The incremental net benefit of lipid-lowering therapy with PCSK9 inhibitors: A Systematic Review and Meta-analysis of cost-utility studies

Introduction: Proprotein convertase subtilisin/kexin 9 inhibitors (PCSK9i) are monoclonal antibodies that lower lipid levels by inhibiting PCSK9. Although several cardiovascular outcome trials reported beneficial clinical effectiveness of PCSK9i, the evidence on cost-effectiveness is mixed. We systematically reviewed the evidence on cost-effectiveness and synthesized incremental net benefit (INB) to quantify the pooled cost-effectiveness of PCSK9i lipid-lowering therapy. Methods: We systematically searched for full economic evaluation studies reporting outcomes of PCSK9 inhibitors compared with any other lipid-lowering pharmacotherapies. We searched PubMed, Embase, Scopus, and Tufts Registry for eligible studies up-to September 2020, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We pooled the INB with a 95% confidence interval using a random-effects model. We assessed the Heterogeneity using the Cochrane-Q test and I2 statistic. We used the modified economic evaluations bias (ECOBIAS) checklist to evaluate the quality of the selected studies. Results: A total of 20 studies were eligible, mainly from high-income countries (HIC). The pooled INB of PCSK9i versus other lipid-lowering pharmacotherapies were estimated from n=21 comparisons; with high heterogeneity (I2=98.04). The INBp (95% CI) was US$-46,665 (-196,203; 102,874), PCSK9i was found to be not cost-effective when compared with other standard therapies; however, this finding was not statistically significant. On subgroup analysis PCSK9i was significantly not cost-effective [US$ -25,686 (-26,085;-25,287), I2=0] compared to other lipid-lowering pharmacotherapies among HICs, with payers perspective [US$-25,686 (-26,086;-25,287), I2=0] and with higher discount rates of 5$ -25,686 (-26,086;-25,287), I2=0]. The sensitivity analysis revealed the subgroup findings are not robust. Conclusion: PCSK9is’ are not cost-effective compared to other lipid-lowering pharmacotherapies in HICs. Further, current pieces of evidence are predominantly from HICs with largely lacking evidence from other economies. Prospero registration: ID CRD4202020604

Stars as catalysts: an event-study analysis of the impact of star-scientist recruitment on local research performance in a small open economy

Abstract There is increasing interest among policymakers in small open economies in the use of star-scientist recruitment policies to catalyse the development of local clusters in targeted research areas. We use Scopus to assemble a dataset on over 1.4 million publications and subsequent citations for Denmark, Ireland and New Zealand from 1990 to 2017. An event-study model is used to estimate the dynamic effects of a star arrival on quality-adjusted research output at both the department and matched individual incumbent levels. Star arrivals are associated with statistically significant increases in department output (excluding the output of the star) of between 12% and 25% after 4 years. At the incumbent level, star arrivals lead to an approximately 5% increase in individual output, with substantially larger increases for incumbents who co-author with the star.</jats:p

Household catastrophic health expenditures for rheumatoid arthritis: a single centre study from South India

Abstract Rheumatoid arthritis (RA) not only has a physical and emotional toll but also has a substantial economic impact. This study aims to estimate the burden of catastrophic health expenditure (CHE) on households due to RA in Tamil Nadu, India. We conducted cross-sectional descriptive hospital-based single-centre study at a tertiary care private multispecialty hospital in Tamil Nadu, India. The study comprised 320 RA patients who visited the outpatient clinic from April to October 2022. Demographic and baseline descriptive characteristics were reported. Multivariable logistic regression analyses were performed to identify major determinants associated with CHE. We also examined the inequality in household annual income and CHE. Most study participants were females (88.1%) with a mean age (SD) of 55.57 ± 12.29 years. About 93% of RA patients were from urban areas, and 89.4% were literate. Only 8.1% of respondents reported having health insurance. Households experiencing CHE owing to RA were 51.4% (n = 162). The mean (95% CI) annual health expenditure for treating RA is ₹44,700 (₹41,710 to 47,690) with a median (IQR) of ₹39,210 (₹25,500) [$476 ($310)]. The corresponding mean (95% CI) and median (IQR) Out of pocket expenditure among RA patients per household were ₹40,698 (₹38,249 to 43,148) [$494 ($464 to $524)] and ₹36,450 (23,070) [$442 ($280)] respectively. Nearly half of the households with RA patients had a financial catastrophe due to healthcare costs being paid out-of-pocket and limited health insurance coverage. The results underscore the need for comprehensive approaches to strengthening public health policies along with financial risk protection and quality care in India

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020