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Background Atopic dermatitis (AD) is relatively common worldwide; costs associated with the disease have been reported recently for various countries, but no estimates of costs in Canada are currently available. The objective of this study was to estimate the costs associated with AD in Canada, assessed from resource use determined for a Canadian setting.Methods Seventy-six patients in Ontario with AD were surveyed to determine information about severity of disease, healthcare practitioner visits, over-the-counter medication use, household expenses and absenteeism relating to their condition. Based on this information, costs were determined based on the Ontario billing schedule, estimated prescription use, reported out-of-pocket expenses and stated family income. Data about sleep disturbance and concern over topical corticosteroid use were also obtained. ResultsPatients reported an average of 3.6 publicly funded doctor visits per year for AD; 58% of these visits were to general practitioners and 28% to dermatologists. The annual per patient expenditure was estimated to be Cdn$282, $454 and $1242 for patients with mild, moderate and severe AD, respectively. The total cost of AD in Canada was estimated to be Cdn$1.4 billion annually. More than half of the patients experienced sleep disturbances owing to their condition, and 71% reported having concerns about topical corticosteroid use.Conclusions Although the cost per patient of AD in Canada is relatively low, owing to the prevalence of the disease, the total cost to society is large. Most of the cost is borne by patients and their employers, primarily owing to indirect costs associated with absenteeism.

Background Several treatments for plaque psoriasis are available, but it remains challenging for physicians to make informed treatment decisions due to a lack of head-to-head trials. Objectives This network meta-analysis (NMA) compares the efficacy of brodalumab to other biologic agents in Canada for moderate-to-severe plaque psoriasis. Methods A systematic literature review of randomized controlled trials (RCTs) published before October 2017 was conducted to populate the NMA. Comparators included etanercept, infliximab, adalimumab, ustekinumab, secukinumab, ixekizumab, guselkumab, and placebo. The primary outcome was the psoriasis area and severity index (PASI) response at the end of induction phase. A random effects Bayesian multinomial likelihood and probit link model analyzed PASI 75, 90, and 100 responses. Inconsistency and heterogeneity were assessed. Sensitivity analyses were conducted to explore potential effect modifiers like baseline PASI score, age, and weight. Results A total of 43 RCTs were included. Brodalumab 210 mg had significantly better PASI response than etanercept, ustekinumab, adalimumab, secukinumab, and guselkumab and comparable responses to infliximab and ixekizumab. Relative risk of PASI 90 response for brodalumab varied from 2.84 (95% credible interval [CrI]: 2.35-3.52, P < .05) to 0.99 (95% CrI: 0.88-1.11, ns) compared to etanercept and ixekizumab. This was similar across PASI 75 responses, but a larger relative risk between brodalumab and all comparators except ixekizumab was observed for PASI 100. No significant heterogeneity or inconsistencies were identified. The results were consistent across sensitivity analyses, indicating robustness of the results. Conclusion Brodalumab 210 mg has efficacy superior to most biologic agents for moderate-to-severe plaque psoriasis in Canada.

Purpose. To characterize the economic and quality of life burden of diabetic macular edema (DME) in Canadian patients. Patients and Methods. 145 patients with DME were followed for 6 months with monthly telephone interviews and medical chart reviews at months 0, 3, and 6. Visual acuity in the worst-seeing eye was assessed at months 0 and 6. DME-related healthcare costs were determined over 6 months, and vision-related (National Eye Institute Visual Functioning Questionnaire) and generic (EQ-5D) quality of life was assessed at months 0, 3, and 6. Results. Mean age of patients was 63.7 years: 52% were male and 72% had bilateral DME. At baseline, visual acuity was categorized as normal/mild loss for 63.4% of patients, moderate loss for 10.4%, and severe loss/nearly blind for 26.2%. Mean 6-month DME-related costs/patient were as follows: all patients (n = 135), $2,092; normal/mild loss (n = 88), $1,776; moderate loss (n = 13), $1,845; and severe loss/nearly blind (n = 34), $3,007. Composite scores for vision-related quality of life declined with increasing visual acuity loss; generic quality of life scores were highest for moderate loss and lowest for severe loss/nearly blind. Conclusions. DME-related costs in the Canadian healthcare system are substantial. Costs increased and vision-related quality of life declined with increasing visual acuity severity.