Economic burden and productivity loss related to eczema: A prevalence-based follow-up study in Vietnam.

OBJECTIVE: Eczema, a chronic dermatologic disease, has been recognized as an economic burden in publications all over the word but only minimally as such in Vietnam. The aim of this prospective study was to quantify the financial hardships and impairments suffered by eczema patients. METHODS: This cross-sectional prevalence-based study involved 136 patients, whose conditions were classified into three severity levels on the basis of the medications that they were prescribed. Prescription therapy was administered for a month, after which there was patient-oriented assessment of effectiveness. The work productivity and activity impairment (WPAI) questionnaire was used to evaluate productivity loss, which was expressed in percentage form. Bootstrapping was conducted to determine continuous variables and demographybased differences in cost values among the patient groups. RESULTS: For the month-long treatment, each eczema patient needed an average of US$68.1 (range: US$56.2- US$81.5) with the highest proportion being spent on cosmetic treatments. There is noticeable difference between groups among which patients' symptoms demonstrated in distinct levels. The estimates indicated that eczema resulted in 27.8% and 23.1% impairments in work and daily activities, respectively. CONCLUSIONS: The aggravation of disease symptoms can increase the direct costs borne by eczema patients. A decrease in productivity, which is one of the most serious consequences of the condition, should be paid adequate attention to minimize burdens to society.

Topical treatment utilization for patients with atopic dermatitis in the United States, and budget impact analysis of crisaborole ointment, 2.

BACKGROUND: Atopic dermatitis (AD), a chronic inflammatory skin disease, is often treated with topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Crisaborole ointment is a non-steroidal, phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate AD. In December 2016, crisaborole was approved in the US for mild-to-moderate AD in patients ≥2 years of age. AIMS: To evaluate real-world utilization and cost of TCS and TCI in the US and estimate the budget impact of crisaborole over 2 years from a third-party payer perspective. METHODS: TCS and TCI prescriptions in 2015 for patients ≥2 years of age with ≥1 AD diagnosis in the Truven Health Analytics MarketScan Commercial and Medicare Supplemental Research Databases were analyzed for patients receiving TCI or TCS alone or in combination (TCS/TCI population) and patients receiving TCI alone or in combination with TCS (TCI population). A budget impact model used TCS and TCI market shares, annual use, and cost per prescription. Crisaborole uptake rates of 4.7% (TCS) and 20.2% (TCI), with an annual increase of 1% in year 2, were assumed. Budget impact was calculated as total and per-member-per-month (PMPM) cost over 2 years for a health plan of 1 million members. RESULTS: Annual prescriptions/patient ranged from 1.36-6.41; annual cost/patient was $53-$1,465. The budget impact of crisaborole over 2 years in the TCS/TCI population was $350,946 (PMPM, $0.015), with increases of $162,106 in year 1 (PMPM, $0.014) and $188,841 in year 2 (PMPM, $0.016). The budget impact in the TCI population was -$22,871, with decreases of $11,160 in year 1 and $11,712 in year 2 (each PMPM, -$0.001). For both populations, one-way sensitivity analyses showed that budget impact was most sensitive to changes in crisaborole cost and annual use. CONCLUSIONS: From US payer perspectives, adoption of crisaborole results in modest pharmacy budget impact/savings.

Conversion From Once-Daily Prolonged-Release Tacrolimus to Once-Daily Extended-Release Tacrolimus in Stable Liver Transplant Recipients.

OBJECTIVES: After organ transplant, strategies to simplify the therapeutic regimen may improve adherence and prevent rejection and/or graft loss. The aim of the present study was to evaluate the safety of conversion from once-daily prolonged-release tacrolimus (Advagraf; Astellas Pharma Europe Limited, Middlesex, UK) to once-daily extended-release tacrolimus (Envarsus; Chiesi SAS, Nanterre, France) in stable adult liver transplant recipients. MATERIALS AND METHODS: This observational study inclu-ded 44 liver transplant patients (median age of 59 y; 63.6% men; median delay after transplant of 72.5 mo). Conversion was based on a 1:0.70 proportion. RESULTS: Mean dose of tacrolimus was 2.65 ± 1.24 mg/day before conversion and 2.09 ± 1.68 mg/day after conversion (P < .05), with ratio of 1:0.79. Mean serum tacrolimus trough level increased after conversion (4.92 ± 1.65 vs 5.60 ± 2.89 ng/mL; P < .05), with ratio of 1:1.14. Six months after conversion, mean dose of tacrolimus was 1.65 ± 0.93 mg/day (ratio of 1:0.62) and mean serum tacrolimus trough level was 4.82 ± 1.85 ng/mL, similar to the initial level before conversion. At the end of follow-up, 2 patients had returned to once-daily prolonged-release tacrolimus because of adverse effects (allergy, digestive trouble), which resolved thereafter. The mean cost of tacrolimus therapy was 5.54 ± 2.29 Euros/patient/day before conversion and 4.11 ± 2.32 Euros/patient/day after conversion (P < .05). CONCLUSIONS: Conversion from prolonged-release to extended-release tacrolimus in stable liver transplant patients is safe and cost-effective; however, initially, dose adaptations and careful monitoring are required.

Cost analysis on the use of rituximab and calcineurin inhibitors in children and adolescents with steroid-dependent nephrotic syndrome.

BACKGROUND: Rituximab (RTX) is increasingly being used in place of calcineurin inhibitors (CNI) in pediatric patients with steroid-dependent nephrotic syndrome (SDNS). However, despite its favorable safety profile, its unit cost is prohibitive. We therefore compared the healthcare costs associated with the use of both agents in a retrospective cohort. METHODS: This study was a retrospective analysis of data retrieved from the medical charts and electronic databases of pediatric patients (age range 2-18 years) with SDNS who were treated with either CNI or RTX from January 2008 to December 2012 at Children's Hospital of New Orleans, Louisiana. The minimum follow-up period was 12 months. RESULTS: Of the 18 patients whose medical data were analyzed, ten received RTX and eight were treated with CNI. The annualized healthcare cost for the rituximab group was $197,031 versus $189,857 (all values in US dollars) for the CNI group (p > 0.05). At the 12-month follow-up, more patients in the RTX group were in remission (40 vs. 25%). Duration of freedom from steroid use was longer in the RTX group, while body mass index was higher in the CNI arm (p > 0.05). No significant adverse events occurred in either group. CONCLUSION: The expenditure for the RTX and CNI groups was comparable, but there were fewer clinical encounters in the former group, potentially reducing the burden of healthcare on the patient's family.

Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience.

BACKGROUND: Calcineurin inhibitors are alternatives to corticosteroid for treatment of atopic dermatitis. OBJECTIVES: We sought to compare the beneficial effects and adverse events associated with these therapies in treating patients with atopic dermatitis. METHODS: Four databases were searched for randomized clinical trials comparing topical calcineurin inhibitors versus corticosteroids in children and adults. Methodological quality was evaluated to assess bias risk. Clinical outcome and costs were compared. RESULTS: Twelve independent randomized clinical trials comparing calcineurin inhibitors (n = 3492) versus corticosteroids (n = 3462) were identified. Calcineurin inhibitors and corticosteroids had similar rates of improvement of dermatitis (81% vs 71%; risk ratio [RR] 1.18; 95% confidence interval [CI] 1.04-1.34; P = .01) and treatment success (72% vs 68%; RR 1.15; 95% CI 1.00-1.31; P = .04). Calcineurin inhibitors were associated with higher costs and had more adverse events (74% vs 64%; RR 1.28; 95% CI 1.05-1.58; P = .02) including a higher rate of skin burning (30% vs 9%; RR 3.27; 95% CI 2.48-4.31; P < .00001) and pruritus (12% vs 8%; RR 1.49; 95% CI 1.24-1.79; P < .00001). There were no differences in atrophy, skin infections, or adverse events that were serious or required discontinuation of therapy. LIMITATIONS: Only a small number of trials reported costs. CONCLUSION: Calcineurin inhibitors and corticosteroids have similar efficacy. Calcineurin inhibitors are associated with higher costs and have more adverse events, such as skin burning and pruritus. These results provide level-1a support for the use of corticosteroids as the therapy of choice for atopic dermatitis.

Systematic review on the efficacy, safety, and cost-effectiveness of topical calcineurin inhibitors in atopic dermatitis.

BACKGROUND: Topical calcineurin inhibitors (TCIs) are widely used as an alternative to topical corticosteroids (TCSs) in treating of atopic dermatitis, but their risk versus benefit compared with TCSs remains unclear. OBJECTIVE: We performed a systematic review of the efficacy, safety, and cost-effectiveness of TCI compared with TCS and emollients. METHODS: Published meta-analysis, systematic reviews, and individual studies from January 2005 to January 2015 on the comparative efficacy, safety, and cost-effectiveness of TCI against emollients and TCS were included. RESULTS: Tacrolimus is comparable to TCS in efficacy, safety profile, and cost-effectiveness. Pimecrolimus has a similar safety profile compared with TCS, emollients, and tacrolimus. It is superior to emollients but inferior to TCS and tacrolimus in efficacy and cost-effectiveness. The association of tacrolimus with malignancy remains uncertain. CONCLUSIONS: Tacrolimus is an efficacious and cost-effective alternative to TCS, but its benefits need to be weighed against its still uncertain risk for malignancy. Pimecrolimus is appropriate for mild atopic dermatitis when TCS or tacrolimus is unsuitable.