A systematic review of economic evaluations of therapy in asthma

Katayoun Bahadori1, Bradley S Quon2, Mary M Doyle-Waters1, Carlo Marra3, J Mark FitzGerald21Centre for Clinical Epidemiology and Evaluation (C2E2), 2Department of Medicine, Respiratory Division, 3Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, CanadaBackground: Asthma’s cost-effectiveness is a major consideration in the evaluation of its treatment options. Our objective was to perform a systematic review of the cost-effectiveness of asthma medications.Methods: We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, OHE-HEED, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessments Database, NHS Economic Evaluation Database, and Web of Science and reviewed references from key articles between 1990 and Jan 2008.Results: A total of 49 RCTs met the inclusion criteria. Maintenance therapy with inhaled corticosteroids was found to be very cost-effective and in uncontrolled asthmatics patients currently being treated with ICS, the combination of an ICS/LABA represents a safe, cost-effective treatment. The simplified strategy using budesonide and formoterol for maintenance and reliever therapy was also found to be as cost-effective as salmeterol/fluticasone plus salbutamol. Omalizumab was found to be cost-effective. An important caveat with regard to the published literature is the relatively high proportion of economic evaluations which are funded by the manufacturers of specific drug treatments.Conclusion: Future studies should be completed independent of industry support and ensure that the comparator arms within studies should include dosages of drugs that are equivalent.Keywords: asthma, medication, cost-effectiveness, cost of illness, economic cost

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Disparities in Socioeconomic Status and Access to Lung Transplantation in Cystic Fibrosis

Thesis (Master's)--University of Washington, 2012Context: Patients with Medicaid experience persistent health disparities for a wide range of diseases and treatments in the United States compared to those without Medicaid, but disparities with respect to access to lung transplantation for cystic fibrosis (CF) patients are largely unknown. Objective: To determine whether access to lung transplantation for CF patients with end-stage lung disease differs according to Medicaid status. Design, Setting and Participants: Observational study of 2,167 adult CF patients with end-stage lung disease who underwent initial lung transplant evaluation between 2001 to 2009 identified through the United States CF Foundation Patient Registry including 1009 (47%) receiving Medicaid and 1158 (53%) without Medicaid. The main outcome measure was acceptance for lung transplant following evaluation. Results: 1,349 (62%) of 2,167 adult CF patients who underwent lung transplant evaluation were accepted. In a multivariate logistic model accounting for demographic characteristics, disease severity, potential contraindications to lung transplant, and pre-/post-use of the lung allocation score, Medicaid recipients were 54% [95% confidence interval (CI):25%-88%] more likely to be not accepted for lung transplant compared to patients without Medicaid. This association was independent of other SES indicators including race, education, zip code median household income, and driving time from residence to closest transplant center (OR=1.37, 95% CI:1.10-1.72). Patients not completing high school (OR=2.37, 95% CI:1.49-3.79) and those residing in the lowest (vs. highest) zip code median household income category (OR=1.39, 95% CI:1.01-1.93) were also more likely not to be accepted for lung transplant. Conclusions: In this nationally representative study of adult CF patients, multiple indicators of a lower socioeconomic position, including receipt of Medicaid, were associated with higher likelihoods of not being accepted for lung transplant. A more complete understanding of what specific aspects of socioeconomic position influence acceptance for lung transplantation is needed in order to ensure more equitable allocation of this treatment

Recent advances in the understanding and management of cystic fibrosis pulmonary exacerbations [version 1; referees: 3 approved]

Pulmonary exacerbations are common events in cystic fibrosis and have a profound impact on quality of life, morbidity, and mortality. Pulmonary exacerbation outcomes remain poor and a significant proportion of patients fail to recover their baseline lung function despite receiving aggressive treatment with intravenous antibiotics. This focused review provides an update on some of the recent advances that have taken place in our understanding of the epidemiology, pathophysiology, diagnosis, and management of pulmonary exacerbations in cystic fibrosis as well as direction for future study

Experience to date with CFTR modulators during pregnancy and breastfeeding in the British Columbia Cystic Fibrosis clinic

The introduction and rapid uptake of CFTR modulator therapy, in addition to other treatments, has significantly increased life expectancy in CF and provided more women the opportunity to consider and successfully be managed throughout pregnancy. There is however limited evidence to guide patient management and enable informed decision making. Here we report the experience to date from a large multidisciplinary Cystic Fibrosis quaternary referral center in managing patients on CFTR modulators in the peri- and post-partum periods. While women in this case series were advised to discontinue CFTR modulators during pregnancy, they would likely receive a very different message today

Correction: Dagenais et al. Real-World Safety of CFTR Modulators in the Treatment of Cystic Fibrosis: A Systematic Review. J. Clin. Med. 2021, 10, 23

In the original article, there was a mistake in Table 1 as published. Reference citation [34] was wrong. The corrected Table 1 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated. In the original article, there was a mistake in Table 2 as published. Subtitle “Lumacaftor/ Ivacaftor” was wrong. The corrected Table 2 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated. In the original article , there was a mistake in Table A2 as published. Reference citation [48,49,53,54] were wrong. “Talkwalker” was misspelled. The corrected Table A2 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated.Medicine, Faculty ofOther UBCReviewedFacultyResearcherOthe

Evaluating Adult Cystic Fibrosis Care in BC: Disparities in Access to a Multidisciplinary Treatment Centre

Background. Cystic fibrosis (CF) care that is delivered through dedicated, multidisciplinary CF clinics is believed to be partly responsible for improvements in the length and quality of life of persons with CF. We hypothesized patients living farthest from a CF clinic would be seen less frequently than recommended, which would result in reduced access to guideline-recommended care and poorer health outcomes. Methods. We performed a retrospective chart review of 168 patients who accessed CF care primarily through the St. Paul’s Hospital Adult CF Clinic. Subjects were stratified into four geographical groups according to the estimated one-way travel time by automobile from their home address to the clinic (<45 mins, 45–150 mins, 150–360 mins, and >360 mins). Results. There were no significant differences in pulmonary function, nutritional status, CF-related complications, or access to guideline-recommended CF pulmonary therapies between the four groups. Compared to the reference (<45 mins) group, subjects in the two farthest groups (>150 mins) were less likely to be seen in the clinic quarterly as recommended by current CF care guidelines (p=0.002). Those in the farthest group (>360 mins) were at risk for more rapid decline in lung function compared to the reference group (FEV1% predicted annual change: −3.1%/year [95% CI −5.1 to −1.1] versus −0.9%/year [95% CI −1.6 to 0.1], resp., p=0.04). Conclusions. Access to CF care is a challenge for individuals who live outside Metro Vancouver and has health policy implications. Further initiatives should be undertaken to ensure equitable care for people living with CF

Nebulized levofloxacin for chronic Burkholderia cenocepacia pulmonary infection in cystic fibrosis: A case report

We present a patient with cystic fibrosis who used nebulized levofloxacin off-label to suppress chronic Burkholderia cenocepacia pulmonary infection. The patient was initially using tobramycin inhalation powder (TIP) off-label continuously for suppression of chronic B. cenocepacia; this was changed to alternating months of nebulized levofloxacin and TIP. Following initiation of nebulized levofloxacin, the patient had significant improvement in respiratory symptom burden and lung function (as measured by forced expiratory volume in 1 second [FEV1]), and a decrease in the frequency of pulmonary exacerbations. Further research is necessary to determine whether the benefits observed with nebulized levofloxacin in our patient translate to a larger population of patients with chronic Burkholderia spp. pulmonary infection

Evaluating Adult Cystic Fibrosis Care in BC: Disparities in Access to a Multidisciplinary Treatment Centre

Background. Cystic fibrosis (CF) care that is delivered through dedicated, multidisciplinary CF clinics is believed to be partly responsible for improvements in the length and quality of life of persons with CF. We hypothesized patients living farthest from a CF clinic would be seen less frequently than recommended, which would result in reduced access to guideline-recommended care and poorer health outcomes. Methods. We performed a retrospective chart review of 168 patients who accessed CF care primarily through the St. Paul’s Hospital Adult CF Clinic. Subjects were stratified into four geographical groups according to the estimated one-way travel time by automobile from their home address to the clinic (360 mins). Results. There were no significant differences in pulmonary function, nutritional status, CF-related complications, or access to guideline-recommended CF pulmonary therapies between the four groups. Compared to the reference (150 mins) were less likely to be seen in the clinic quarterly as recommended by current CF care guidelines (p=0.002). Those in the farthest group (>360 mins) were at risk for more rapid decline in lung function compared to the reference group (FEV1% predicted annual change: −3.1%/year [95% CI −5.1 to −1.1] versus −0.9%/year [95% CI −1.6 to 0.1], resp., p=0.04). Conclusions. Access to CF care is a challenge for individuals who live outside Metro Vancouver and has health policy implications. Further initiatives should be undertaken to ensure equitable care for people living with CF