Cost-effectiveness modelling of biological treatment sequences in moderate to severe rheumatoid arthritis in France

Objectives. Modern treatment of RA includes the use of biologics. Their cost is high and comparison between different treatment strategies is needed. Method. Direct medical costs of RA in France were evaluated based on expert opinion. Then, simulation-decision analytical models were developed to assess four biologic treatment sequences over 2 years in patients failing to respond to at least one anti-TNF agent. Effectiveness was expressed in theoretical expected number of days (TEND) in remission or low disease activity [low disease activity score (LDAS)] based on DAS-28 scores. Results. Direct medical costs of RA in France (excluding the cost of biologics) were estimated at €905 (s.d. 263) for 6 months and €696 (s.d. 240) for each subsequent 6 months (P < 0.001) for patients achieving LDAS and €1215 for 6 months (s.d. 405) for patients not achieving LDAS. Based on LDAS criteria, using abatacept after an inadequate response to the first anti-TNF agent (etanercept) appeared significantly (P < 0.01) more efficacious over a 2-year period (102 TEND) compared with using rituximab at a 6-month re-treatment interval (82 TEND). Mean cost-effectiveness ratios showed significantly lower costs (P < 0.01) per TEND with abatacept as second biologic agent (€278) compared with rituximab (€303). After an inadequate response to two anti-TNF agents, using abatacept also appeared significantly more efficacious than an anti-TNF agent (P < 0.01). All comparisons were confirmed when using remission criteria instead of LDAS. Conclusion. Advanced simulation models based on clinical evidence and medical practice appear to be a promising approach for comparing cost-effectiveness of biologic strategies in R

The Lantern Vol. 72, No. 1, Fall 2004

• Jazz • Bifocal Brainfreeze • A Mug of Tea • Autumn Blend • Montana Skies • Madeleine Parenthesis • Ghosts Come Out at Night • Time • 144 Cromwell Road • Market East • Secret • Stream • What Might Have Been or What Never Was • Buried Mirth • Conversations With a Writer • Churning Through • Chum-Salmon Intentions • Cages • Lola Sang of Green Glass Landscapes • Peg\u27s Antiques • Life at 120 Decibelshttps://digitalcommons.ursinus.edu/lantern/1165/thumbnail.jp

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Role limitant du systeme noradrenergique cortical sur la propagation d'une activite epileptogene focale chez le rat

SIGLECNRS T Bordereau / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

COST-EFFECTIVENESS SIMULATION MODEL OF ABATACEPT VERSUS RITUXIMAB IN RHEUMATOID ARTHRITIS IN FRANCE

International audienc

Direct Cost-Modeling of Rheumatoid Arthritis According to Disease Activity Categories in France

International audienceObjective. The objective of this cost-of-illness study was to assess the use of direct medical resources, excluding drug costs, by patients with rheumatoid arthritis (RA) in France, and to construct cost estimates according to level of disease activity. Methods. Three categories of RA disease activity were defined according to Disease Activity Score 28-joint count (DAS28) thresholds: remission (DAS28 3.2). Eight resource utilization items were defined: medical visits, laboratory tests, hospitalization, imaging, physiotherapy, nursing, adaptive aids, and transportation. Resource utilization and unit costs from the national-payer perspective were estimated through expert opinion and simulated using distribution ranges for each item. Cost distributions were computed by Monte-Carlo simulations estimating overall costs per 6 months over a 2-year period. Results. For patients achieving remission, costs were estimated at a mean of (sic)771 (SD 199) for the first 6 months and at (sic)511 (SD 162) for each subsequent 6-month period. For patients achieving LDAS, costs were estimated at (sic)905 (SD 263) for the first 6 months and (sic)696 (SD 240) for each subsequent 6-month period. For patients in MHDAS, costs were estimated at (sic)1215 per 6 months (SD 405). Conclusion. This cost-of-illness assessment provided current estimates of direct medical costs for RA according to disease activity in France. The findings suggest that achieving remission or LDAS is associated with substantially lower medical costs for RA versus being in MHDAS. (First Release Dec 1 2010; J Rheumatol 2011;38:439-45; doi:10.3899/jrheum.100589

Cost-effectiveness simulation model of abatacept versus anti-TNF treatment strategies in rheumatoid arthritis in France

International audienc

Cost-effectiveness modelling of biological treatment sequences in moderate to severe rheumatoid arthritis in France.

International audienceModern treatment of RA includes the use of biologics. Their cost is high and comparison between different treatment strategies is needed. Direct medical costs of RA in France were evaluated based on expert opinion. Then, simulation-decision analytical models were developed to assess four biologic treatment sequences over 2 years in patients failing to respond to at least one anti-TNF agent. Effectiveness was expressed in theoretical expected number of days (TEND) in remission or low disease activity [low disease activity score (LDAS)] based on DAS-28 scores. Direct medical costs of RA in France (excluding the cost of biologics) were estimated at euro 905 (s.d. 263) for 6 months and euro 696 (s.d. 240) for each subsequent 6 months (P < 0.001) for patients achieving LDAS and euro 1215 for 6 months (s.d. 405) for patients not achieving LDAS. Based on LDAS criteria, using abatacept after an inadequate response to the first anti-TNF agent (etanercept) appeared significantly (P < 0.01) more efficacious over a 2-year period (102 TEND) compared with using rituximab at a 6-month re-treatment interval (82 TEND). Mean cost-effectiveness ratios showed significantly lower costs (P < 0.01) per TEND with abatacept as second biologic agent (euro 278) compared with rituximab (euro 303). After an inadequate response to two anti-TNF agents, using abatacept also appeared significantly more efficacious than an anti-TNF agent (P < 0.01). All comparisons were confirmed when using remission criteria instead of LDAS. Advanced simulation models based on clinical evidence and medical practice appear to be a promising approach for comparing cost-effectiveness of biologic strategies in RA

Survey of the therapeutic management of rheumatoid arthritis in France: the OPALE study.

International audienceTo describe the therapeutic practice used in 2006 by French rheumatologists and hospital staff in RA patients, and to estimate the proportion of patients currently treated with DMARDs including biologics, and to estimate the ratio of patients treated according to the SFR national recommendations. This multicentre cross-sectional study was performed in a random sample of rheumatologists selected from a comprehensive national database and stratified by setting and region. Each rheumatologist established a registry of subsequent RA patients (first step), and filled in a detailed questionnaire for the 10 first patients from the registry (second step). At the day of inclusion, RA characteristics and DMARD treatments over the past 12 months were recorded. The majority of the RA patients were women (mean age: 58 yrs). The mean DAS 28 score was 3.6, and RA was considered as clinically and radiologically severe in almost 27.0% of the cases. In the registry part, 89.9% of RA patients were currently treated with DMARDs, and 29.3% of them received a biologic DMARD alone or in combination. In 1610 patients with detailed questionnaire record, the efficacy of the current DMARD treatment was good in almost 60% of the patients. Finally, the physician's decision was to continue the ongoing treatment in 4/5 cases. In this study, RA characteristics were similar to the typical RA observed in previous studies. Biologics were major drugs in DMARD treatments with 30.1% RA patients currently treated. Modification of treatments was essentially linked to a lack of therapeutic response