Issue: Recent health technology reviews by CADTH, including a national Environmental Scan of biologics for PsO across public drug plans and a review of the clinical evidence on the comparative effectiveness of biologics for PsO, have suggested that the appropriate use of biologics for the treatment of plaque psoriasis (PsO) may favour new-generation biologics (i.e., anti-interleukin [IL]-17 and anti-IL-23 inhibitors) over old-generation biologics (i.e., anti–tumour necrosis factor and anti-IL-12/23 biologics). Specifically, these reviews found: New-generation biologics for PsO consistently demonstrated greater efficacy compared to old-generation biologics in recent head-to-head trials (e.g., AMAGINE-2 and AMAGINE−3, FIXTURE, IMMvent, NAVIGATE, UltIMMA-1 and UltIMMA−2, UNCOVER-2 and UNCOVER-3, and VOYAGE-1 and VOYAGE−2). Formulary listings of the old-generation biologics mostly predate any pan-Canadian Pharmaceutical Alliance (pCPA) agreements, which increases the likelihood of fewer product listing agreements (PLAs) with public payers for these drugs, whereas all new-generation biologics have all undergone pCPA negotiations. For private payer formulary listings, PLAs are not publicly disclosed although, according to the Canadian Life and Health Insurance Association (CLHIA), they are likely to occur. Old-generation biologics have reached the expiration of their exclusivity periods (i.e., time when an originator biologic is protected from biosimilar competition), whereas all new-generation biologics currently have active exclusivity status. Approach: A national utilization study was conducted to assess the utilization patterns of old- versus new-generation biologics in PsO for both public payers (using Canadian Institute for Health Information [CIHI] data) and private payers (using Reformulary and CLHIA data), prescribing patterns (market share and average costs) for old- versus new-generation biologics for both public and private insurance among new and existing users, and expenditures (excluding PLAs) on biologics for PsO after LoE by public and private payers. Findings: Although new-generation biologics in PsO are associated with greater efficacy, approximately 44% of patients newly initiating a biologic across public and private drug plans in Canada were prescribed an old-generation biologic in 2020. Average annual cost per new patient was typically higher for old-generation originator biologics (range = $11,645 to $16,047) versus new-generation biologics (range = $8,303 to $15,229) across public payers. Ustekinumab is associated with the highest cost estimate among new patients within public drug plans and, despite having expired exclusivity status, does not have a marketed biosimilar option available. Canadian taxpayers (i.e., public and private drug spending) have spent up to $9 billion (gross expenditures) on all claims for originator biologics indicated for PsO that have lost exclusivity between 2016 and 2020. To put this in perspective, analyses of data from the National Prescription Drug Utilization Information System (NPDUIS) revealed that, in Canada, spending on oncology drugs in the latest reported year (2019) was $3.9 billion and spending on the top 50 drugs in the 2019–2020 fiscal year was $4.3 billion. Implications for policy-makers: Given the potential for improved efficacy and lower costs of new-generation biologics, the promotion of the appropriate use of biologics in PsO should be considered by payers.
Sand cleanouts remain one of the most common applications of coiled tubing (CT) in the oil and gas industry. However, offshore operational complexity increases with deck space limitations, lower crane capacity and low reservoir pressures. This paper reviews one such challenging offshore scenario, with limited spatial capacity and not space for a full CT fleet. The paper describes the challenges encountered and the solutions formulized to conduct a successful concentric CT boat spooling and intervention. The first operational task of boat spooling was completed from an offshore vessel to the platform using two injectors, one on the vessel and the other on the platform. The need for boat spooling arose due to the limited lifting capacity at the platform which was below the weight of the concentric coiled tubing (CCT), 1-in. CT constrained in a 2-in. string. At project end, the CCT was removed in a similar manner. Deck space was also limited and the fluid and nitrogen support equipment (pumps, tanks, chemical mixing) were located on a supply vessel. Numerous challenges were faced during the operation, all of which were successfully tackled without health, safety or environmental (HSE) incident. Additionally, there was a provision of tanks and pumps on the platform to act as a back-up in the event of failure of supply from the vessel to the CT. This paper describes the methods utilized to successfully boat spool 14,825-ft of pipe of total weight 27-tonnes and cascade the benefits to future boat spooling operations throughout the globe. While catenary CT operations are common in the Asia Pacific, boat spooling remains a relatively rare operation in the industry. It is believed this is a first operation where a CT operation was conducted in this manner with the fluid and nitrogen pump on a supply vessel and boat spooling was conducted for CCT. Detailing the execution procedures, risk mitigations, operational results and lessons learning will be of value to the industry.
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