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Kemler M.A.,Martini Hospital | Raphael J.H.,City University London | Bentley A.,Abacus International | Taylor R.S.,Universities of Exeter and Plymouth
Value in Health | Year: 2010

Objectives: Health-care policymakers and payers require cost-effectiveness evidence to inform their treatment funding decisions. The aims of this study were to assess the cost-effectiveness of the addition of spinal cord stimulation (SCS) compared with conventional management alone (CMM) in patients with complex regional pain syndrome (CRPS), and to determine the cost-effectiveness of nonrechargeable versus rechargeable SCS implanted pulse generators (IPGs). Methods: A decision analytic model was used to synthesize data on CRPS patient outcomes and health-care costs over a 15-year time horizon from the perspective of the UK National Health Services. Data were sourced from two SCS randomized controlled trials. Results are expressed as an incremental cost per quality-adjusted life-year (QALY) in 2008 GBP. Results: The incremental cost-effectiveness of SCS compared with CMM was £3562 per QALY, a finding that was robust across sensitivity analyses with an 87% probability that SCS is cost-effective at a willingness to pay threshold of £30,000. When the longevity of an IPG is 4 years or less, a rechargeable (and initially more expensive) IPG is more cost-effective than a nonrechargeable IPG. Conclusions: In selected patients with CRPS, SCS is cost-effective as an adjunct to CMM. Despite their initial increased expense, rechargeable IPGs should be considered when IPG longevity is likely to be short. These findings support policymakers to extend the use of SCS as a good value for money treatment for CRPS. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Svensson A.,Skane University Hospital | Chambers C.,Astellas Pharma Europe Ltd | Ganemo A.,Skane 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.

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.

Dakin H.,Abacus International | Dakin H.,University of Oxford | Bentley A.,Abacus International | Dusheiko G.,Center for Hepatology
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 £20,000 per quality-adjusted life-year (QALY) gained. First-line TDF cost £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 £20,000 to £30,000/QALY ceiling ratio, costing £19,084/QALY gained compared with the next best alternative. © 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

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).

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