Cost-minimization analysis of alemtuzumab compared to fingolimod and natalizumab for the treatment of active relapsing-remitting multiple sclerosis in the Netherlands

Aim: In active relapsing remitting multiple sclerosis (RRMS) patients requiring second-line treatment, the Dutch National Health Care Institute (ZiN) has not stated a preference for either alemtuzumab, fingolimod, or natalizumab. The aim was to give healthcare decision-makers insight into the differences in cost accumulation over time between alemtuzumab—with a unique, non-continuous treatment schedule—and fingolimod and natalizumab for second-line treatment of active RRMS patients in the Netherlands. Methods: In line with ZiN’s assessment, a cost-minimization analysis was performed from a Dutch healthcare perspective over a 5-year time horizon. Resource use was derived from hospital protocols and summaries of product characteristics, and validated by two MS specialists. Unit costs were based on national tariffs and guidelines. Robustness of the base case results was verified with multiple sensitivity and scenario analyses. Results: Alemtuzumab results in cost savings compared to fingolimod and natalizumab from, respectively, 3.3 and 2.8 years since treatment initiation onwards. At 5 years, total discounted costs per patient of alemtuzumab were €79,717, followed by fingolimod with €110,044 and natalizumab with €122,238, resulting in cost savings of €30,327 and €42,522 for alemtuzumab compared to fingolimod and natalizumab, respectively. Key drivers of the model are drug acquisition costs and the proportions of patients that do not require further alemtuzumab treatment after either two, three, or four courses. Limitations: No treatment discontinuation and associated switching between treatments were incorporated. Consequences of JC virus seropositivity while continuing natalizumab treatment (e.g. additional monitoring) were omitted from the base case. Conclusion: The current cost-minimization analysis demonstrates that, from the Dutch healthcare perspective, treating active RRMS patients with alemtuzumab results in cost savings compared to second-line alternatives fingolimod and natalizumab from ∼3 years since treatment initiation onwards. After 5 years, alemtuzumab’s cost savings are estimated at €30k compared to fingolimod and €43k compared to natalizumab

A physiologically-based pharmakokinetic (PB-PK) model for ethylene dibromide: relevance of extrahepatic metabolism

A physiologically-based pharmacokinetic (PB-PK) model was developed for ethylene dibromide (1,2-dibromoethane, EDB) for rats and humans, partly based on previously published in vitro data (Ploemen et al., 1997). In the present study, this PB-PK model has been validated for the rat. In addition, new data were used for the human class ΘGST T1-1. Validation experiments are described in order to test the predictive value of kinetics to describe "whole-body" metabolism. For the validation experiments, groups of cannulated rats were dosed orally or intravenously with different doses of EDB. Obtained blood concentration–time curves of EDB for all dosing groups were compared to model predictions. It appeared that metabolism, which previously was assumed to be restricted to the liver, was underestimated. Therefore, we extended the PB-PK model to include all the extrahepatic organs, in which the enzymes involved in EDB metabolism have been detected and quantified. With this extended model, the blood concentrations were much more accurately described compared to the predictions of the "liver-model". Therefore, extrahepatic metabolism was also included in the human model. The present study illustrates the potential application of in vitro metabolic parameters in risk assessment, as well as the use of PB-PK modelling as a tool to understand and predict in vivo data

Inkjet-Printed Gold Nanoparticle Surfaces for the Detection of Low Molecular Weight Biomolecules by Laser Desorption/Ionization Mass Spectrometry

Effective detection of low molecular weight compounds in matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS) is often hindered by matrix interferences in the low m/z region of the mass spectrum. Here, we show that monolayer-protected gold nanoparticles (AuNPs) can serve as alternate matrices for the very sensitive detection of low molecular weight compounds such as amino acids. Amino acids can be detected at low fmol levels with minimal interferences by properly choosing the AuNP deposition method, density, size, and monolayer surface chemistry. By inkjet-printing AuNPs at various densities, we find that AuNP clusters are essential for obtaining the greatest sensitivity

Data from: Analysis of local-scale background concentrations of methane and other gas-phase species in the Marcellus Shale

The Marcellus Shale is a rapidly developing unconventional natural gas resource found in part of the Appalachian region. Air quality and climate concerns have been raised regarding development of unconventional natural gas resources. Two ground-based mobile measurement campaigns were conducted to assess the impact of Marcellus Shale natural gas development on local scale atmospheric background concentrations of air pollution and climate relevant pollutants in Pennsylvania. The first campaign took place in Northeastern and Southwestern PA in the summer of 2012. Compounds monitored included methane (CH4), ethane, carbon monoxide (CO), nitrogen dioxide, and Proton Transfer Reaction Mass Spectrometer (PTR-MS) measured volatile organic compounds (VOC) including oxygenated and aromatic VOC. The second campaign took place in Northeastern PA in the summer of 2015. The mobile monitoring data were analyzed using interval percentile smoothing to remove bias from local unmixed emissions to isolate local-scale background concentrations. Comparisons were made to other ambient monitoring in the Marcellus region including a NOAA SENEX flight in 2013. Local background CH4 mole fractions were 140 ppbv greater in Southwestern PA compared to Northeastern PA in 2012 and background CH4 increased 100 ppbv from 2012 to 2015. CH4 local background mole fractions were not found to have a detectable relationship between well density or production rates in either region. In Northeastern PA, CO was observed to decrease 75 ppbv over the three year period. Toluene to benzene ratios in both study regions were found to be most similar to aged rural air masses indicating that the emission of aromatic VOC from Marcellus Shale activity may not be significantly impacting local background concentrations. In addition to understanding local background concentrations the ground-based mobile measurements were useful for investigating the composition of natural gas emissions in the region

Analysis of local-scale background concentrations of methane and other gas-phase species in the Marcellus Shale

The Marcellus Shale is a rapidly developing unconventional natural gas resource found in part of the Appalachian region. Air quality and climate concerns have been raised regarding development of unconventional natural gas resources. Two ground-based mobile measurement campaigns were conducted to assess the impact of Marcellus Shale natural gas development on local scale atmospheric background concentrations of air pollution and climate relevant pollutants in Pennsylvania. The first campaign took place in Northeastern and Southwestern PA in the summer of 2012. Compounds monitored included methane (CH4), ethane, carbon monoxide (CO), nitrogen dioxide, and Proton Transfer Reaction Mass Spectrometer (PTR-MS) measured volatile organic compounds (VOC) including oxygenated and aromatic VOC. The second campaign took place in Northeastern PA in the summer of 2015. The mobile monitoring data were analyzed using interval percentile smoothing to remove bias from local unmixed emissions to isolate local-scale background concentrations. Comparisons were made to other ambient monitoring in the Marcellus region including a NOAA SENEX flight in 2013. Local background CH4 mole fractions were 140 ppbv greater in Southwestern PA compared to Northeastern PA in 2012 and background CH4 increased 100 ppbv from 2012 to 2015. CH4 local background mole fractions were not found to have a detectable relationship between well density or production rates in either region. In Northeastern PA, CO was observed to decrease 75 ppbv over the three year period. Toluene to benzene ratios in both study regions were found to be most similar to aged rural air masses indicating that the emission of aromatic VOC from Marcellus Shale activity may not be significantly impacting local background concentrations. In addition to understanding local background concentrations the ground-based mobile measurements were useful for investigating the composition of natural gas emissions in the region

Atmospheric Emission Characterization of Marcellus Shale Natural Gas Development Sites

Limited direct measurements of criteria pollutants emissions and precursors, as well as natural gas constituents, from Marcellus shale gas development activities contribute to uncertainty about their atmospheric impact. Real-time measurements were made with the Aerodyne Research Inc. Mobile Laboratory to characterize emission rates of atmospheric pollutants. Sites investigated include production well pads, a well pad with a drill rig, a well completion, and compressor stations. Tracer release ratio methods were used to estimate emission rates. A first-order correction factor was developed to account for errors introduced by fenceline tracer release. In contrast to observations from other shale plays, elevated volatile organic compounds, other than CH₄ and C₂H₆, were generally not observed at the investigated sites. Elevated submicrometer particle mass concentrations were also generally not observed. Emission rates from compressor stations ranged from 0.006 to 0.162 tons per day (tpd) for NO_<i>x</i>, 0.029 to 0.426 tpd for CO, and 67.9 to 371 tpd for CO₂. CH₄ and C₂H₆ emission rates from compressor stations ranged from 0.411 to 4.936 tpd and 0.023 to 0.062 tpd, respectively. Although limited in sample size, this study provides emission rate estimates for some processes in a newly developed natural gas resource and contributes valuable comparisons to other shale gas studies