Additional file 2: Table S2. of Cost-effectiveness of adding novel or group 5 interventions to a background regimen for the treatment of multidrug-resistant tuberculosis in Germany

Utility data used for health states in the economic model. (DOCX 13 kb

Systematic literature review and network meta-analysis of cladribine tablets versus alternative disease-modifying treatments for relapsing–remitting multiple sclerosis

<p><b>Objective:</b> To assess the comparative efficacy and safety of cladribine tablets versus alternative disease modifying treatments (DMTs) in patients with active relapsing–remitting multiple sclerosis (RRMS), and in a subgroup with high disease activity (HRA + DAT), using systematic literature review (SLR) and network meta-analysis (NMA).</p> <p><b>Methods:</b> MEDLINE, Embase, MEDLINE In-Process and CENTRAL databases were systematically searched to identify English-language publications of relevant studies of approved DMTs for RRMS. Searches were conducted from database inception to January 2017. Conference websites and trial registries were also searched. NMA considered the effects of DMTs on annualized relapse rate (ARR), confirmed disease progression (CDP), no evidence of disease activity (NEDA) and safety.</p> <p><b>Results:</b> Of 10,825 articles retrieved and screened, 44 studies assessing 12 DMTs contributed to the NMA. In patients with active RRMS, cladribine tablets were associated with a significant 58% reduction in ARR versus placebo (<i>p</i> < .05); cladribine tablets were similar or significantly better than other DMT regimens and ranked fourth among DMTs, behind alemtuzumab, natalizumab and ocrelizumab. For CDP for 6 months and NEDA, improvements with cladribine tablets were significantly greater than those of placebo (<i>p</i> < .05), with no comparator DMT demonstrating significantly better results. Similar findings were reported in the HRA + DAT population. Overall adverse event risk for cladribine tablets did not differ significantly from that of placebo and most alternative DMTs.</p> <p><b>Conclusion:</b> In this first NMA to consider cladribine tablets, ocrelizumab and daclizumab for treatment of RRMS, cladribine tablets are a comparatively effective and safe alternative to other DMTs in both active RRMS and HRA + DAT populations.</p

Cost-Effectiveness of Adding Bedaquiline to Drug Regimens for the Treatment of Multidrug-Resistant Tuberculosis in the UK

<div><p>Objective</p><p>To evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for multidrug-resistant tuberculosis (MDR-TB) in the United Kingdom (UK).</p><p>Methods</p><p>A cohort-based Markov model was developed to estimate the incremental cost-effectiveness ratio of bedaquiline plus BR (BBR) versus BR alone (BR) in the treatment of MDR-TB, over a 10-year time horizon. A National Health Service (NHS) and personal social services perspective was considered. Cost-effectiveness was evaluated in terms of Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs). Data were sourced from a phase II, placebo-controlled trial, NHS reference costs, and the literature; the US list price of bedaquiline was used and converted to pounds (£18,800). Costs and effectiveness were discounted at a rate of 3.5% per annum. Probabilistic and deterministic sensitivity analysis was conducted.</p><p>Results</p><p>The total discounted cost per patient (pp) on BBR was £106,487, compared with £117,922 for BR. The total discounted QALYs pp were 5.16 for BBR and 4.01 for BR. The addition of bedaquiline to a BR resulted in a cost-saving of £11,434 and an additional 1.14 QALYs pp over a 10-year period, and is therefore considered to be the dominant (less costly and more effective) strategy over BR. BBR remained dominant in the majority of sensitivity analyses, with a 81% probability of being dominant versus BR in the probabilistic analysis.</p><p>Conclusions</p><p>In the UK, bedaquiline is likely to be cost-effective and cost-saving, compared with the current MDR-TB standard of care under a range of scenarios. Cost-savings over a 10-year period were realized from reductions in length of hospitalization, which offset the bedaquiline drug costs. The cost-benefit conclusions held after several sensitivity analyses, thus validating assumptions made, and suggesting that the results would hold even if the actual price of bedaquiline in the UK were higher than in the US.</p></div

Cost-effectiveness acceptability curve for bedaquiline + BR versus BR only from a UK payer perspective (assuming price of £18,800 per treatment course).

<p>BR: background regimen</p

Markov model state structure.

<p>MDR-TB: multi-drug resistant tuberculosis; TB: tuberculosis. *Transitions to the death state are possible from every state, but not shown on the diagram for clarity.</p

Total and per patient costs, split by category (UK base case).

<p>All costs reported in 2013 values</p><p>BR: background regimen; TB: tuberculosis</p><p>Total and per patient costs, split by category (UK base case).</p

Tornado diagram representing deterministic sensitivity analysis based on incremental cost per QALY.

<p>* Fixed ranges of +/- 20% were chosen due to the lack of available ranges in the literature. BR: background regimen; ICER: incremental cost-effectiveness ratio; QALY: quality adjusted life-year; TB: tuberculosis</p

Cost-effectiveness plane for bedaquiline + BR versus BR only from a UK NHS and PSS perspective.

<p>BR: background regimen; NHS: National Health Service; PSS: Personal Social Services; QALY: quality adjusted life-year</p

Total and incremental results for bedaquiline + BR vs. BR alone (UK base case).

<p>All costs reported in 2013 values</p><p>BR: background regimen; QALYs: quality adjusted life-years; DALYs: disability adjusted life-years</p><p>Total and incremental results for bedaquiline + BR vs. BR alone (UK base case).</p

A matching-adjusted indirect comparison of acalabrutinib versus zanubrutinib in relapsed or refractory chronic lymphocytic leukemia

Video abstract for our matching-adjusted indirect comparison of acalabrutinib versus zanubrutinib in relapsed or refractory chronic lymphocytic leukemia</p