3This meta-analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single-pill combinations (SPCs) vs free-equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual allcause and hypertension-related health care costs was $1357 (95% confidence interval [CI], $778-$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC groups was twice as likely as the FEC groups (pooled risk ratio, 2.1; 95% CI, 1.1-4.1). Improved adherence and persistence may have contributed to the lower costs in the SPC groups via improved clinical outcomes. J Clin Hypertens (Greenwich). 2011;13:898-909. Ó2011 Wiley Periodicals, Inc.Hypertension is a chronic medical condition and recent estimates suggest that 76.4 million US adults 20 years or older have hypertension.1 Total costs (direct plus indirect) for hypertension in the United States were estimated at $73.4 billion in 2009. Pharmaceutical treatment of hypertension can be very successful, with the potential to reduce blood pressure (BP) to recommended levels in almost all patients (<140 ⁄ 90 mm Hg or <130 ⁄ 80 mm Hg for patients with diabetes or chronic kidney disease). However, recent data show that only 50% of patients with hypertension achieved BP control.2 Uncontrolled BP can result in significant morbidity and mortality, with increased risk of adverse cardiovascular (CV), cerebrovascular, and renal outcomes.3-5 Furthermore, uncontrolled BP can result in increased medication costs compared with costs for hypertension patients with appropriately controlled BP. 6Two of the main reasons for a lack of adequate BP control are lack of adherence (missing doses of an antihypertensive medication in the context of ongoing treatment) and lack of persistence (discontinuation of an antihypertensive medication). 7,8 Adherence to antihypertensive therapy is often very low, ranging from 15% to 35%.9 One major factor contributing to decreased adherence and persistence with antihypertensive medications is the complexity of treatment regimens. Many patients with hypertension require !2 medications to provide adequate BP control. Only one third of patients with hypertension require a single medication for BP control, one third require 2 medications, and the remaining one third require !3 medications. 10Strategies to improve adherence and persistence to prescribed antihypertensive medications are likely to improve BP control and thus can potentially have substantial medical and economic benefits. One such strategy is the use of fixed-dose single-pill combination (SPC) medications, which combine !2 active agents in a single pill. SPC medications simpl...

The K-GEM showed KRd is cost-effective, with an ICER of $107,520 per QALY gained against Rd for the treatment of patients with RMM (1-3 prior therapies) at a willingness-to-pay threshold of $150,000. Reimbursement of KRd for patients with RMM may represent an efficient allocation of the healthcare budget.

Background Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption.

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Kd56 is cost-effective for patients with R/RMM at a willingness-to-pay threshold of $150,000/QALY. Trial data in the model may limit generalizability; however, SEER registry data mitigates this challenge. Kd56 provides additional value in key subgroups, and remains cost-effective after steep comparator discounts.