Aflibercept vs. Ranibizumab: cost-effectiveness of treatment for wet age-related macular degeneration in Sweden.

PURPOSE: Monthly dosing with ranibizumab (RBZ) is needed to achieve maximal visual gains in patients with neovascular ('wet') age-related macular degeneration (wAMD). In Sweden, dosing is performed as needed (RBZ PRN), resulting in suboptimal efficacy. Intravitreal aflibercept (IVT-AFL) every 2 months after three initial monthly doses was clinically equivalent to RBZ monthly dosing (RBZ q4) in wAMD clinical trials. We assessed the cost-effectiveness of IVT-AFL versus RBZ q4 and RBZ PRN in Sweden. METHODS: A Markov model compared IVT-AFL to RBZ q4 or RBZ PRN over 2 years. Health states were based on visual acuity in better-seeing eye; a proportion discontinued treatment monthly or upon visual acuity <20/400. Parameters were estimated from trial data, published literature or expert opinion. Analyses were performed from a societal perspective with a lifetime horizon. The model calculated costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), discounted 3% annually. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Lifetime cost of IVT-AFL was 578 400 SEK, compared with 565 700 SEK for RBZ PRN and 686 600 SEK for RBZ q4. Compared with RBZ PRN, the ICER of IVT-AFL was 27 000 SEK/QALY gained. RBZ q4 cost 20.4 million SEK/QALY gained versus IVT-AFL. Results were sensitive to IVT-AFL efficacy, but IVT-AFL had a 100% probability of being cost-effective versus both RBZ PRN and RBZ q4 at a willingness-to-pay threshold of 500 000 SEK. CONCLUSION: Results suggest, in Sweden, at parity price level, IVT-AFL is less costly than RBZ q4, while demonstrating similar efficacy; IVT-AFL is cost-effective versus RBZ PRN.

Cost-effectiveness analysis of interferon beta-1b for the treatment of patients with a first clinical event suggestive of multiple sclerosis.

OBJECTIVES: To assess, from a Swedish societal perspective, the cost effectiveness of interferon ß-1b (IFNB-1b) after an initial clinical event suggestive of multiple sclerosis (MS) (ie, early treatment) compared with treatment after onset of clinically definite MS (CDMS) (ie, delayed treatment). METHODS: A Markov model was developed, using patient level data from the BENEFIT trial and published literature, to estimate health outcomes and costs associated with IFNB-1b for hypothetical cohorts of patients after an initial clinical event suggestive of MS. Health states were defined by Kurtzke Expanded Disability Status Scale (EDSS) scores. Model outcomes included quality-adjusted life years (QALYs), total costs (including both direct and indirect costs), and incremental cost-effectiveness ratios. Sensitivity analyses were performed on key model parameters to assess the robustness of model results. RESULTS: In the base case scenario, early IFNB-1b treatment was economically dominant (ie, less costly and more effective) versus delayed IFNB-1b treatment when QALYs were used as the effectiveness metric. Sensitivity analyses showed that the cost-effectiveness results were sensitive to model time horizon. Compared with the delayed treatment strategy, early treatment of MS was also associated with delayed EDSS progressions, prolonged time to CDMS diagnosis, and a reduction in frequency of relapse. CONCLUSION: Early treatment with IFNB-1b for a first clinical event suggestive of MS was found to improve patient outcomes while controlling costs.

Hand function in 45 patients with sporadic inclusion body myositis.

The purpose of this study was to explore hand function in patients with sporadic inclusion body myositis (sIBM) using the Sollerman Hand function test, finger range of motion, hand- and pinch strength, and fine motor ability as well as subjective estimate of hand- and grip function. Forty-five outpatients with definite sIBM were investigated using handgrip-, lateral-, and pinch strength, active finger range of motion (AROM), fine motor ability with Purdue Pegboard test, Sollerman Hand function test, and patients' estimated hand- and grip function. The association between these variables were assessed using correlation statistics. A second test occasion was performed in 16 patients in order to investigate the intra-rater reliability. We found that the reduction of hand- and pinch strength was more pronounced (37% right, 31% left hand) than lateral strength (50%) in relation to normal values. AROM was impaired in 25 (56%) in the right and 29 (64%) in the left hand. Fine motor ability was fairly well preserved; mean right/ left 70 and 60% of normal. AROM deficit was found to be present in 50% of patients 7 years after perceived hand weakness. This is important since it was found to impair the usefulness of the different strength measures, while limitations due to AROM deficit were not found regarding the Sollerman and to a lesser extent the Purdue Pegboard tests. Results of the test-retest showed very good reliability. Our results indicate that impairment of hand function is frequent and severe in sIBM patients. Reduction in AROM is frequent, and it is important to identify since it affects the usefulness of handgrip measurements, and further that may be treatable. Several different tests are probably needed in order to describe the patients' limitations and to capture changes over time. Compensatory strategies when gripping test items is a problem especially in patients with AROM deficits. Research on validity and reliability of these tests in sIBM patients are lacking. Copyright © 2012 John Wiley & Sons, Ltd.