Treatment of seasonal allergic rhinoconjunctivitis with a once-daily SQ-standardized grass allergy immunotherapy tablet

Abstract

Objectives:

Specific immunotherapy with the grass allergy immunotherapy tablet (AIT) has been developed as an effective, well tolerated, and convenient treatment for grass pollen induced seasonal allergic rhinoconjunctivitis (ARC). Six phase II/III randomized, placebo-controlled trials with the duration of a single grass pollen season of treatment using the SQ-standardized grass AIT, Grazax (Phleum pratense, 75,000 SQ-T/2,800 BAU, ALK, Denmark), have been published previously. This review compares results from these trials.     

A cost-effectiveness analysis of fixed-combination therapies in patients with open-angle glaucoma: a European perspective

ABSTRACT

Objective: To compare the efficacy and cost implications of the use of the intraocular pressure-lowering prosta­glandin analogues bimatoprost, travoprost, and latano­prost as fixed-combination therapies with timolol, a β-adrenergic receptor antagonist.

Methods: A decision analytic cost-effectiveness model was constructed. Since no head-to-head studies comparing the three treatment options exist, the analysis was based on an indirect comparison. Hence, the model was based on efficacy data from five randomized, controlled, clinical studies. The studies were comparable with respect to study design, time horizon, patient population and type of end point presented. The measure of effectiveness was the percentage reduction of the intraocular pressure level from baseline. The cost evaluated was the cost of medication and clinical visits to the ophthalmologist. All drug costs were market prices inclusive of value-added tax, and visit costs were priced using official physician fees. Cost-effectiveness analyses were carried out in five European countries: Spain, Italy, United Kingdom, Norway and Sweden. The time horizon for the analyses was 3 months.

Results: The analysis showed that fixed-combination bimatoprost/timolol was more effective and less costly than fixed-combination travoprost/timolol and fixed-combination latanoprost/timolol in three out of the five countries analyzed. In two countries, bimatoprost/timolol was less costly than latanoprost/timolol, and cost the same as travoprost/timolol.

Conclusions: This cost-effectiveness analysis showed that the fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was a cost-effective treatment option for patients with primary open-angle glaucoma. This study was limited by available clinical data: without a head-to-head trial, indirect comparisons were necessary. In the United Kingdom, Sweden, Norway, Italy, and Spain, from a health service viewpoint, bimatoprost/timolol was a slightly more effective as well as less costly treatment strategy when compared to both travoprost/timolol and latanoprost/timolol.     

The cost-effectiveness of treatment with desloratadine in patients with persistent allergic rhinitis

Abstract

Objectives:

A new classification of persistent allergic rhinitis (PER) has been developed by the ARIA working group. Although the burden of AR is significant, treatment itself is also costly. It is unclear if treatment based on the new definition of PER is cost-effective.     

The cost-effectiveness of bimatoprost,latanoprost and timolol in treatment of primary open angle glaucoma in five European countries

ABSTRACT

Objective: The objective of this cost-effectiveness analysis is to evaluate cost-effectiveness ratios of the intraocular pressure (IOP)-lowering agents bimatoprost, latanoprost and timolol in five major European countries: France, Germany, Italy, Spain and the UK.

Methods: The cost-effectiveness analysis is based on achievement of IOP targets between 13 and 18?mm Hg. Thus, the cost-effectiveness ratios express the costs of having one patient successfully achieving IOP target. The perspective of the analysis is that of the health care sector payer, including costs of medicine and costs of ophthalmologist visits. The time frame is first year of glaucoma treatment. Four treatment strategies are analysed: Timolol as first line with add-on latanoprost or bimatoprost if IOP targets are not met, and latanoprost and bimatoprost as first line with add-on timolol.

Results: In the UK, Spain, Italy and Germany the timolol first with add-on of bimatoprost is the least expensive treatment. This strategy dominates both strategies involving latanoprost (as add-on to timolol or as first line) in these four countries. The incremental cost-effectiveness ratio of bimatoprost first-line therapy versus timolol with add-on bimatoprost varies from each country and target (from £305 to €43 720 per patient). In France the timolol first line and latanoprost add-on is not dominated and is the cheapest alternative. The incremental cost-effectiveness ratio of timolol with add-on bimatoprost versus add-on latanoprost lies between £71 and €355 per patient depending on target (18 and 13?mm Hg, respectively).

Conclusion: First-line treatment of latanoprost is dominated in all countries. In four out of five countries the timolol first-line therapy with add-on latanoprost is also dominated. Based on this pharmacoeconomic analysis, the most costeffective strategy seems to be timolol first line with add-on bimatoprost if target is not met after 3 months.     

The cost-effectiveness of depression treatment for co-occurring disorders: A clinical trial

The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The incremental cost effectiveness ratio was $131 for each point improvement of the BDI-II and $49 for each additional depression-free day. The incremental cost–utility ratio ranged from $9,249 to $17,834 for each additional quality adjusted life year. Although the intervention costs substantially more than usual care, the cost effectiveness and cost–utility ratios compare favorably to other depression interventions. Health care reform should promote dissemination of group CBT to individuals with depression in residential SUD treatment.     

中药玉屏风颗粒联合安脱达变应原免疫疗法治疗慢性荨麻疹

目的玉屏风颗粒联合安脱达(Alutard SQ)变应原免疫疗法(allergen immunotherapy,AIT)治疗慢性荨麻疹临床疗效观察。方法 133例慢性荨麻疹患者分为玉屏风颗粒联合安脱达脱敏治疗组68例和单纯脱敏对照组65例。均同时口服抗组胺药物。疗程6个月,比较临床疗效。结果对照组总有效率81.54%,治疗组为89.71%,两组差异有显著性意义(P<0.05)。结论玉屏风颗粒联合安脱达脱敏治疗慢性荨麻疹有明显的临床疗效。     

The effects of allergen-specific immunotherapy on polymorphonuclear leukocyte functions in patients with seasonal allergic rhinitis

Immunotherapy plays an important role in the therapy of allergic rhinitis and bronchial asthma. However, there is not much information about the effects of allergen-specific immunotherapy (SIT) on the polymorphonuclear leukocyte functions. The aim of this study was to investigate the effects of specific immunotherapy on phagocytic and intracellular killing activities of polymorphonuclear leukocytes (PMN) derived from patients with seasonal allergic rhinitis. Twenty-four patients with seasonal allergic rhinitis documented to be sensitive to grass pollen were included in this study. Patients were divided into 3 groups. Group 1 (n=7) received conventional immunotherapy whereas patients in Group 2 (n=7) were treated with short-term immunotherapy and the third group (n=10) were given placebo during the study process. Both phagocytic and intracellular killing activities were significantly increased (p=0.002, p<0.0001, respectively) by conventional immunotherapy when compared to the first determination. In the short-term immunotherapy group, phagocytic activity was increased very significantly (p=0.0001), whereas intracellular killing activity was not affected (p=0.252). There were no changes in these parameters in the placebo group. These results suggest that allergen-specific immunotherapy has an enhancing effect on PMNs functions in the patients with seasonal allergic rhinitis. It should be clarified by further studies whether this enhancement might be considered as another beneficial effect of the immunotherapy.     

头孢哌酮舒巴坦钠在院内感染应用的成本效果分析

目的：探讨头孢哌酮舒巴坦钠在院内感染应用的成本效果。方法院内感染住院患者90例根据治疗药物的不同分为A组、B组与C组各30例,A组采用头孢哌酮舒巴坦钠治疗,B组采用头孢唑啉钠治疗,C组采用头孢地嗪钠治疗。结果A组有效率为90.0%,B组有效率为70.0%,C组的有效率为100.0%,三组有效率对比差异有统计学意义（P＜0.05）。三组的医疗成本对比差异有统计学意义（P＜0.05）。A组的C/E值为26.80,B组为39.95,C组为35.22,C/E值对比差异有统计学意义（P＜0.05）。结论头孢哌酮舒巴坦钠在院内感染治疗中的应用费用少,有效率高,从而有很好的成本效果。     

厄他培南对比哌拉西林/他唑巴坦治疗复杂性腹腔感染的成本效果分析

目的：为了解厄他培南与哌拉西林/他唑巴坦治疗复杂性腹腔感染（cIAI）的经济性,为临床合理用药提供参考。方法：构建决策树模型对厄他培南治疗复杂性腹腔感染进行成本效果分析,疾病治疗情况和治疗费用,临床试验中药物的治疗有效性和中国的耐药菌的药物敏感度情况等参数主要来源于相关临床试验和文献。针对参数的不确定性进行敏感性分析。结果：厄他培南与哌拉西林/他唑巴坦相比有效率略高,单次住院厄他培南较哌拉西林/他唑巴坦可节约2566元,多治愈一位cIAI患者可节约卫生费用33966元。敏感性分析显示厄他培南和哌拉西林/他唑巴坦的疗效会对结果产生较大影响,其他因素对结果影响不大,上述结论相对稳健。结论：厄他培南在治疗复杂性腹腔感染与哌拉西林/他唑巴坦相比是成本节约的,即厄他培南治疗复杂性腹腔感染具有经济性。     

Clopidogrel versus aspirin in patients with atherothrombosis: CAPRIE-based calculation of cost-effectiveness for Germany

ABSTRACT

Objectives: To model the 2-year cost-effectiveness of secondary prevention with clopidogrel versus aspirin (acetylsalicylic acid) (ASS) in German patients with myocardial infarction (MI), ischaemic stroke (IS) or diagnosed with peripheral arterial disease (PAD), based on CAPRIE trial data and from the perspective of German third party payers (TPP).

Methods: An existing Markov model was adapted to Germany by using German cost data. The model was extended by using different datasets for cardiovascular event survival times (Framingham vs. Saskatchewan health databases) and in two separate scenarios.

Results: The treatment with clopidogrel leads to a reduction of 13.19 vascular events per 1000 patients, of which 2.21 are vascular deaths. The overall incremental costs for the 2-year management of atherothrombotic patients with clopidogrel instead of ASS are calculated to be about €1 241 440 per 1000 patients. The number of life-years saved (LYS) has been calculated as the difference in the number of life-years lost due to vascular death or events with ASS versus clopidogrel: it is 86.35 LYS when analysis is based on Framingham data and 66.07 LYS with Saskatchewan-based survival data. The incremental costs per LYS are €14 380 and €18 790, respectively. Cost-effectiveness is sensitive to changes in survival data, discounting and daily costs of clopidogrel, but stable against substantial (± 25%) changes in all other cost data.

Conclusion: The findings for Germany are in line with published results for Belgium (€13 390 per LYS) and also with results for Italy (€17 500 per LYS), both based on Saskatchewan data, and with a French analysis based on Framingham data (€15 907 per LYS). Even if no officially accepted cost-effectiveness threshold exists for Germany at present, incremental cost-effectiveness results of less than €20 000 per LYS for the treatment with clopidogrel can be assumed to be acceptable for German third party payers.     

药学经济学评价方法分类及成本效果分析法的应用例析

面对有限的卫生资源,临床治疗费用的居高不下,需要对临床治疗方案进行选择,此时药学经济学评价就发挥了巨大的作用,它能够提高卫生资源的应用效率,以使得社会获得最大收益。本文描述了药学经济学评价的四种方法,并阐述了药学经济学评价在临床治疗方案筛选决策中的应用现状,最后,对药学经济学评价方法中的成本效果分析法在临床治疗方案筛选决策中的应用进行了探讨。     

四种药物治疗门静脉高压性胃病急性出血的成本-效果分析

目的评价肝硬化门静脉高压性胃病（PHG）急性出血的四种药物治疗方案的成本-效果比。方法肝硬化PHG急性出血患者共70例,分别选用奥曲肽、生长抑素、特利加压素和垂体后叶素治疗,应用药物经济学成本-效果分析法进行分析。结果奥曲肽、生长抑素、特利加压素、垂体后叶素四组治疗PHG急性出血的有效率分别为100%、100%、100%、80%,药物费用分别为1 891．5元、2 970．6元、5 520元、65元,成本．效果比分别为18．91、29．71、55．2、0．81。结论在治疗PHG急性出血的药物选择上应首先考虑应用成本-效果比最低的垂体后叶素治疗,在经济条件允许、效果不佳或伴有心脑血管疾病时可及时更换生长抑素类药物。     

Safety evaluation of standardized allergen extract of Japanese cedar pollen for sublingual immunotherapy

Japanese cedar (JC) pollinosis is caused by Japanese cedar pollen (JCP) and most common seasonal allergic disease in Japan. Subcutaneous immunotherapy (SCIT) with allergen extract of JCP (JCP-allergen extract) is well established for JC pollinosis treatment with improvement of symptoms. However, major drawbacks for SCIT are repeated painful injections, frequent hospital visits and anaphylactic risk. Currently, sublingual immunotherapy (SLIT) has received much attention as an advanced alternative application with lower incidence of systemic reactions because the liquid or tablet form of allergen is placed under the tongue. The aim of this study was safety evaluation of standardized JCP-allergen extract currently developed for SLIT in JC pollinosis. JCP-allergen extract showed no potential genotoxicity. No systemic effects were observed in rats administered JCP-allergen extract orally for 26 weeks followed by 4-week recovery period. Mild local reactions such as hyperplasia and increased globule leukocytes resulting from vehicle (glycerin)-induced irritation were observed in stomach. No-observed-adverse-effect level was greater than 10,000 JAU/kg/day for systemic toxicity, equivalent to 300-fold the human dose. No local irritation was found in rabbits oral mucosae by 7-day sublingual administration. These results demonstrate the safe profile of standardized JCP-allergen extract, suggesting it is suitable for SLIT in JC pollinosis.     

Comparison of loratadine and terfenadine in allergic seasonal rhinoconjunctivitis with emphasis on nasal stuffiness and peak flow.

Non-sedating antihistamines have been used in the treatment of allergic rhinoconjunctivitis. Recommended dosage of loratadine (CAS 79794-75-5) is 10 mg once daily, whereas terfenadine (CAS 50679-08-8) until recently has been recommended as 60 mg twice daily. 105 patients took part in this double-blind 3-week controlled study comparing loratadine 10 mg once daily to terfenadine 120 mg once daily. Patient's daily symptom score and physician's assessment of symptoms, treatment effect and anterior rhinoscopy were evaluated as well as an objective parameter, nasal peak flow. In addition nasal peak flow was compared to patient's symptom score of stuffiness. A significant treatment effect in both treatment groups was found but there was no statistically significant difference between the two groups. Correlation between patient's feeling of stuffiness and nasal peak flow was significant. It is concluded that loratadine 10 mg once daily is as effective as terfenadine 120 mg once daily in controlling allergic rhinoconjunctivitis, and that patients' feeling of stuffiness correlates well to nasal peak flow.     

国产与进口左氧氟沙星治疗临床细菌性感染的成本一效果分析

目的比较国产和进口左氧氟沙星治疗细菌性感染的成本-效果。方法将208例随机分为两组,口服用药,A组：国产左氧氟沙星110例,B组：进口左氧氟沙星98例．用药物经济学方法进行成本-效果分析。结果A,B组治疗方案的痊愈率分别为79．1％、74．5％。有效率分别为92．7％、93．9％,A组的成本-效果比低于B组。结论治疗呼吸系统、泌尿系统的细菌性感染,国产左氧氟沙星和进口左氧氟沙星的临床疗效相似,但应用国产左氧氟沙星更合理、更经济,成本,效果比优于进口组。     

A cost-effectiveness analysis of epoetin usage for patients with AIDS

Epoetin (recombinant human erythropoietin) therapy for patients with AIDS may reduce the need for blood transfusion; however, it is expensive. We conducted a cost-effectiveness analysis of the use of epoetin for AIDS patients from a healthcare system perspective. We constructed a decision analysis model using probability, outcome and cost data from the literature and hospital sources. The incremental cost-effectiveness ratio was measured in dollars per unit of blood saved. In AIDS patients undergoing transfusion with serum epoetin concentrations less than or equal to 500 U/L treatment with epoetin cost $US1007 per unit of blood saved compared with treatment without epoetin. One-way sensitivity analysis revealed that the incremental cost-effectiveness ratio was sensitive to the efficacy and unit price of epoetin, but less sensitive to the current price cap determined by the distributor.     

儿童社区获得性肺炎两种治疗方案的成本-效果分析

目的:评价两种治疗儿童社区获得性肺炎方案的经济学效果。方法:将86例肺炎患儿随机分为头孢唑肟钠治疗组和头孢呋辛钠治疗组,运用药物经济学的成本-效果分析方法进行比较。结果:两种治疗方案治愈率分别为95.3%、97.7%(P>0.05),成本分别为(1680.30±161.50)元(、1215.20±123.20)元(P<0.05);成本-效果比分别为(17.63±1.69)和(12.44±1.26)。结论:头孢呋辛钠治疗儿童社区获得性肺炎比头孢唑肟钠经济。