OBJECTIVES: Condoliase, an enzyme that specifically degrades glycosaminoglycans, main constituents of the nucleus pulposus, and reduces the compressions on nerves, can serve as a less-invasive curative treatment for patients with lumbar disc herniation and is expected to reduce associated medical cost due to shortened hospital stays. This study aims to evaluate the cost-effectiveness of the treatment with condoliase compared with conventional surgical therapy in the Japanese healthcare system. METHODS: A Markov model was developed to estimate quality-adjusted life year (QALY) and associated costs over 1 year. QOL scores were converted from corresponding Oswestry Disability Index (ODI). ODI of condoliase group came from the results of a phase 3, multicenter, double-blind, randomized placebo-controlled study conducted in Japan. ODI of surgery group was estimated from the values obtained from published literatures. The risk of re-operation after treatment was considered during calculation. Surgical treatment costs and re-operation costs were collected and estimated using a Japanese administrative claims database (Japan Medical Data Center, JMDC). Payer perspective was adopted, and discounting was not applied due to the short timeframe of the analysis. One-way sensitivity analysis was performed to assess the impact of parameter uncertainty on the model's conclusion. RESULTS: Average cost and effectiveness gained per patient for condoliase group and surgery group were 385,344 JPY vs. 798,919 JPY, 0.694 QALY vs. 0.685 QALY, respectively, meaning condoliase group was dominant compared to surgery group. One-way sensitivity analysis showed the robustness of this result. CONCLUSIONS: From the payer perspective, treatment with condoliase for patients with lumbar disc herniation in Japan is expected to reduce medical costs compared to conventional surgery treatment even taking into account the uncertainties.OBJECTIVES: Rheumatoid Arthritis (RA) destroys synovial joints and generates pain. Its prevalence in Chile has been estimated to be 0.46% (IC 95% 0.24-0.8). Available drugs for treatment include conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs), biological therapies and a new drug approved for treatment after failure of csDMARDs: tofacitinib. The aim of this study is to compare the costs-effectiveness of tofacitinib relative to biological therapies as an initial treatment in adults with RA after failure of methotrexate in Chile. METHODS: A simulation model of individual patients compared two treatment sequences for RA: tofacitinib vs biological therapy as initial medications; always assuming a combination therapy with methotrexate; biological therapies validated with rheumatologists and included in the model were etanercept, infliximab, tocilizumab, adalimumab, rituximab and salvage therapy (defined by experts). The characteristics of the patient included: age, weight, initial HAQ score, and clinical response to short and long term treatment. HAQ scores were used to calculate utilities, measured in Q...
Gout is the most common and progressive arthritic condition. Its severity is assumed to have implications for the humanistic and economic burden of the illness. The objective of this study is to examine the burden of gout between patients with and without tophi using electronic health records (EHR). METHODS: The Humedica EHR database was searched starting on January 1, 2008 through February 28, 2013 for patients having an initial gout diagnosis (ICD-9 274.xx) and a confirmatory gout diagnosis at least 30 days later. Deidentified patients with enrollment from 6-months pre/12-months post initial gout diagnosis and at least one serum uric acid (SUA) level were included in the study. Patients (n= 933) with a diagnosis of tophaceous gout (274.03, 274.81, and 274.82) during the 12-months postindex period were compared to all other gout (non-tophaceous) patients (n= 45,512). Demographic characteristics and comorbidities, SUA levels, and use of colchicine for acute flares during the 12-months post-index period were compared using chisquare tests. RESULTS: Gout patients with tophi were more likely to be female (p< 0.01) and have uncontrolled (SUA= 6-8) or severely uncontrolled (SUA = > 10) SUA (p< 0.0001) than patients without tophi. Colchicine use was higher in patients with tophi (p< .0001). There were significantly higher levels of cardiovascular comorbidities in the gout patients with tophi vs those without: hypertension (p< 0.05), myocardial infarction (p< 0.01), atherosclerosis (p< 0.0001), dyslipidemia (p< 0.0001), peripheral arterial disease (p< 0.0001), congestive heart failure (p< 0.0001), chronic heart disease (p< 0.0001), cardiomyopathy(p< 0.0001), ischemic and valvular heart disease (p< 0.0001) and left ventricular hypertrophy (p< 0.001). Gout patients with tophi had higher levels of chronic kidney disease, Stages 3-5, (p< 0.0001), osteoarthritis (p< 0.0001), rheumatoid arthritis (p< 0.0001). CONCLUSIONS: Gout patients with tophi had significantly greater burden of disease and greater frequency of comorbidities than those without. Preventing the development of tophi may reduce comorbidities and frequency of colchicine use and warrants further investigation.
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