Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare, immune-mediated disorder, which causes peripheral nervous system dysfunction. Guidelines recommend maintenance treatment with intravenous (IVIG) or subcutaneous (SCIG) immunoglobulins. Drawbacks for IVIG include the burden of hospital administration, which is less for SCIG, which allows self- or caregiver-assisted administration at home. However, conventional SCIG (c-SCIG) requires more frequent administration than IVIG. Recently, facilitated-SGIG (f-SCIG) was developed, spacing injections so that administration frequency is analogous to IVIG. The aim of this study was to estimate and compare the costs of IVIG, c-SCIG, and f-SCIG for CIDP maintenance treatment in Spain. A cost-analysis model based on a decision tree was developed to evaluate the annual cost per patient treated with each immunoglobulin from a societal perspective. Costs considered included direct health costs (pharmaceutical acquisition and administration), non-health costs (transport to hospital), and indirect costs related to labor productivity. All costs were valued in 2024 euros. The annual cost for a patient with CIDP receiving maintenance treatment was €109,212.67 with IVIG, €98,161.97 with c-SCIG, and €98,191.37 with f-SCIG. Across all treatments, direct healthcare costs were the highest. The main driver of the difference between SCIG and IVIG cost was treatment administration (−€10,705.78). Sensitivity analyses were generally consistent with the base case results. Overall, the findings of this analysis suggest that SCIG may be a cost-saving alternative to IVIG for patients with CIDP requiring maintenance treatment in Spain, with a similar cost between c-SCIG and f-SCIG.
BACKGROUND/AIMS:Bulevirtide (Hepcludex®) is the first drug approved for the treatment of chronic hepatitis D (CHD), unlike the current off-label treatment (PEG-IFN-α), limited in clinical practice and associated with post-treatment relapses. In a hypothetical cohort of CHD patients in Spain, the study aim was to compare the efficiency of bulevirtide with PEG-IFN-α in terms of clinical events avoided and associated cost savings. METHODS:A validated economic model reflecting the natural history of the disease was used to project lifetime liver complications and costs for two hypothetical cohorts treated with bulevirtide or PEG-IFN-α. The model considered progression to complications such as decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplantation (LT), and death. The efficacy rates used at 24 and 48 weeks were defined as the combined response rate for bulevirtide and undetectable HDV RNA to PEG-IFN-α. The numbers of clinic events and associated costs were evaluated from the perspective of the National Healthcare System. RESULTS:In a hypothetical cohort of 3882 patients, bulevirtide reduced the numbers of complications events in comparison to PEG-IFN-α (152 DCC, 113 HCC, 11 LT, and 321 deaths over a lifetime). This was associated with a reduction of event-related costs of €11,837,044 (DCC €1,138,059; HCC €1,503,583; LT €7,834,291; and death €1,361,111). CONCLUSION:In patients with CHD, bulevirtide could prevent a significant number of clinical events compared to PEG-IFN-α and contribute to cost savings through these reduction in liver complications. Further testing for hepatitis D virus is needed so that more patients can benefit from bulevirtide.
Quality-of-life (QoL) measures are key for monitoring health of patients with Parkinson’s disease (PD). This systematic review aimed to gather evidence on the psychometric properties of available patient-reported outcomes measures (PROMs) for assessing QoL in people with PD (PwPD). A search of PROMs was conducted in PubMed (MEDLINE), Embase, Scopus, Web of Science, PSICDOC, and ‘gray literature’ (April 2024, PROSPERO-ID: CRD42024526458). After screening and data extraction, in a two-phase procedure conducted by independent reviewers, a critical assessment of feasibility, validity (content, structural, known-group, and criterion) and reliability (internal consistency, test–retest, and measurement error) was conducted based on the COSMIN criteria for good psychometric properties. The search identified 83 eligible studies from which 29 PROMs were gathered (15 PD-specific and 14 generic/unspecific PROMs validated for PD). All PROMs proved their feasibility and included common dimensions between them, suggesting adequate content validity. Among the 29 PROMs, 17 reported data on structural validity (58.6
Objective. To assess the cost-effectiveness of an Intelligent Endoscopy Module for computer-assisted detection and characterization (CADe/CADx) compared to standard practice, from a Spanish National Health System perspective. Methods. A Markov model was designed to estimate total costs, life years gained (LYG), and quality-adjusted life years (QALYs) over a lifetime horizon with annual cycles. A hypothetical cohort of 1,000 patients eligible for colonoscopy (mean age of 61.32 years) was distributed between Markov states according to polyp size, location, and histology based on national screening programs’ data. CADe/CADx efficacy was determined based on adenoma miss rates, and natural disease evolution was simulated according to annual transition probabilities. Detected polyps’ management involved polypectomy and histopathology in standard practice, while with CADe/CADx leave-in-situ strategy was applied for ≤5mm rectosigmoid non-adenomas and resect-and-discard strategy for the rest of ≤5mm polyps. Unit costs (€,2024) included the diagnostic procedure and polyp and CRC management. A 3% annual discount rate was applied to costs and outcomes. The model’s inputs were validated by an expert panel. Results. CADe/CADx resulted more effective (16.37 LYG and 14.32 QALYs) than standard practice (16.33 LYG and 14.27 QALYs) over a lifetime horizon. Total cost per patient was €2,300.76 with CADe/CADx and €2,508.75 with colonoscopy alone. In a hypothetical cohort of 1,000 patients, CADe/CADx avoided 173 polypectomies, 370 histopathologies, and 7 CRC cases. Sensitivity analyses confirmed the model's robustness. Conclusions. The results of this analysis suggest that CADe/CADx would result in a dominant strategy versus standard practice in patients undergoing colonoscopies in Spain.
This study aims to evaluate the prevalence of undiagnosed hepatitis delta in southern Spain (Andalusia) and assess the effectiveness and cost-efficiency of implementing reflex testing for hepatitis D detection in HBsAg-positive patients. A multicenter ambispective study was conducted in 17 Andalusian hospitals. The retrospective phase (January 2018-June 2022) analyzed diagnostic processes for hepatitis delta in HBsAg-positive patients. The prospective phase (October 2022-March 2023) implemented reflex testing, performing anti-HDV serology on all HBsAg-positive patients without prior testing. HDV RNA testing followed for those who tested anti-HDV-positive. In the retrospective phase, out of 18,583 HBsAg-positive patients, anti-HDV tests were performed on 3,436 (18%), identifying 205 (6%) positive cases. HDV RNA was tested in 158 (77%) anti-HDV-positive patients, with 69 (44%) testing positive. In the prospective phase, out of 2,384 HBsAg-positive patients without prior anti-HDV testing, 2,293 (96%) were tested, identifying 109 (4.7%) positive cases. HDV RNA was analyzed in 97 (89%) anti-HDV-positive patients, with 30 (31%) testing positive. Reflex testing increased anti-HDV detection by 77%, resulting in a fourfold increase in detecting anti-HDV-positive patients and a threefold increase in detecting HDV RNA-positive patients, reducing undiagnosed HDV RNA-positive cases to 4% compared to 45% with clinical practice. Cost analysis indicated a saving of €265,954 with reflex testing. Reflex testing improves HDV detection, reduces costs, and simplifies diagnosis, making it an efficient strategy for managing chronic hepatitis D patients.
