ABSTRACT
BACKGROUND: The Italian National Health Service (INHS) has recently reimbursed the monoclonal antibody inebilizumab as a second line monotherapy after rituximab (RTX) use for neuromyelitis optica spectrum disorders (NMOSD) patients ≥ 18 years anti-aquaporin 4 antibody-immunoglobulin G positive, who experienced a relapse in the last year or cannot receive RTX, if incident patients. Other INHS-reimbursed drugs for NMOSD treatment are satralizumab, eculizumab and, off-label, besides RTX, ocrelizumab, tocilizumab, and immunosuppressants. RESEARCH DESIGN AND METHODS: A 3-year (2023-2025) prevalence-based budget impact model following the INHS viewpoint compared the costs and the NMOSD attacks without (1st scenario) and with inebilizumab (2nd scenario). The epidemiology of NMOSD, and the INHS-funded healthcare resources (drugs and their administration; specialist visits; hospitalizations due to drug-related adverse events and NMOSD attacks) were obtained from the literature. One-way, threshold value and scenario sensitivity analyses investigated the robustness of the baseline findings. RESULTS: During 2023-2025 inebilizumab saves the INHS 8,373,125.13 (1st scenario: 176,770,028.63; 2nd scenario: 168,396,903.50) and 12.74 NMOSD attacks (1st scenario: 213.94; 2nd scenario: 201.19). Sensitivity analyses confirmed the robustness of the baseline results. CONCLUSION: Inebilizumab reduces the INHS expenditure for NMOSD drugs. Future research should explore the cost-effectiveness of inebilizumab vs other NMOSD-targeting drugs in Italy.
Subject(s)
Neuromyelitis Optica , Humans , Neuromyelitis Optica/drug therapy , State Medicine , Immunosuppressive Agents , Rituximab/adverse effectsABSTRACT
CO2 reduction in Solid Oxide Electrolysis Cells (SOECs) is a key-technology for the transition to a sustainable energy infrastructure and chemical industry. Ceria (CeO2) holds great promise in developing highly efficient, cost-effective and durable fuel electrodes, due to its promising electrocatalytic properties, and proven ability to suppress carbon deposition and to tolerate high concentrations of impurities. In the present work, we investigate the intrinsic electrocatalytic activity of ceria towards CO2 reduction by means of electrochemical impedance spectroscopy (EIS) on model systems with well-defined geometry, composition and surface area. Aiming at the optimization of the intrinsic catalytic properties of the material, we systematically study the effect of different dopants (Zr, Gd, Pr and Bi) on the reaction rate under varying operating conditions (temperature, gas composition and applied polarization) relevant for SOECs. The electrochemical measurements reveal the dominant role of the surface defect chemistry of the material in the reaction rate, with doping having only a mild effect on the rate and activation energy of the reaction. By analyzing the pO2 and overpotential dependence of the reaction rate with a general micro-kinetic model, we are able to identify the second electron transfer as the rate limiting step of the process, highlighting the dominant role of surface polarons in the energy landscape. These insights on the correlation between the surface defects and the electrocatalytic activity of ceria open new directions for the development of highly performing ceria-based technological electrodes.
ABSTRACT
BACKGROUND: Healthcare decision makers need to make trade-offs between different elements of value of new treatments. Multicriteria decision analysis (MCDA) provides a framework that can help decision makers to understand stakeholders' preferences and be explicit about the trade-offs that are being made. OBJECTIVE: The objective of this study was to use MCDA to obtain preferences and views on decision criteria across three stakeholder groups (patients, clinicians and payers) in Italy and to use these to assess the performance of obinutuzumab for rituximab-refractory indolent non-Hodgkin lymphoma (iNHL). METHODS: We used EVIDEM V3.0, an MCDA framework, and collected participants' preferences via an online survey and structured meetings. RESULTS: Patients and clinicians expressed a preference for interventions targeting severe conditions. Payers expressed preference for treatments targeting areas with an unmet need, which are cheaper than the comparator, and with high-quality evidence. Obinutuzumab in combination with bendamustine, compared with bendamustine alone, received high positive scores for the criteria 'disease severity' and 'type of therapeutic benefit' by all three groups, and negative scores on the economic-related criteria, according to all stakeholder groups. CONCLUSIONS: MCDA can be used to elicit the views of different stakeholder groups and has the potential to structure and inform reimbursement decisions.
