Healthcare resource utilization and costs among patients with psoriasis treated with ixekizumab or adalimumab over 2 years of follow-up in real-world settings.

AIMS: To compare long-term healthcare resource utilization (HCRU) and costs among patients who initiated ixekizumab (IXE) or adalimumab (ADA) for treatment of psoriasis in the United States. METHODS: Adult patients with psoriasis who had ≥1 claim for IXE or ADA were identified from IBM MarketScan claims databases prior to the COVID-19 pandemic (1 March 2016-31 October 2019). The index date was the date of first claim for the index drug of interest. Inverse probability of treatment weighting was employed to balance treatment cohorts. All-cause and psoriasis-related HCRU and costs were examined for 24 months of follow-up. Costs were reported as per patient per month. Costs of psoriasis-related biologics were adjusted using published Institute for Clinical and Economic Review (ICER) discount factors. Index drug costs were adjusted for adherence and ICER discount rates. RESULTS: The analyses included 407 IXE and 2,702 ADA users. IXE users had significantly higher inpatient admission rate (all-cause HCRU: 14.9% vs. 11.0%; p =0.012) and greater mean length of stay per admission (days, 6.6 vs. 4.1; p =0.004) than ADA users. ICER-adjusted costs were significantly higher in IXE than ADA users (all-cause costs: $4,132 vs. $3,610; p <0.001; psoriasis-related costs $3,077 vs. $2,700; p <0.001). After adjusting for ICER and adherence, IXE and ADA drug costs were comparable ($3,636 vs. $3,677; p =0.714). LIMITATIONS: Study relied on administrative claims data, subjected to data coding limitations and data entry errors. Rebates, patient assistance programs, and commission to wholesalers are not always captured in claims. Adjustment made by ICER discount factors may lead to double-discounting if the discounts have been applied in claim payments. CONCLUSIONS: All-cause HCRU was higher in IXE than ADA users. Healthcare costs were also higher in IXE than ADA users after ICER adjustment, over 24 months. Cost differences were largely driven by higher treatment adherence associated with IXE. Index drug costs were comparable after ICER and adherence adjustments.

Imported SARS-CoV-2 Variants of Concern Drove Spread of Infections across Kenya during the Second Year of the Pandemic

Using classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression. SARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens. Over the pandemic duration (March 2020–January 2022), Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country. In conclusion, the emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country.

Changes in HIV testing services after COVID-19 in 11 sub-saharan african countries

Background: The COVID-19 pandemic has interrupted the implementation of many HIV prevention programs supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), especially in sub-Saharan Africa. We evaluated the effects of COVID-19 pandemic (e.g., lockdowns, lack of personal protective equipment, community fears) on efforts to reach the UNAIDS 90-90-90 targets by HIV case finding using index testing (IT) and provider-initiated testing and counseling (PITC) as well as HIV treatment initiation. Methods: We conducted a descriptive analysis using programmatic data from persons aged 15 years and older reported to PEPFAR from 11 purposefully selected countries in sub-Saharan Africa. We calculated the percentage change in reported HIV case finding indicators during the COVID period, defined as January-June 2020, as compared to the pre-COVID period, during the same time frame in the preceding year, January-June 2019. Results: Of the 11 countries, persons tested for HIV through PITC declined in seven (64%) and persons testing positive declined in 10 (91%), comparing the COVID to pre-COVID periods (see Table 1). Across all countries, total HIV testing and total number of persons testing positive by PITC decreased by 20% and 23% when comparing the COVID to the pre-COVID period, respectively. In parallel, five of the 11 countries (Cameroon, DRC, Mozambique, Nigeria, South Africa) saw an increase in both IT and HIV case finding through IT, in COVID as compared to the pre-COVID period. Across all countries, total IT increased by 13% and HIV case finding through IT increased by 17% when comparing the COVID to the pre-COVID period. The number of HIV-positive people linked to treatment decreased in seven (64%) countries during the COVID period compared to pre- COVID. Across all countries, an increase of 3% in those HIV-positive people linked to treatment. Conclusion: While testing through PITC decreased during the COVID period, testing and case finding through IT increased. The increase in IT may reflect the actions of healthcare facilities and providers to ensure that HIV-exposed individuals identified by an index case were still tested. Focusing on IT may help programs effectively identify HIV-positive people, even during a pandemic or other disturbance.