Cost-utility analysis of infliximab and adalimumab for refractory ulcerative colitis

<p>Abstract</p> <p>Objective</p> <p>To evaluate cost-utility of infliximab and adalimumab for the treatment of moderate-to-severe ulcerative colitis (UC) refractory to conventional therapies in Canada.</p> <p>Methods</p> <p>A Markov model was constructed to evaluate incremental cost-utility ratios (ICUR) of 5 mg/kg and 10 mg/kg infliximab and adalimumab therapies compared to 'usual care' in treating a hypothetical cohort of patients (aged 40 years and weighing 80 kg) over a five-year time horizon from the perspective of a publicly-funded health care system. Clinical parameters were derived from the Active Ulcerative Colitis Trials 1 and 2. Costs were obtained through provincial drug benefit plans. ICUR was the main outcome measure and both deterministic and probabilistic sensitivity analyses were conducted.</p> <p>Results</p> <p>Compared to the strategy A ('usual care') in the base case analysis, the ICURs were CA$358,088/QALY for the strategy B ('5 mg/kg infliximab + adalimumab') and CA$575,540/QALY for the strategy C ('5 mg/kg and 10 mg/kg infliximab + adalimumab'). The results were sensitive to: the remission rates maintained in responders to 'usual care' and to 5 mg/kg infliximab, the rate of remission induced by adalimumab in non-responders to 5 mg/kg infliximab, early surgery rate, and utility values. When the willingness to pay (WTP) was less than CA$150,000/QALY, the probability of 'usual care' being the optimal strategy was 1.0. The probability of strategy B being optimal was 0.5 when the WTP approximated CA$400,000/QALY.</p> <p>Conclusions</p> <p>The ICURs of anti-TNF-α drugs were not satisfactory in treating patients with moderate-to-severe refractory UC. Future research could be aimed at the long-term clinical benefits of these drugs, especially adalimumab for patients intolerant or unresponsive to infliximab treatment.</p

Development of Clinical Vignettes to Describe Alzheimer's Disease Health States: A Qualitative Study.

AIMS:To develop clinical descriptions (vignettes) of life with Alzheimer's disease (AD), we conducted focus groups of persons with AD (n = 14), family caregivers of persons with AD (n = 20), and clinicians who see persons with AD in their practices (n = 5). METHODS:Group participants read existing descriptions of AD and commented on the realism and comprehensibility of the descriptions. We used thematic framework analysis to code the comments into themes and develop three new vignettes to describe mild, moderate, and severe AD. RESULTS:Themes included the types of symptoms to mention in the new vignettes, plus the manner in which the vignettes should be written. Since the vignette descriptions were based on focus group participants' first-hand knowledge of AD, the descriptions can be said to demonstrate content validity. CONCLUSION:Members of the general public can read the vignettes and estimate their health-related quality-of-life (HRQoL) as if they had AD based on the vignette descriptions. This is especially important for economic evaluations of new AD medications, which require HRQoL to be assessed in a manner that persons with AD often find difficult to undertake. The vignettes will allow the general public to serve as a proxy and provide HRQoL estimates in place of persons with AD

Clinical and Economic Effects of a Therapeutic Substitution Policy for Proton Pump Inhibitors in Aboriginal Patients in Northern Communities in Canada's Northwest Territories

Background and objective: Proton pump inhibitors (PPIs), which are used to treat gastroesophageal symptoms, can vary in price, but are thought not to differ in clinical benefits. Health Canada's Non-Insured Health Benefits Program instituted a therapeutic substitution policy for PPIs as a cost-containment strategy in 2005. The objective of this pilot study was to identify signals of what might be occurring as a result of this policy in Aboriginal people in northern, isolated communities. Methods: Five pharmacies in the Northwest Territories identified a sample of patients who were affected by the substitution policy. Eligible patients who provided informed consent had a face-to-face or telephone interview with a pharmacist using a standardized questionnaire. Results: Of 66 identified patients, 44 consented to be interviewed, and 40 were used in the analyses: 70% were female and the mean age of the patients for whom data were analyzed was 57 years. Thirty-four (85%) patients reported health problems after the switch in PPI. Nineteen (48%) patients visited a local nursing station or physician and six (15%) visited a hospital for assessment because of perceived health problems following the switch in PPI. During the initial 15 months of the therapeutic substitution policy, there was a net increment in drug costs of $Can30.96 (year 2006 values) per person due to drug wastage, delayed switching to the policy PPI, and switching back to the patient's original PPI. A conservative estimate of the additional healthcare service costs related to health problems perceived to be due to the switch was$Can36_624.41 for the 40 patients. Conclusions: The majority of the sampled patients who took part in the PPI therapeutic substitution policy experienced problems following the PPI switch that were possibly associated with either diminished treatment efficacy or adverse drug effects. Although causality was not proven, patient perceptions in this sample did influence resource use, resulting in no net savings (average incremental cost of $Can915.61 per patient) during the first 15 months of the policy.Cost-analysis, Gastrointestinal-disorders, Generic-substitution, Proton-pump-inhibitors

The Burden of Asthma Symptoms and the Positive Role of Patient Management

Background: Asthma is a major public health problem in developed countries. In Canada, the prevalence of asthma is approximately 5 to 7%, with some provincial variation. A retrospective study using data collected in 1990 estimated the total costs of asthma in Canada to be between $Can504 million and$Can648 million (1990 dollars). 61% of all asthma costs were direct costs ($Can306 million). Of these, drugs were the single largest component ($Can124 million). Illness-related disability ($Can76 million) was the largest contributor to indirect costs. Objective: To obtain individual patient-derived data on productivity loss and level of function related to severity of asthma symptoms, and briefly review the published data on the role of education and drug therapy in asthma management. Design: This was a community-based prospective study of outpatients identified from the bronchial inhaler study of the Canadian Pharmacy Medication Monitoring Program. Methods: Study patients recruited through community pharmacies were monitored for 6 months. Data were collected through structured telephone interviews at 1, 3 and 6 months. Primary Outcome Measures and Results: The primary outcome measures were symptom-free days (SFDs), productivity-loss days (PLDs) and patient-reported function level. Patients who did not use inhaled corticosteroids had similar numbers of SFDs and PLDs compared with patients who did. Daily corticosteroid usage was a surrogate measure for severe disease because this group also reported fewer SFDs and more PLDs than patients who use corticosteroids as needed and patients who did not use inhaled corticosteroids. Discussion: The evidence suggests that the greatest impact on productivity for the majority of patients comes from the number of days symptoms interfere with usual daily activities as opposed to actual days missed from work. Further, if corticosteroids are used appropriately in current nonusers who are not optimally controlled, a decrease in PLD and an increase in SFD may be seen. Results from another Canadian study have depicted the under-prescribing of inhaled corticosteroids, and the effectiveness of asthma education on improving the quality of life. A meta-analysis of relevant studies has confirmed that education improves important clinical outcomes in adults with asthma. Conclusions: Better patient management in asthma is needed to reduce the economic burden of this disease.Pharmacoeconomics, Asthma, Cost-analysis, Quality-of-life, Antiasthmatics, Patient-education

Focus group themes and sub-themes.

<p>Focus group themes and sub-themes.</p

Sample characteristics.

<p>Sample characteristics.</p

Examples of content contributions to vignettes based on focus group themes and sub-themes.

<p>Examples of content contributions to vignettes based on focus group themes and sub-themes.</p