Previous studies have suggested that adherence to imatinib therapy can be an obstacle among patients with chronic myeloid leukemia (CML). We studied adherence to imatinib therapy among CML patients treated at the Sahlgrenska University Hospital. We identified all CML patients that were alive at the 1st of January 2010 (n = 70). Nineteen patients were excluded due to a history of allogenic hematopoietic stem cell transplantation, and nine were excluded due to treatment with other tyrosine kinase inhibitors. Thirty-eight out of 42 patients (90%) treated with imatinib accepted inclusion in the study. The patients were interviewed in a structured way, and adherence was evaluated in a standardized way using the nine-item Morisky Medication Adherence Scale that ranges from 1 to 13. A Morisky score ≤10 indicates nonadherence and ≥11 indicates adherence. In addition, predefined follow-up questions were asked to identify factors known to influence adherence to therapy. In contrast to previous studies, our patients showed good adherence to imatinib therapy with a mean Morisky score of 12.3 out of 13 (range, 9-13). The interviews revealed factors known to predict adherence to therapy, namely being well informed and having frequent contact with a single hematologist. Furthermore, the patients had easy access to the treating clinic and felt that they took part in decisions concerning their disease and treatment. We show that adherence to imatinib can be very good in CML patients, and we suggest that simple measures such as increased patient information and continuity of care will increase adherence in patients with CML.
Objectives: To review clinical guidelines, recent HTA decisions, and the influence of economic analyses in HTA decisions related to biologic therapies in UC. MethOds: A literature review and targeted research provided information on clinical treatment guidelines (US and Europe) and HTAs (Europe) related to biologics in UC. Economic models in UC were identified and reviewed to determine how these affected HTA decisions. Results: Since several biologics were approved after the last version of the US treatment guidelines, the US guidelines only address the use of infliximab for the treatment of moderate or severe UC. In the UK, NICE has recommended infliximab, adalimumab, and golimumab as possible treatments for adults with moderate to severe UC in whom conventional therapy hasn't worked or isn't suitable. A recent NICE HTA recommends vedolizumab as an option for treating moderately to severely active UC in adults only if the company provides vedolizumab with the discount agreed in the patient access scheme. The Scottish Medicines Consortium (SMC) recommends vedolizumab for the treatment of adult patients with moderate-to-severe UC and an inadequate response, lost response, or intolerance to conventional therapy or a TNFα antagonist; this advice is "contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower." Earlier SMC advice did not recommend adalimumab, golimumab or infliximab for use within NHS Scotland due to lack of robust economic analyses. The SMC advice is superseded by the NICE HTA decisions. cOnclusiOns: In the UK and Scotland, more than 9 HTA have been performed in the 10 years since biologics have become available for the treatment of moderate-to-severe UC. Differential cost-effectiveness among specific indications, lines of treatment, and countries have resulted in a variety of recommendations as to their use which supplement clinical guidelines in UC.
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