40 research outputs found
A comment on Craig et al. : ''Retigabine for the adjunctive treatment of adults with partial-onset seizures in epilepsy with and without secondary generalization: a NICE single technology appraisal''
Cost-utility analysis of Ruconest® (conestat alfa) compared to Berinert® P (human C1 esterase inhibitor) in the treatment of acute, life-threatening angioedema attacks in patients with hereditary angioedema
Introduction: Administration of human C1 esterase inhibitor (Berinert® P) from target import is the most widespread treatment strategy for patients with hereditary angioedema (HAE). However, a therapeutic health program including Ruconest® (conestat alfa) could shorten a patient’s expectancy for a life-saving treatment. Aim: To evaluate the cost-utility of Ruconest® (conestat alfa) financed from public funds within the newly introduced therapeutic health program compared with Berinert® P (human C1 esterase inhibitor) in the treatment of acute angioedema attacks in adults with HAE. Material and methods: The cost-utility analysis from the Polish healthcare payer’s perspective was performed for 1 year (2012). The costs and health outcomes were simulated for three pairs of eligible HAE patient groups (active treatment and corresponding placebo). The incremental costs of each intervention compared with placebo were listed together (direct or indirect comparisons between options were impossible due to limited clinical data available). Results: The incremental cost-utility ratios (ICURs) for the evaluated interventions compared with placebo were as follows: EUR 15,226 per QALY (Ruconest®) and EUR 27,786 per QALY (Berinert® P). The probability of cost-utility (ICUR < EUR 24,279 per QALY) assessed for Ruconest® administered in the case of acute angioedema attack was 61% and 41% for Berinert® P. Conclusions: The administration of Ruconest® in acute life-threatening angioedema attacks is economically justified from the Polish healthcare payer’s perspective, results in lower costs and is characterized by higher cost-utility probability compared with Berinert® P
Effectiveness of fixed-dose combination therapy in hypertension : systematic review and meta-analysis
Introduction: Clinical studies have revealed that fixed-dose combinations
(FDCs) of drugs can have a better effect on blood pressure than free-equivalent combinations (FECs). Our objectives were to perform an up-to-date assessment of the effectiveness of FDCs and FECs in antihypertensive therapy,
to provide more accurate results by using a stratified meta-analysis.
Material and methods: A systematic review was performed in PubMed, Web
of Science, and Cochrane databases according to PRISMA guidelines. The
outcomes were adherence (compliance), persistence to medication, reduction of blood pressure and the safety profile. We used the Newcastle Ottawa
scale or the Delphi list for the assessment of the quality of cohort studies or
clinical trials, respectively. Heterogeneity was assessed using the Cochrane
Q test and I2 statistic.
Results: Of 301 abstracts screened, 26 primary studies and 2 other metaanalyses were identified, of which 12 studies were included in the metaanalyses and 3 studies were included in the narrative review. The FDC
treatment is associated with a significant improvement in adherence and
persistence in comparison with FEC treatment, e.g., the average medicine
possession ratio increased with FDC by 13.1% (p < 0.001). For endpoints
correlated with higher adherence (e.g., a reduction in blood pressure), a nonsignificant benefit was observed for FDCs. Moreover, it was demonstrated
that higher adherence can lead to a lower risk of cardiovascular events.
Conclusions: In comparison with FECs, the FDC treatment is associated with
a significant improvement in the cooperation between a doctor and a patient and with increased patients’ adherence to the treatment schedule
Cost-effectiveness analysis of Crohn's disease treatment with vedolizumab and ustekinumab after failure of tumor necrosis factor- antagonist
Vanadium derivatives as compounds of high biological significance : part II : effect on neoplastic cells
Sodium orthovanadate affects growth of some human epithelial cancer cells (A549, HTB44, DU145)
Health-related quality of life impairment and indirect cost of Crohn’s disease : a self-report study in Poland
Evidence on indirect cost of Crohn's disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity).A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients' characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient's version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients' productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients' productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders.The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care.Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland
Sipuleucel-T immunotherapy for castration-resistant prostate cancer : a systematic review and meta-analysis
Introduction: Sipuleucel-T is a novel active cellular immunotherapy for the treatment of asymptomatic or minimally symptomatic metastatic castrate-resistant
prostate cancer (mCRPC). It is assumed to be associated with less adverse events
than conventional docetaxel-based chemotherapy.
Material and methods: A systematic review of literature published between January, 1 1966 and February, 6 2012 was performed to assess the efficacy and safety of sipuleucel-T in patients with mCRPC. Databases were searched: Medline,
EMBASE, Cochrane, CancerLit as well as ASCO and ESCO websites.
Results: Three randomized clinical trials with a total of 737 participants fulfilled
established criteria. The overall survival of patients who received sipuleucel-T
in comparison to the control group was significantly longer with a hazard ratio
(HR) of 0.73 (95% CI: 0.61-0.88; p = 0.001). Time to disease progression was not
prolonged using sipuleucel-T compared to placebo, HR = 0.89 (95% CI: 0.75-1.05;
p = 0.18). Relative benefit (RB) of serum PSA level reduction of at least 50% for
sipuleucel-T compared to placebo did not meet statistical significance, RB = 1.97
(95% CI: 0.48-8.14; p = 0.38). The safety population consisted of 729 patients
with mCRPC. Compared to the control group, the pooled relative risks (RR) of all
adverse events – RR = 1.03 (95% CI: 1.00-1.05; p = 0.06), grade 3 to 5 adverse
events - RR = 0.98 (95% CI: 0.79-1.22; p = 0.86) and cerebrovascular events –
RR = 1.93 (95% CI: 0.73-5.09; p = 0.18) were not significantly higher for men
treated with sipuleucel-T.
Conclusions: The use of sipuleucel-T prolonged the overall survival among men
with mCRPC. No effect on time to disease progression was observed and
the safety profile was acceptable