Objective To determine whether the utilization of healthcare resources is reduced after chronic migraine patients are treated for 6 months with onabotulinumtoxin A . Background Onabotulinumtoxin A is indicated for headache prophylaxis in patients with chronic migraine, but its effect on healthcare resource use is unknown. Methods We analyzed data from an open‐label study of 230 chronic migraine patients refractory to ≥2 oral prophylactics who presented to a headache specialty clinic and who were treated with two cycles of onabotulinumtoxin A . Frequency and cost of migraine‐related healthcare resource use, including visits to emergency departments, urgent care, or hospitalization, were compared for the 6 months before and after initial treatment. Costs were based on publicly available sources. Results Compared with the 6 months predating initial treatment, patients had 55% fewer emergency department visits (174 vs 385), 59% fewer urgent care visits (61 vs 150), and 57% fewer hospitalizations (19 vs 45) during the 6‐month treatment period ( P < .01 for all). Analysis of treatment‐related costs yielded an average reduction of $1219.33/patient, off‐setting 49.7% of the total estimated cost for 6 months of treatment with onabotulinumtoxin A . Conclusions Although we are unable to distinguish onabotulinumtoxin A 's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment‐refractory patients with chronic migraine experienced a significant cost‐offset through reduced migraine‐related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxin A . Future analyses will assess the longer‐term effect of onabotulinumtoxin A treatment and the potential contribution of regression to the mean.
We demonstrate a new model framework as an innovative approach to more accurately estimate and project prevalence and survival outcomes in oncology.We developed an oncology simulation model (OSM) framework that offers a customizable, dynamic simulation model to generate population-level, country-specific estimates of prevalence, incidence of patients progressing from earlier stages (progression-based incidence), and survival in oncology. The framework, a continuous dynamic Markov cohort model, was implemented in Microsoft Excel. The simulation runs continuously through a prespecified calendar time range. Time-varying incidence, treatment patterns, treatment rates, and treatment pathways are specified by year to account for guideline-directed changes in standard of care and real-world trends, as well as newly approved clinical treatments. Patient cohorts transition between defined health states, with transitions informed by progression-free survival and overall survival as reported in published literature.Model outputs include point prevalence and period prevalence, with options for highly granular prevalence predictions by disease stage, treatment pathway, or time of diagnosis. As a use case, we leveraged the OSM framework to estimate the prevalence of bladder cancer in the United States.The OSM is a robust model that builds upon existing modeling practices to offer an innovative, transparent approach in estimating prevalence, progression-based incidence, and survival for oncologic conditions. The OSM combines and extends the capabilities of other common health-economic modeling approaches to provide a detailed and comprehensive modeling framework to estimate prevalence in oncology using simulation modeling and to assess the impacts of new treatments on prevalence over time.
Introduction Several targeted immune modulators (TIMs) have demonstrated effectiveness in moderate-to-severe ulcerative colitis, including adalimumab, golimumab, infliximab, infliximab biosimilars, tofacitinib, ustekinumab, and vedolizumab. In addition to assessing individual TIMs, evaluating TIM sequences can inform clinical care as well as coverage and reimbursement policies. Our objective was to identify optimal treatment sequences based on maximum net health benefit (NHB), lowest total cost (cost minimizing), quality-adjusted life-year (QALY) maximization, or convenience (avoidance of intravenous treatments), and to evaluate their cost effectiveness compared with conventional treatment from the health sector perspective. Methods We developed a Markov model with eight-week cycles and a lifetime time horizon. The health states were active, clinical response without remission, remission, and death. TIM efficacy was informed by a network meta-analysis conducted by the Institute for Clinical and Economic Review. Sequences were generated by ranking TIMs and then conventional treatment according to NHB, cost minimization, QALY maximization, or convenience and combining top ranked TIMs in the biologic naïve and biologic experienced populations. NHB was calculated at USD 150,000 per QALY. Probabilistic sensitivity analysis (PSA) was undertaken to estimate the probability of each sequence having the highest NHB rank, QALY maximizing rank, and cost-minimizing rank. Results Twenty-one sequences were evaluated. The sequence with the highest NHB was infliximab followed by tofacitinib (-0.12 QALYs), which also had the lowest incremental costs (USD37,266). For orally and subcutaneously administered TIMs, the sequence of golimumab-tofacitinib had the highest NHB (-0.34 QALYs). Ustekinumab-vedolizumab was not only the top ranked sequence as measured by QALY maximization (0.172 incremental QALYs), but it also had the highest total incremental cost (USD166,094). Results of the PSA were consistent with deterministic rankings for the top-ranking sequences and showed that the top two or three regimens were close in magnitude. Conclusions The optimal sequence with regard to NHB and cost minimization was infliximab or biosimilars, followed by tofacitinib, adalimumab, or vedolizumab. Sequences that generated the most QALYs began with ustekinumab, followed by vedolizumab, tofacitinib, and adalimumab.
Objective: To quantify the annual budget impact if all US commercially insured type 1 diabetes mellitus patients on basal–bolus therapy (T1DMBBT), type 2 diabetes mellitus patients on basal–oral therapy (T2DMBOT), and type 2 diabetes mellitus patients on basal–bolus therapy (T2DMBBT) switched from insulin glargine (IGlar) to insulin degludec (IDeg).Methods: A short-term (1 year) budget impact model was developed to evaluate the costs of IDeg vs. IGlar in three treatment groups (T1DMBBT, insulin-naïve T2DMBOT, and T2DMBBT) through a simulation for a potential US health plan population of 35 million. The analysis captured direct medical costs associated with insulin treatment (insulin, needles, and self-monitored glucose testing) and costs related to managing hypoglycemic episodes. There were a total of 59,780 T1DMBBT patients, 383,145 T2DMBOT patients, and 171,325 T2DMBBT patients expected to be using long-acting insulin. A sensitivity analysis on the entire US population was also conducted.Results: Among T1DMBBT patients, IDeg was associated with an annual cost savings of −$357.13 per patient per year (PPPY), driven primarily by reduced insulin utilization. IDeg was also found to be cost saving among T2DMBOT patients (−$1206.61 PPPY), driven primarily by reductions in the cost of treating severe hypoglycemic episodes. Among T2DMBBT patients, IDeg was associated with an additional cost to the plan of $1420.04 PPPY; however, this result was driven by a higher insulin dose for IDeg compared to IGlar. Overall, IDeg demonstrated cost savings of $240 million per year, which accounted for total cost savings of 3.5% vs. IGlar.Conclusions: The results of this analysis suggest that the reduced insulin utilization and fewer hypoglycemic episodes associated with IDeg may translate into reduced costs for payers. The model is limited by simplification of a complex disease state and assumptions surrounding disease state, treatment patterns, and costs. Therefore, results may not accurately reflect actual health plans or real-world practice patterns.
Objective: To assess and report utilization and patient perceptions of migraine prophylaxis in chronic migraine (CM) and episodic migraine (EM). Background Prophylaxis therapy can help decrease headache frequency in patients with CM and EM. However, perceptions of migraine prophylaxis in CM and EM patients have not been investigated. Design/Methods: A web-based survey of the burden of migraine was administered to 32,782 subjects from 6 countries. Responders (n=16,663) were eligible for the main questionnaire if they were ≥ 18 years of age, reported at least 1 headache during the last 3 months, and reported symptoms meeting diagnostic criteria for migraine. Eligible responders (n= 1,183) were classified as CM and EM, based on reported headache frequency (≥15 and Results: Respondents (n=1,165) were predominantly female (75.0%) with a mean age of 43.6 ± 12.2 years. 42.3% (n=493) of subjects were classified as CM. More CM subjects reported ever taking prophylaxis (CM vs. EM: 62.8% vs. 39.9%, p Conclusions: These findings support previous reports that most migraineurs, including many CM patients, have never tried prophylaxis. Though migraine type (chronic vs. episodic) appears to influence patient perceptions of prophylaxis, perceptions are multifactorial. Disclosure: Dr. Sanderson has received personal compensation for activities with Allergan, Inc. Dr. Devine has nothing to disclose. Dr. Bloudeck has received personal compensation for activities with Allergan, Inc as an employee. Dr. Varon has received personal compensation for activities with Allergan, Inc. Dr. Varon holds stock and/or stock options in Allergan, Inc., which sponsored research in which Dr. Varon was involved as an investigator. Dr. Sullivan has nothing to disclose.
The objective of this literature review was to evaluate the costs associated with the use of long-acting insulin analogues (LAIAs) compared with non-LAIA agents, including human insulin, oral antidiabetic drugs, and other injectable therapies, in the treatment of patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).A systematic review of the medical literature (MEDLINE, EMBASE, Cochrane, EconLit) conducted from 2004 to 2016.The review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria for studies were: patients with T1D and/or T2D, LAIA intervention, and comparators, including oral antidiabetics (OADs) or neutral protamine Hagedorn (NPH). Outcomes of interest were adherence measures; economic outcomes, including total costs, cost savings, and willingness-to-pay; and cost-effectiveness or incremental cost-effectiveness analyses. Real-world costs of individual LAIAs were also evaluated and are often compared against those of other LAIAs in the economic analyses.We identified and included 117 relevant studies. Patients using LAIAs had higher drug costs than those using OADs and NPH but had neutral or reduced total and diabetes-related costs compared with patients using non-LAIAs. Use of LAIA pen-delivery systems may lead to improved adherence and reduction in costs. Patients receiving insulin glargine demonstrated higher adherence and persistence than patients on insulin detemir. Economic models suggest that LAIAs are more cost-effective than NPH for T1D; for T2D, insulin glargine is more costly than NPH but less so than insulin detemir.Despite higher drug costs, the real-world overall medical costs of LAIAs are not significantly different from those of NPH in patients with diabetes. The findings may be helpful for formulary decision making for patients with diabetes in a cost-constrained environment.
