or IL-17A, in accordance with the treatment guidelines for patients with AS. What is already known about this subject• This is the first economic evaluation study that examines the cost-effectiveness of treatment strategies with biologics according to the treatment guidelines for patients with AS from the U.S. health care payer's perspective. • This study suggests that all treatment strategies with biologics,

BACKGROUND: Anticyclic citrullinated peptide (anti-CCP) positivity may be a strong predictor of joint erosion and a potential biomarker for guiding treatment decisions for rheumatoid arthritis (RA). However, limited studies are currently available on the effect of anti-CCP positivity on health care utilization and/or medical costs of RA patients. OBJECTIVE: To investigate short-term and long-term direct health care expenditures associated with anti-CCP positivity in newly diagnosed RA patients.METHODS: A retrospective cohort study was conducted in adult RA patients within a U.S. integrated health care delivery system (January 1, 2007-June 30, 2015. Patients were required to have 2 RA diagnoses and treatment with a conventional or biologic disease-modifying antirheumatic drug (DMARD) within 12 months. The first RA diagnosis date was labeled as the index date, and patients were followed until they left the health plan, died, or reached the end of the study period. Patient demographics, anti-CCP results, comorbid conditions, and health care resource utilization during baseline (12 months before the index date) and follow-up periods were collected. Nationally recognized direct medical costs were assigned to health care utilization to calculate health care costs in 2015 U.S. dollars. The baseline differences between anti-CCP positivity and negativity and differences in censoring during follow-up were addressed using propensity scores. The mean differences in costs were estimated using recycled prediction methods.RESULTS: 2,448 newly diagnosed RA patients were identified and followed for a median of 3.7 years (range = 1-8 years). At baseline, 65.8% of patients were anti-CCP positive. Anti-CCP-positive patients had fewer comorbid conditions at baseline. During the first 12 months of follow-up, median (interquartile range) total health care expenditures for anti-CCP-positive

Objectives: Secukinumab is the first fully human monoclonal antibody that selectively neutralizes IL-17A, which is approved for the treatment of Ankylosing Spondylitis (AS). In the context of no head to head trial comparing secukinumab 150mg (SEC150) with other biological agents listed by the Brazilian Unified Health System (SUS) for the treatment of AS (adalimumab, etanercept, infliximab and golimumab), we conducted a cost-minimization analysis (CMA) to compare the costs generated by the use of SEC150 compared to other biologics in AS. MethOds: As for any CMA, it was assumed that the efficacy of SEC150 was comparable to those of the comparators. Annual treatment costs per patient in the first and second year of treatment were calculated in order to capture the difference in costs of induction and maintenance treatment phases between treatments. Only drug costs were considered, which were estimated using the latest public price for government purchases and the number of doses required for 48 weeks, according to the SUS AS Clinical Guideline. To evaluate the robustness of the analysis, one-way sensitivity analyses (OWSA) were performed. Results: SEC150 had the lowest annual drug costs in both first and second year of treatment (BRL 9,895.20 and BRL 7,916.16, respectively). The difference on the annual drug costs of SEC150 versus other biologics ranged from-BRL 5,428.56 to-BRL 18,967.20 in the first year and from-BRL 7,407.60 to-BRL 13,730.64 in the second year. Based on the maintenance treatment phase (from second year on), the savings generated per patient per year ranged from 48% (vs. golimumab) to 63% (vs. infliximab). The OWSA confirmed the favorable results for SEC150 in all scenarios evaluated. cOnclusiOns: SEC150 is a costsaving alternative when compared to other biologic agents already reimbursed by SUS for the treatment of AS in Brazil.

Objectives: We examined the effect of patient centered medical home (PCMH) on health service expenditures and utilization in a national probability sample of US civilian noninstitutionalized adult population who were diagnosed with hypertension. MethOds: The 2010-2015 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥ 18 years of age diagnosed with hypertension. We investigated the impact of PCMH on the direct hypertension-related total, inpatient, prescription medications, outpatient, emergency room, office based, and other medical expenditures by employing Log transformed multiple linear regression models and the propensity score method. Results: Of the 18,630 adults identified with hypertension, 19.2% (n = 3,583) had received PCMH care during 2010 to 2015. After matching, No PCMH group showed greater mean in all hypertension-related health service expenditures and utilization. After adjusting for confounders, PCMH group showed significant lower total, office-based, outpatient, number of office-based visits and outpatient visits compared with control group. cOnclusiOns: A significant relationship between experiencing PCMH care and a lower total health care expenditure were found among patient with hypertension. To reduce the overall cost of care for those patients, policy makers should implement new intervention strategies that are effective in facilitating the access to PCMH.

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