Dakin H.,Abacus International |
Dakin H.,University of Oxford |
Bentley A.,Abacus International |
Dusheiko G.,Royal Free Hospital London
Value in Health | Year: 2010
Objective: The aim of this study was to assess the cost-effectiveness of tenofovir disoproxil fumarate (TDF) in the treatment of chronic hepatitis B (CHB) versus alternative nucleos(t)ides from a UK National Health Service (NHS) perspective. Methods: A Markov model was used to calculate costs and benefits of nucleos(t)ide strategies in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with hepatitis B virus mono-infection and compensated liver disease. The model included 18 disease states representing CHB progression. Quality-of-life data and costs for severe disease states were based on published studies, while monitoring costs for other disease states were based on expert opinion. Transition probabilities for movements between states were based on a meta-analysis, clinical trials, and natural history studies. Results: First-line TDF generated the highest net benefits of all 211 nucleos(t)ide strategies evaluated at a threshold of Â£20,000 per quality-adjusted life-year (QALY) gained. First-line TDF cost Â£19,084/QALY gained compared with giving lamivudine (LAM) first-line and switching to TDF when LAM resistance occurs. First-line TDF was also more effective and less costly than first-line entecavir (ETV), and showed extended dominance over first-line adefovir and strategies reserving adefovir, ETV, or combination therapy until after LAM resistance develops. For patients who have developed LAM resistance, TDF was also the most cost-effective treatment, generating greater net benefits than any other second-line strategy. Conclusions: First-line TDF is the most cost-effective treatment for patients with CHB at a Â£20,000 to Â£30,000/QALY ceiling ratio, costing Â£19,084/QALY gained compared with the next best alternative. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Osei-Assibey G.,Abacus International |
Boachie C.,University of Aberdeen
Public Health Nutrition | Year: 2012
Objective To systematically review weight and cardiovascular risk reduction in blacks by diet and lifestyle changes. Design Randomised and non-randomised controlled trials of diet with/without lifestyle changes with duration of intervention ≥3 months, and published between January 1990 and December 2009, were searched in electronic databases including MEDLINE, EMBASE, CINAHL and CCTR (Cochrane Controlled Trials Register). Studies were included if they reported weight/BMI changes with changes in at least one of the following: systolic and diastolic blood pressure, fasting plasma lipids and glucose, and glycated haemoglobin. Setting Clinical, community and church-based interventions. Subjects Study participants were of African ancestry (blacks). Results Eighteen studies met the inclusion criteria. Average mean difference in weight loss was -2.66 kg, with improvements in all outcomes except total cholesterol. No significant difference was observed in outcome measures between all studies and studies that recruited only healthy participants or patients with type 2 diabetes. Conclusions Diet and lifestyle changes result in weight loss with improvements in cardiovascular risk factors in blacks. However, more culturally tailored programmes have been suggested to motivate and encourage blacks to participate in intervention trials. © The Authors 2011.
News Article | December 14, 2016
BURLINGTON, Mass., Dec. 14, 2016 /PRNewswire/ -- A recently published paper analysing global research collaborations for Network Meta-Analysis (NMA) has placed DRG Abacus1 as the third most prolific consultancy in terms of NMA publications. Network meta-analysis is commonly used to determine the relative efficacy of treatments for a condition and to inform economic decision models to estimate their relative cost-effectiveness. Network meta-analysis is acknowledged as an appropriate methodology to inform economic analyses by HTA agencies world-wide including NICE, the Canadian Agency for Drugs and Technologies in Health (CADTH), Federal Joint Committee (G-BA) in Germany, the French Haute Autorite de la Sante (HAS), and the Pharmaceutical Benefits Advisory Committee in Australia (PBAC), as well as emerging national agencies in Austria, Brazil, Colombia, Cuba, and Ireland. The paper, published in the scientific journal PLOS One, characterised global patterns of published NMAs between 1997 and 2015. The research found that 81% of NMAs identified were published in the last 5 years with the UK leading in terms of the volume of the number of published NMAs. DRG Abacus were one of the first agencies to offer in-house meta-analysis and NMA capabilities to support reimbursement activities globally. We have been conducting robust meta-analyses for over 5 years, in which time we have developed a high level of expertise and established strong academic links with pioneers in the field ahead of much larger global consultancies. "It is great so see that the NMA research at DRG Abacus has been recognized within this social network analysis publication. We continue to work with leading academics to develop NMA methods as part of our thought leadership program and have several exciting projects in the pipeline." "It is gratifying that our pioneering work in the meta-analysis field has been acknowledged in this way and also to see how our statistical offering has expanded even since this publication under Sarah's leadership." To obtain copies of the research papers published by Dr. Sarah Batson and Dr. Stephen Mitchell, or to contact them for further comments, please email Access@TeamDRG.com. Follow DRG on Twitter @DRGInsights and on LinkedIn and keep up with the latest industry news on the DRG Blog. About Decision Resources Group DRG, a subsidiary of Piramal Enterprises Ltd., offers best-in-class, high-value data, analytics and insights products and services to the healthcare industry, delivered by more than 1,000 employees across 17 offices in North America, Europe and Asia. DRG provides the Life Sciences, Provider, Payer and Financial Services industries the data, tools, insights and advice they need to compete and thrive in an increasingly complex and value-based marketplace. decisionresourcesgroup.com. DRG Abacus, part of Decision Resources Group's consulting arm, provides integrated health economics and outcomes research, as well as market access solutions throughout the product life-cycle. We balance scientific rigor with commercial awareness, differentiating ourselves from our competition through innovation, technical excellence and design. 1 Decision Resources Group acquired Abacus International, which is now known as DRG Abacus, in 2012; this paper refers to DRG Abacus as Abacus International.
Dakin H.,Abacus International |
Dakin H.,University of Oxford |
Fidler C.,Abacus International |
Harper C.,Abacus International
Value in Health | Year: 2010
Background/aims: Five nucleoside/nucleotide treatments are now available for chronic hepatitis B (CHB). This meta-analysis aimed to assess the relative efficacy of adefovir, entecavir, lamivudine, telbivudine, tenofovir disoproxil fumarate (TDF), and nucleos(t)ide combinations in the treatment of CHB. Methods: A systematic review of MEDLINE and the Cochrane library was conducted to identify all studies evaluating these nucleos(t)ides in adults with CHB. Randomized controlled trials were included in the meta-analysis if they reported the proportion of patients with undetectable hepatitis B virus (HBV) DNA or hepatitis B e antigen (HBeAg) loss/seroconversion at 1 year. Bayesian mixed treatment comparison meta-analyses were conducted in WinBUGS to assess relative efficacy. Results: A random-effects meta-analysis of trials on treatment-naive patients with HBeAg-positive CHB demonstrated that 94% of patients will achieve HBV DNA < 300 copies/ml after 1 year with TDF, compared with 73% for entecavir, 50% for adefovir, and 38% for lamivudine. There was a 97.7% probability that TDF enabled a greater proportion of patients to achieve HBV DNA < 300 copies/ml at 1 year than all other treatments considered in the analysis. TDF was significantly superior to all nucleos(t)ides for this outcome at the 0.05 level. There were no statistically significant differences between nucleos(t)ides in HBeAg seroconversion at 1 year, based on a fixed-effects meta-analysis in the same population. More trials on HBeAg-negative and drug-resistant patients are required to facilitate meta-analyses for these subgroups. Conclusions: In nucleos(t)ide-naive patients with HBeAg-positive CHB, TDF is associated with the highest probability of achieving undetectable HBV DNA at 1 year of all nucleos(t)ides considered. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: Analysis of American college of Rheumatology criteria scores 20, 50, and 70
Orme M.E.,Icera Consulting |
MacGilchrist K.S.,Abacus International |
Mitchell S.,Abacus International |
Spurden D.,Pfizer |
Biologics: Targets and Therapy | Year: 2012
Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with suboptimal response or intolerance to conventional DMARDs. The objective of this systematic review and meta-analysis was to compare the relative Efficacy of EU-licensed bDMARD combination therapy or monotherapy for patients intolerant of or contraindicated to continued methotrexate. Methods: Comprehensive, structured literature searches were conducted in Medline, Embase, and the Cochrane Library, as well as hand-searching of conference proceedings and reference lists. Phase II or III randomized controlled trials reporting American College of Rheumatology (ACR) criteria scores of 20, 50, and 70 between 12 and 30 weeks' follow-up and enrolling adult patients meeting ACR classification criteria for rheumatoid arthritis previously treated with and with an inadequate response to conventional DMARDs were eligible. To estimate the relative Efficacy of treatments whilst preserving the randomized comparisons within each trial, a Bayesian network meta-analysis was conducted in WinBUGS using Fixed and random-effects, logit-link models fitted to the binomial ACR 20/50/70 trial data. Results: The systematic review identified 10,625 citations, and after a review of 2450 full-text papers, there were 29 and 14 eligible studies for the combination and monotherapy meta-analyses, respectively. In the combination analysis, all licensed bDMARD combinations had Significantly higher odds of ACR 20/50/70 compared to DMARDs alone, except for the rituximab comparison, which did not reach significance for the ACR 70 outcome (based on the 95% credible interval). The etanercept combination was Significantly better than the tumor necrosis factor-α inhibitors adalimumab and infiximab in improving ACR 20/50/70 outcomes, with no Significant differences between the etanercept combination and certolizumab pegol or tocilizumab. Licensed-dose etanercept, adalimumab, and tocilizumab monotherapy were Significantly better than placebo in improving ACR 20/50/70 outcomes. Sensitivity analysis indicated that including studies outside the target population could affect the results. Conclusion: Licensed bDMARDs are efficacious in patients with an inadequate response to conventional therapy, but tumor necrosis factor-α inhibitor combination therapies are not equally effective. © 2012 Orme et al, publisher and licensee Dove Medical Press Ltd.
Cost-effectiveness of tacrolimus ointment in adults and children with moderate and severe atopic dermatitis: Twice-weekly maintenance treatment vs. standard twice-daily reactive treatment of exacerbations from a third party payer (U.K. National Health Service) perspective
Healy E.,University of Southampton |
Bentley A.,Abacus International |
Fidler C.,Abacus International |
Chambers C.,Astellas Pharma Europe Ltd.
British Journal of Dermatology | Year: 2011
Summary Background: A twice-weekly maintenance treatment regimen with tacrolimus ointment for atopic dermatitis (AD) significantly delayed and reduced the number of disease exacerbations over a 12-month period compared with the standard reactive treatment regimen. Objectives To determine the cost-effectiveness of tacrolimus ointment used in the maintenance treatment regimen vs. the standard reactive treatment regimen for the management of moderate and severe AD in adults and children. Methods Data from two pivotal phase III studies conducted in adults and children receiving 0·1% and 0·03% tacrolimus ointment, respectively, were used to populate a decision-analytic model. The costs and benefits associated with maintenance vs. reactive use of tacrolimus ointment were calculated over a 12-month period based on the clinical and quality of life data from the clinical trials. The analysis was conducted from the perspective of the U.K. National Health Service. Sensitivity analyses were conducted to assess the degree of uncertainty surrounding the results. Results For both adults and children with moderate and severe AD, twice-weekly maintenance treatment with tacrolimus ointment was shown to be a more effective and less costly (dominant) treatment regimen than the standard treatment regimen. Sensitivity analyses demonstrated that the model was robust and largely insensitive to changes in model parameters. Conclusions Maintenance treatment with tacrolimus ointment for the management of moderate and severe AD provides incremental health benefits at a lower cost compared with the reactive treatment regimen. © 2011 British Association of Dermatologists.
Choy E.,University of Cardiff |
Marshall D.,Inverclyde Royal Hospital |
Gabriel Z.L.,Pfizer |
Mitchell S.A.,Abacus International |
And 2 more authors.
Seminars in Arthritis and Rheumatism | Year: 2011
Objectives: To review the literature on pharmacological treatments for fibromyalgia. Methods: Relative efficacy was estimated in terms of outcome measures highlighted by the Outcome Measures in Rheumatology Network using a Bayesian mixed treatment comparison (MTC) meta-analysis. Randomized controlled trials reporting treatments for fibromyalgia were identified by systematically reviewing electronic databases (Cochrane Library, Medline, EMBASE; accessed February 2008) and conducting manual bibliographic searches. Results: Forty-five randomized controlled trials met the prespecified inclusion criteria for the systematic review. There were limited robust clinical data for some therapeutic classes (tricyclic antidepressants, analgesics, sedative hypnotics, monoamine oxidase inhibitors) and only 21 studies met the more stringent criteria for inclusion in the MTC. The majority of studies included in the MTC assessed the anticonvulsant pregabalin (n = 5) or the serotonin norepinephrine reuptake inhibitors (SNRIs) duloxetine (n = 3) and milnacipran (n = 3). Licensed doses of pregabalin and duloxetine were significantly (P < 0.05) more efficacious than placebo in terms of absolute reduction in pain, number of "responders" (≥30% reduction in pain), or change in Fibromyalgia Impact Questionnaire score (pregabalin 450 mg/d only). There was no significant difference between licensed doses of pregabalin and duloxetine for these outcomes. However licensed doses of pregabalin produced significantly greater improvements in sleep compared with milnacipran (as measured by Medical Outcomes Study Sleep Scale). Conclusions: The current study confirms the therapeutic efficacy of pregabalin and the SNRIs, duloxetine and milnacipran, in the treatment of fibromyalgia. Given their different modes of action, combination therapy with pregabalin plus an SNRI should be investigated in future research. © 2011 Elsevier Inc.
Svensson A.,Skåne University Hospital |
Chambers C.,Astellas Pharma Europe Ltd |
Ganemo A.,Skåne University Hospital |
Mitchell S.A.,Abacus International
Current Medical Research and Opinion | Year: 2011
Objective: A systematic review and meta-analysis was conducted to determine the efficacy and tolerability of tacrolimus ointment for the treatment of atopic dermatitis (AD) compared with topical corticosteroids. Methods: Electronic searches were performed in Medline, Embase and the Cochrane Library, as well as relevant conference proceedings. Two researchers independently selected trials investigating the efficacy and/or safety of tacrolimus ointment in the treatment of AD. No language restrictions were applied. Relevant outcome data from included trials were extracted by two independent reviewers. Direct meta-analysis to calculate relative risks (RR) (95% confidence intervals (CIs)) was conducted on dichotomous efficacy/safety outcomes of interest. Results: Seventeen trials comparing tacrolimus ointment with topical corticosteroids in both paediatric (n=2328) and adult (n=2849) patients were identified. No studies comparing tacrolimus ointment with class IV topical corticosteroids were identified. Tacrolimus 0.1% ointment was found to be of similar efficacy to class I/II and class III topical corticosteroids. In three individual trials (comparing tacrolimus 0.1% ointment to a topical corticosteroid), evaluation of the Physician's Global Evaluation of Clinical Response (PGECR) resulted in RRs of 0.95 (95% CI 0.78-1.16), 3.09 (95% CI 2.14-4.45) and 1.35 (95% CI 0.86-2.12), where values above one favour tacrolimus ointment. With the exception that tacrolimus ointment caused more skin burning than comparator treatments (tacrolimus 0.03% versus a class III topical corticosteroid, the RR was 3.00 (95% CI 1.21-7.43) in favour of the corticosteroid), no significant differences with regards to side-effects and withdrawals due to AEs were found. Quality of life data were reported in two studies. While one study reported greater improvements in tacrolimus-treated adult patients compared with topical steroids, the second reported greater improvements in paediatric patients treated with steroids compared with tacrolimus ointment. Conclusions: The current review and meta-analysis showed tacrolimus ointment to be of similar efficacy to corticosteroids. The interpretation of available data is limited by heterogeneity in outcome measures between trials. Further trials are needed to assess the impact of treatments on patient reported outcomes. © 2011 Informa UK Ltd.
Freemantle N.,University of Birmingham |
Lafuente-Lafuente C.,Service de Medecine Interne A. Hopital Lariboisiere |
Mitchell S.,Abacus International |
Eckert L.,Sanofi S.A. |
Reynolds M.,Beth Israel Deaconess Medical Center
Europace | Year: 2011
Aims: Mixed treatment comparisons (MTC) were performed to assess the relative efficacy and tolerability of the main anti-arrhythmic drugs used for the treatment of atrial fibrillation (AF)/flutter. Methods and results: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) examining amiodarone, dronedarone, flecainide, propafenone, sotalol, or placebo for the treatment of AF. Thirty-nine RCTs met inclusion criteria and were combined using MTC models to provide direct and indirect comparisons in a single analysis. Results are presented vs. placebo. Amiodarone had the largest effect in reducing AF recurrence (OR 0.22, 95% CI 0.16-0.29). Amiodarone was associated with the highest rate of patients experiencing at least one serious adverse event (OR 2.41, 95% CI 0.96-6.06) and treatment withdrawals due to adverse events (OR 2.91, 95% CI 1.66-5.11). Dronedarone was associated with the lowest rate of proarrhythmic events including bradycardia (OR 1.45, 95% CI 1.02-2.08). Dronedarone significantly reduced the risk of stroke (OR 0.69, 95% CI 0.57-0.84). Trends towards increased mortality for sotalol (OR 3.44, 95% CI 1.02-11.59) and amiodarone (OR 2.17, 95% CI 0.63-7.51) were found, which were stronger when small studies randomizing <100 subjects per group were excluded. Conclusion: sAmiodarone has been demonstrated to be the most effective drug in maintaining sinus rhythm. Differences in outcomes between the anti-antiarrhythmic drugs were reported, with sotalol and possibly amiodarone increasing mortality and dronedarone possibly decreasing the incidence of serious adverse events and proarrhythmia. © The Author 2010.
Sullivan S.D.,University of Washington |
Orme M.E.,Abacus International |
Morais E.,Sanofi S.A. |
Mitchell S.A.,Abacus International
International Journal of Cardiology | Year: 2013
Background: To perform a systematic review/meta-analysis evaluating the efficacy and safety of anti-arrhythmic drugs (AADs) in the treatment of atrial fibrillation (AF). Methods: Database searches (accessed April 2009) were conducted to identify randomised controlled trials (RCTs). Comparators of interest included all AADs, rate/rhythm strategies or catheter ablation in comparison with AADs. Primary AADs of interest were restricted to Class IC (flecainide and propafenone) and Class III (amiodarone, dofetilide, dronedarone and sotalol). Data were analysed on an intention-to-treat basis and meta-analysis performed using the Peto odds ratio (OR)/fixed-effect model. Results: 113 publications met inclusion criteria. Of these, 74 publications considered an AAD of primary interest. The odds of AF recurrence were generally significantly lower with all active treatments versus non-active control. Dronedarone was the only AAD to show a (non-significant) trend towards reducing the odds of mortality with a narrow CI (OR 0.85 [0.66, 1.09]). Withdrawals due to adverse events (AEs), incidence of serious adverse events (SAEs) and treatment discontinuation were increased following active treatment compared with control, with few significant differences reported between active treatments. Data for other morbidity outcomes such as cardiovascular mortality, hospitalizations or persistence/compliance and health-related quality of life (HRQoL) were limited and meta-analyses were not possible for these outcomes. Conclusion: The current meta-analysis confirms the efficacy of AADs in preventing AF recurrence, although their use is associated with a greater incidence of AEs and treatment discontinuation. Further RCTs are required to establish the benefit of AADs in the management of both morbidity outcomes and HRQoL. © 2012 Elsevier Ireland Ltd.