Understanding patient preferences and willingness to pay for hemophilia therapies

Shraddha S Chaugule,1 Joel W Hay,1 Guy Young2 1Department of Clinical Pharmacy, Pharmaceutical Economics and Policy, University of Southern California, 2Hemostasis and Thrombosis Center, Children’s Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA Background: Despite clearly improved clinical outcomes for prophylaxis compared to on-demand therapy, on average only 56% of patients diagnosed with severe hemophilia receive prophylactic factor replacement therapy in the US. Prophylaxis rates generally drop as patients transition from childhood to adulthood, partly due to patients becoming less adherent when they reach adulthood. Assessment of patient preferences is important because these are likely to translate into increased treatment satisfaction and adherence. In this study, we assessed preferences and willingness to pay (WTP) for on-demand, prophylaxis, and longer acting prophylaxis therapies in a sample of US hemophilia patients.Methods: Adult US hemophilia patients and caregivers (N=79) completed a discrete-choice survey that presented a series of trade-off questions, each including a pair of hypothetical treatment profiles. Using a mixed logit model for analysis, we compared the relative importance of five treatment characteristics: 1) out-of-pocket treatment costs (paid by patients), 2) factor dose adjustment, 3) treatment side effects, 4) availability of premixed factor, and 5) treatment effectiveness and dosing frequency. Based on these attribute estimates, we calculated patients’ WTP.Results: Out-of-pocket treatment costs (P<0.001), side effects (P<0.001), and treatment effectiveness and dosing frequency (P<0.001) were found to be statistically significant in the model. Patients were willing to pay US $410 (95$164–$656) out of pocket per month for thrice-weekly prophylaxis therapy compared to on-demand therapy and$360 (95% confidence interval: 145–575) for a switch from thrice-weekly to once-weekly prophylaxis therapy.Conclusion: Improvements in treatment effectiveness and dosing frequency, treatment side effects, and out-of-pocket costs per month were the greatest determinants of hemophilia treatment choice and WTP. The positive preferences and WTP for longer acting prophylactic therapies suggest that the uptake is likely to increase adherence, improving treatment outcomes. These preferences should also inform the Food and Drug Administration’s assessment of new longer acting hemophilia therapies. Keywords: hemophilia, patient, preferences, willingness to pa

Antiasthamatic Activity of Tinospora Cordifolia Leaves Extract on Ova Induced Airway Inflammation in Rats

Introduction: There are several plants used and registered as medicine in alternative systems of medicine but their claim is not yet evaluated scientifically in laboratory animals. Present study was intended to evaluate anantiasthmatic activity of Tinosporacordifolia (TC) leaves extract in rats to confirm anethnomedical claim made by traditional health practitioners. Objectives: Procurement of a plant TC and its authentication; preparation of extract; preparation of oral solution and its administration in rats; in-vivo activity evaluation in rats for one month; histopathology study; Results discussion and conclusion. Methods: Plant was obtained from the botanical garden located at Pune and authenticated at Botanical Survey of India, Pune. Dried leaves of a plant were extracted in ethanol using soxhletextracter. Ethanolic extract was dried using rota evaporator and stored at cool and dry place. Extract was orally administered in rats (125mg/kg, 250mg/kg and 500mg/kg) and evaluated using OVA induced allergic airway inflammation, simultaneously taking Montelukast (10mg/kg) as a standard drug. Rats were sacrificed at the end of study and organs were fixed for the histopathology details. Results: In OVA induced airway inflammation model, TC leaves extract significantly reduces white blood cell count in BALF. It also shows significant decrease in Emphysema, Hemorrhage, Bronchial Hyperplasia and Mononuclear cells in histopathology report. The histo-pathological examination showed milder pathology, reduced inflammatory cell infiltrates and a lower density of Eosinophils in the lungs of treated rats, which further supported our results from the BALF analysis Conclusions: Significant antiasthmatic activity comparable with standard dose of Montelukast was observed in experimental rats. This confirms anethnomedical claim of a few workers regarding anantiasthmatic activity of this plant possibly through its antihistaminic, antispasmodic, or anti-inflammatory effects.&nbsp

TAP Investigation of NO Adsorption on Pd/Al2O3: Effect of Thermal Aging

INGENIERIE+YSC:CMI:MGRThis paper deals with the aging effect on the kinetics of the NO decomposition on a commercial Pd/Al2O3 catalyst. Temporal analysis of products experiments are discussed in the light of a selected mechanism involving the recombination of two NOads species to form N2O, which is an intermediate in N-2 formation. Experiments over the fresh catalyst indicate a strong metal/support interface, with a spill-over effect, which is difficult to model. Thermal aging had a detrimental effect over this interface, the kinetic features depending mainly on the metallic Pd sites. The different heats of adsorption and activation energies are proven consistent with other theoretical studies. The mechanism led to a high surface coverage for O ad-atoms