A569data. Results were presented as incremental cost-effectiveness ratios (ICERs) per PASI90 16-week response. Both one-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Results: Combining Secukinumab 300 significantly greater effectiveness in terms of PASI90 response compared with Ustekinumab and Etanercept with the total 2-year costs accrued in each therapeutic option, the base-case ICERs per PASI90 response of Secukinumab 300 versus Ustekinumab 90, Ustekinumab 45, Ustekinumab 90&45 weighted and Etanercept were € 9,543, € 13,316, € 11,941 and € 17,448, respectively. These ICERs lie well beneath the defined willingness-to-pay threshold of € 36,000 in Greece (twice the per capita income) indicating that Secukinumab 300 is cost-effective versus Ustekinumab and Etanercept in moderate-to-severe plaque psoriasis. The sensitivity analyses confirmed the robustness of the model results. ConClusions: Secukinumab was found to be cost-effective in terms of PASI90 response at 16-weeks compared with both Ustekinumab and Etanercept for the treatment of moderate-to-severe plaque psoriasis in Greece.
database including approximately 6.7 million insured anonymities originating from 63 statutory health insurances. Analyses were performed by the InGef institute. A sample with approximately 4 million insured persons was drawn and stratified by age and gender according to the official demographic structure of the German statutory health insured population (DeStatis, Dec 31st, 2013). Patient data from 2012 -2016 were included if they met the following conditions: Main diagnosis of PsO (ICD-10 code L40.-), and start / maintenance / switch of treatment with PsO approved biological agent(s) (at least for three months). The study evaluated hospital admission, change in medication and direct medical costs (drug, outpatient care, hospitalization). Results: Leading biological agents for 1st line treatment of PsO are adalimumab and apremilast, however, at a low level of share of prescriptions. Adalimumab and etanercept are administered mostly to patients already on treatment (in 2015 adalimumab 40.4 % vs. etanercept 26.6 %). The total costs of the included 2'041 patients add up to € 36'874'827 in 2015. The total number of patients, the number of hospital admissions and the total treatment costs including all individual cost items grew yearly on average between 1. 7% and 14.5 % (2012 -2015). Hospitalization per patient declined slightly from 0.8 to 0.7. ConClusions: Adalimumab, apremilast and etanercept are those biological agents mainly used for treating PsO. All cost items grew steadily over the last 4 years. Total costs in 2015 were € 36.9 million (on average € 18'067 per patient).
BackgroundPatients with inflammatory bowel disease (IBD) are at risk for iron deficiency. Absorption of orally given iron may be impaired by intestinal inflammation, and treatment with oral iron may aggravate intestinal inflammation. The treatment of iron deficiency anaemia with IBD is a particular challenge and often insufficient.PurposeTo describe the effectiveness and safety of intravenous ferric carboxymaltose (FCM) in IBD adult patients.Material and methodsObservational, retrospective study in two general hospitals. IBD adult patients who had received at least one dose of FCM from August 2013 to August 2015 for up to 3 months were analysed. Data collection from clinical records: age, gender, IBD (Crohn’s disease (CD) or ulcerative colitis (UC)), FCM dosage, biological drug treatment, haemoglobin (g/dL), haematocrit (%), mean corpuscular Hb concentration (MCHC g/dL), serum ferritine level (SFL ng/mL), all pre-FCM and post-FCM infusion. The safety profile was evaluated on the basis of the proportion of patients who experienced any adverse drug reaction (ADR). Statistical analysis was powered by SPSS 15.0 (paired t test).ResultsIn total, 46 IBD patients were treated for concomitant iron deficiency anaemia: mean age 49.3 ± 6.6 years, 22 (47.8%) women, 28 with CD (60.9%) and 18 with UC (39.1%). The mean cumulative dose was 978 ± 103.2 mg of iron; without concomitant biological drug 27 (58.7%) patients, 14 (30.4%) with infliximab, 4 (8.7%) with adalimumab and 1 (2.2%) with golimumab. Correction of iron deficiency anaemia was observed with improved mean Hb levels from 11.7 ± 1.4 g/dL at baseline to 13.6 ± 0.9 g/dL within 12 weeks (p < 0.001), mean haematocrit 36.1 ± 4.7% vs 41.0 ± 3.1% (p < 0.001), mean MCHC 27.9 ± 3.2 g/dL vs 30.2 ± 2.4 g/dL (p < 0.001), mean SFL 49.9 ± 84.5 ng/mL vs 205.2 ± 194.4 ng/mL (p < 0.001), respectively. Six (13.1%) subjects reported mild ADRs related to FCM; 4 (8.7%) of these were considered to be potentially related to long duration of administration and to a high volume of saline solution for dilution.ConclusionOverall FCM was well tolerated in this population and appeared to be effective in correcting iron deficiency anaemia. We cannot exclude the fact that correction of iron deficiency anaemia is in some part due to the treatment of the underlying disease and not related to the iron supplementation alone.No conflict of interest.
BackgroundThe role of biological anti-TNF agents (ATBA) in the treatment of rheumatological diseases (RD) has expanded, but dosing patterns have not been thoroughly explored.PurposeTo describe patterns of ATBA use among patients with RD.Material and methodsTo describe patterns of ATBA use we retrospectively collected dispensing records of etanercept, adalimumab, golimumab and infliximab in first line (FL) or subsequent line (SL) settings, from 2011 to 2013, in a general teaching hospital. Variables included: average dose according to the standard dosing interval, dose escalation and discontinuation (gap in treatment >60 days or switch). Time to discontinuation was assessed with Kaplan-Meier curves and U Mann-Whitney tests for average comparisons (SPSS 15.0).ResultsOver 3 years, average doses dispensed were: etanercept (N = 238) 40.2 ± 10.9 mg/week, adalimumab (N = 344) 44.9 ± 8.6 mg/2 weeks, golimumab (N = 38) 52.2 ± 1.6 mg/month, and infliximab (N = 139) 489.1 ± 188.6 mg/8 weeks. The overall percentages with dose escalation or discontinuation were greater in the SL for all ATBAs (42.2% SL vs. 28.6% FL, p = 0.039). The proportion with dose escalation was greater for infliximab patients (71.8% SL vs. 52.2% FL, p = 0.012), as well as for discontinuations (15.2% SL vs. 8.6%, p = 0.029). Time to discontinuation was significantly shorter for SL than FL for all ATBAs (median 10.6 vs. 14.9 months; p = 0.018). The hazard ratio for discontinuing SL vs. FL was 1.321 (p = 0.020).ConclusionIn RD ATBAs have higher rates of discontinuation, dose escalation, and shorter time to discontinuation in SL than in FL, therefore the correct selection of FL is a key question in this setting.References and/or acknowledgementsNo conflict of interest.
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