RESUMO
AIMS: We aimed to describe the clinical, economic, and societal burdens of cystic fibrosis (CF) and impact of CF transmembrane conductance regulator modulator (CFTRm) treatment on people with CF, caregivers, and healthcare systems. MATERIAL AND METHODS: This retrospective study used linked real-world data from Swedish national population-based registries and the Swedish CF Quality Registry to assess clinical, economic, and societal burden and CFTR impact in CF. Records from people with CF and a ten-fold control population without CF matched by sex, birth year, and location were compared during 2019. Outcomes for a subset aged >6 years initiating lumacaftor/ivacaftor (LUM/IVA) in 2018 were compared 12 months pre- and post-treatment initiation. RESULTS: People with CF (n = 743) had >10 times more inpatient and outpatient specialist visits annually vs controls (n = 7406). Those aged >18 had an additional 77·7 (95% CI: 70·3, 85·1) days of work absence, at a societal cost of 11,563 (95% CI: 10,463, 12,662), while caregivers of those aged <18 missed an additional 6.1 (5.0, 7.2) workdays. With LUM/IVA treatment, people with CF (n = 100) had significantly increased lung function (mean change in ppFEV1 [3·8 points; 95% CI: 1·1, 6·6]), on average 0·5 (95% CI: -0·8, -0·2) fewer pulmonary exacerbations and 45·2 (95% CI: 13·3, 77·2) fewer days of antibiotics. Days of work lost by caregivers of people with CF aged <18 decreased by 5·4 days (95% CI: 2·9, 7·9). CONCLUSION: CF is associated with a high clinical economic and societal burden in Sweden. Improvements in clinical status observed in people with CF treated with LUM/IVA were reflected in reduced caregiver and societal burden.
Cystic fibrosis (CF) is a disease caused by a single faulty gene called CFTR, which affects the lungs, pancreas, and other organs. Medications known as CFTR modulators help improve the function of this faulty gene and have shown benefits for people with CF. In Sweden, two such medicines, lumacaftor and ivacaftor (LUM/IVA), have been available since July 2018 for treating CF. This study looks at the impact of CF on patients, caregivers, and the healthcare system, as well as the benefits of CFTR modulators. Using data from Swedish national healthcare and social insurance registries, the study compared 743 people with CF in 2019 to about 7400 people without CF, matched by sex, birth year, and location. The findings show that people with CF had 24 times higher direct healthcare costs, including outpatient visits, hospitalizations, and CF-related medications, totaling 23,233 Euros. Indirect costs, such as work absences for those over 18 with CF anssd caregivers' absences to care for sick children, were 9,629 Euros, which is five times higher than the general population. Those over 6 years old treated with LUM/IVA showed improved lung health, reduced hospitalizations (though not significantly), and needed fewer antibiotics. Caregivers' work absences decreased, but there was no change in work absences for adults with CF. Overall, treatment with LUM/IVA improved clinical outcomes and reduced the burden on caregivers and society.
Assuntos
Aminofenóis , Aminopiridinas , Benzodioxóis , Efeitos Psicossociais da Doença , Regulador de Condutância Transmembrana em Fibrose Cística , Fibrose Cística , Combinação de Medicamentos , Quinolonas , Sistema de Registros , Humanos , Fibrose Cística/tratamento farmacológico , Masculino , Feminino , Suécia , Aminofenóis/uso terapêutico , Aminofenóis/economia , Quinolonas/uso terapêutico , Quinolonas/economia , Estudos Retrospectivos , Benzodioxóis/uso terapêutico , Benzodioxóis/economia , Aminopiridinas/uso terapêutico , Aminopiridinas/economia , Criança , Adolescente , Adulto , Adulto Jovem , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Cuidadores , Pessoa de Meia-Idade , Absenteísmo , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/economiaAssuntos
Análise Custo-Benefício , Fibrose Cística , Medicamentos Genéricos , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Humanos , Medicamentos Genéricos/economia , Aminofenóis/economia , Aminofenóis/uso terapêutico , Benzodioxóis/economia , Benzodioxóis/uso terapêutico , Quinolonas/economia , Quinolonas/uso terapêutico , Custos de Medicamentos , Aminopiridinas/economia , Aminopiridinas/uso terapêutico , Combinação de Medicamentos , Análise de Custo-EfetividadeRESUMO
BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) has revolutionized cystic fibrosis (CF) treatment. However, previous research has demonstrated profound global disparities in diagnosis and treatment access. If unaddressed, these threaten to widen existing health inequities. Therefore, in this analysis we aimed to reappraise gaps and evaluate progress in diagnosis and treatment equity in high-income (HIC) versus low- and middle-income countries (LMICs). METHODS: Estimates of the global CF population were made in 158 countries using patient registries, systematic literature searches, and an international survey of 14 CF experts. Estimates of the global burden of undiagnosed CF were made using epidemiological studies identified in literature searches and registry coverage data. The proportion of people receiving ETI was estimated using publicly available revenue data and a survey of 23 national drug pricing databases. RESULTS: 188,336 (163,421-209,204) people are estimated to have CF in 96 countries. Of these, 111,767 (59%) were diagnosed and 51,322 (27%) received ETI. The undiagnosed patient burden is estimated to be 76,569 people, with 82% in LMICs. ETI is reimbursed in 35 HICs, but only one LMIC. Four years after approval, there are 13,723 people diagnosed with CF who live in a country where ETI is inaccessible. This increases to 76,199 when including the estimated undiagnosed population. CONCLUSIONS: Equitable access to CFTR modulators must become a top priority for the international CF community. ETI costs up to $322,000 per year but could be manufactured for $5000 to allow access under a voluntary license. Given the extent of disparities, other mechanisms to improve access that circumvent the manufacturer should also be considered.
Assuntos
Aminofenóis , Fibrose Cística , Saúde Global , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Quinolonas , Fibrose Cística/diagnóstico , Fibrose Cística/terapia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Fibrose Cística/epidemiologia , Humanos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Quinolonas/uso terapêutico , Aminofenóis/uso terapêutico , Aminofenóis/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Benzodioxóis/uso terapêutico , Combinação de Medicamentos , Pirazóis/uso terapêutico , Piridinas/uso terapêutico , Criança , Países em Desenvolvimento , Países Desenvolvidos/estatística & dados numéricos , Indóis , QuinolinasAssuntos
Aminofenóis , Benzodioxóis , Fibrose Cística , Combinação de Medicamentos , Indóis , Pirazóis , Quinolonas , Humanos , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Benzodioxóis/uso terapêutico , Benzodioxóis/farmacocinética , Aminofenóis/uso terapêutico , Aminofenóis/farmacocinética , Aminofenóis/economia , Quinolonas/uso terapêutico , Quinolonas/farmacocinética , Quinolonas/economia , Indóis/economia , Indóis/uso terapêutico , Indóis/farmacocinética , Pirazóis/uso terapêutico , Pirazóis/farmacocinética , Pirazóis/economia , Piridinas/farmacocinética , Piridinas/uso terapêutico , Piridinas/economia , Quinolinas/uso terapêutico , Quinolinas/farmacocinética , Quinolinas/economia , Custos de Medicamentos , Acessibilidade aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Agonistas dos Canais de Cloreto/uso terapêutico , Agonistas dos Canais de Cloreto/farmacocinética , Agonistas dos Canais de Cloreto/economia , Pirrolidinas/uso terapêutico , Pirrolidinas/farmacocinéticaRESUMO
DISCLOSURES: No funding contributed to the writing of this commentary. Both authors are employed by the Cystic Fibrosis Foundation. The Cystic Fibrosis Foundation has entered into therapeutic development award agreements and licensing agreements to assist with the development of CFTR modulators that may result in intellectual property rights, royalties, and other forms of consideration provided to CFF. Some of these agreements are subject to confidentiality restrictions and, thus, CFF cannot comment on them.
Assuntos
Agonistas dos Canais de Cloreto/uso terapêutico , Regulador de Condutância Transmembrana em Fibrose Cística/agonistas , Fibrose Cística/tratamento farmacológico , Custos de Medicamentos , Aminofenóis/economia , Aminofenóis/uso terapêutico , Benzodioxóis/economia , Benzodioxóis/uso terapêutico , Agonistas dos Canais de Cloreto/economia , Fibrose Cística/economia , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Aprovação de Drogas/economia , Combinação de Medicamentos , Humanos , Indóis/economia , Indóis/uso terapêutico , Assistência Médica , Mutação , Pirazóis/economia , Pirazóis/uso terapêutico , Piridinas/economia , Piridinas/uso terapêutico , Quinolinas/economia , Quinolinas/uso terapêutico , Quinolonas/economia , Quinolonas/uso terapêutico , Resultado do Tratamento , Estados Unidos , United States Food and Drug AdministrationRESUMO
DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, Allergan, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Seidner, Rind, and Pearson are employed by ICER. Tice reports contracts to his institution, University of California, San Francisco, from ICER during the conduct of this study. Wherry has nothing to disclose.
Assuntos
Agonistas dos Canais de Cloreto/uso terapêutico , Análise Custo-Benefício , Regulador de Condutância Transmembrana em Fibrose Cística/agonistas , Fibrose Cística/tratamento farmacológico , Modelos Econômicos , Adolescente , Aminofenóis/economia , Aminofenóis/uso terapêutico , Aminopiridinas/economia , Aminopiridinas/uso terapêutico , Benzodioxóis/economia , Benzodioxóis/uso terapêutico , Criança , Agonistas dos Canais de Cloreto/economia , Fibrose Cística/economia , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Aprovação de Drogas/economia , Combinação de Medicamentos , Custos de Medicamentos , Política de Saúde/economia , Humanos , Indóis/economia , Indóis/uso terapêutico , Mutação , Pirazóis/economia , Pirazóis/uso terapêutico , Piridinas/economia , Piridinas/uso terapêutico , Quinolinas/economia , Quinolinas/uso terapêutico , Quinolonas/economia , Quinolonas/uso terapêutico , Resultado do Tratamento , Estados Unidos , United States Food and Drug AdministrationRESUMO
OBJECTIVES: Cystic fibrosis (CF) is a rare genetic disease with no cure. Until recently, treatment has targeted symptoms of the disease and not the disease-causing genetic defect. Ivacaftor is included in a new class of breakthrough drugs targeting the genetic defects of CF. We sought to estimate the long-term cost-effectiveness of ivacaftor from a US payer perspective. METHODS: We developed an individual-level microsimulation model that followed a cohort of heterogeneous US CF patients over a lifetime. The primary outcome of interest was quality-adjusted life years (QALYs). We also compared unadjusted life years, count of acute pulmonary exacerbations, and count of lung transplants over a lifetime between patients treated with ivacaftor plus best supportive care and patients treated with best supportive care alone. We conducted one-way and probabilistic sensitivity analyses to test the impact of various model inputs and uncertainties. RESULTS: We found a substantial increase in QALYs, life years, and treatment costs over a lifetime for patients treated with ivacaftor plus best supportive care versus best supportive care alone. Discounted results for ivacaftor were 22.92 QALYs and $8 797 840 in total lifetime costs compared to 16.12 QALYs and $2 336 366 lifetime costs for best supportive care alone. The incremental cost-effectiveness ratios (ICERs) were $950 217 per QALY. Results from the probabilistic sensitivity analysis indicated a 0% chance that ivacaftor was cost-effective at a willingness-to-pay (WTP) threshold of $500 000 per QALY. CONCLUSIONS: Treatment with ivacaftor plus best supportive care versus best supportive care alone is not cost-effective at or near commonly accepted WTP thresholds.
Assuntos
Aminofenóis/uso terapêutico , Agonistas dos Canais de Cloreto/uso terapêutico , Fibrose Cística/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Quinolonas/uso terapêutico , Aminofenóis/economia , Agonistas dos Canais de Cloreto/economia , Análise Custo-Benefício , Fibrose Cística/tratamento farmacológico , Fibrose Cística/genética , Custos de Medicamentos , Feminino , Humanos , Masculino , Mutação/genética , Anos de Vida Ajustados por Qualidade de Vida , Quinolonas/economia , Fatores de TempoRESUMO
BACKGROUND: Lumacaftor-ivacaftor combination is a promising treatment for cystic fibrosis (CF) patients homozygous for the F508del-CFTR mutation. Optimal adherence is essential to achieve full health outcomes benefits. METHODS: This retrospective study used pharmacy refills data to calculate proportion of days covered (PDC). Adherence was defined as a PDC ≥80%. A logistic regression analysis was conducted to examine factors associated with medication adherence. RESULTS: Ninety-six patients were included in the final cohort for analysis. The mean PDC was 96% ± 14 at 6 months, and 91% ± 17 at 12 months. The proportion of adherent patients was 89% and 83% at 6 and 12 months respectively. Age and ppFEV1 were found to affect medication adherence. CONCLUSIONS: Considering the medico-economic impact of CFTR modulator therapy, high adherence rates to lumacaftor-ivacaftor found in this study are encouraging.
Assuntos
Aminofenóis , Aminopiridinas , Benzodioxóis , Agonistas dos Canais de Cloreto , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística , Adesão à Medicação/estatística & dados numéricos , Quinolonas , Adulto , Fatores Etários , Aminofenóis/economia , Aminofenóis/uso terapêutico , Aminopiridinas/economia , Aminopiridinas/uso terapêutico , Benzodioxóis/economia , Benzodioxóis/uso terapêutico , Agonistas dos Canais de Cloreto/economia , Agonistas dos Canais de Cloreto/uso terapêutico , Análise Custo-Benefício , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Fibrose Cística/epidemiologia , Fibrose Cística/genética , Combinação de Medicamentos , Feminino , Volume Expiratório Forçado , França/epidemiologia , Homozigoto , Humanos , Masculino , Quinolonas/economia , Quinolonas/uso terapêutico , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: A common narrative is that high prices are necessary for "orphan drugs" because of the fewer patients. In the context of state health insurance systems, the high prices create significant challenges because of limited budgets. RESULTS: This study carefully examines both costs and revenues of two drugs for cystic fibrosis (ivacaftor and lumacaftor), showing that, for this important example, prices are not high because of fewer patients. The study then explores the justifications usually given for high orphan drug prices, including the need to support research and development for new drugs. Each of these standard justifications is shown to be inadequate; instead, it appears that the exercise of market power in the presence of insurance is the dominant driver of high prices. INTERPRETATION: Insurers need to re-examine how they address high-priced drugs.
Assuntos
Aminofenóis/economia , Aminopiridinas/economia , Benzodioxóis/economia , Agonistas dos Canais de Cloreto/economia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Produção de Droga sem Interesse Comercial/economia , Quinolonas/economia , Análise Custo-Benefício , Combinação de Medicamentos , Custos de Medicamentos/estatística & dados numéricos , HumanosRESUMO
BACKGROUND: Cystic fibrosis (CF) is a chronic, progressive, genetic disease affecting more than 30,000 people in the United States and 70,000 people globally. The goals of treatment are to slow disease progression, reduce pulmonary exacerbations, relieve chronic symptoms, and improve the patient's quality of life. Lumacaftor/ivacaftor is a new therapy for CF that has demonstrated good clinical outcomes, including improved absolute percentage predicted forced expiratory volume in 1 second (FEV1%). However, given the high cost of therapy, there is a need to evaluate the overall value of lumacaftor/ivacaftor in CF management. OBJECTIVES: To (a) conduct a cost-effectiveness analysis (CEA) of lumacaftor/ivacaftor to understand the overall effectiveness of the drug compared with its costs and (b) conduct a budget impact analysis (BIA) to understand the potential financial effect of introducing a new drug in a health plan. METHODS: Two static decision models were developed using Microsoft Excel to evaluate the cost-effectiveness and budget impact of lumacaftor/ivacaftor over a 1-year time frame from a payer perspective. Model inputs included drug costs (wholesale acquisition costs), drug monitoring schedules (package inserts), drug monitoring costs (Centers for Medicare & Medicaid physician fee schedule and published literature), FEV1% predicted and pulmonary exacerbation values (clinical trials), and cost to treat pulmonary exacerbations (published literature). The outcomes in the CEA included total cost of therapy; average cost-effectiveness ratio (ACER), defined as cost per FEV1% predicted; and incremental cost-effectiveness ratio (ICER), defined as the difference in the ratio of cost per FEV1% predicted of lumacaftor/ivacaftor and placebo. Outcomes in the BIA included total budget impact; cost per member per month (PMPM), defined as total budget impact per hypothetical plan population; and cost per treated member per month (PTMPM), defined as total budget impact per target CF population. All costs were adjusted to 2016 dollars, and one-way sensitivity analyses were conducted to test the model robustness given uncertainty in model inputs and study assumptions. RESULTS: The annual cost of therapy per patient for lumacaftor/ivacaftor was $379,780. The ACER for lumacaftor/ivacaftor was $151,912, while the ICER for lumacaftor/ivacaftor compared with placebo was $95,016 per FEV1% predicted. The annual total budget impact due to the inclusion of lumacaftor/ivacaftor on the health plan formulary was $266,046. The PMPM cost was $0.02 and the PTMPM cost was $6.21. CONCLUSIONS: In patients with CF, lumacaftor/ivacaftor has demonstrated better clinical effectiveness compared with placebo alongside an increased drug acquisition cost. However, the therapy may be a viable alternative to existing standard therapy over a short time horizon. Health care payers, both private and public, need to evaluate the cost-effectiveness and the financial effect when considering expansion of new drug coverage in CF management. DISCLOSURES: No outside funding supported this study. Covvey and Kamal have received research funding from Novartis Pharmaceuticals. Covvey, Giannetti, and Kamal have received research funding from the College of Psychiatric and Neurologic Pharmacists. Kamal serves as a consultant to the Lynx Group (Cranbury, NJ) and Manticore Consulting Group (Scottsdale, AZ). Mukherjee has nothing to disclose. A related poster abstract was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; March 27-30, 2017; Denver, CO.
Assuntos
Aminofenóis/economia , Aminofenóis/uso terapêutico , Aminopiridinas/economia , Aminopiridinas/uso terapêutico , Benzodioxóis/economia , Benzodioxóis/uso terapêutico , Orçamentos , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Custos de Medicamentos , Quinolonas/economia , Quinolonas/uso terapêutico , Medicamentos para o Sistema Respiratório/economia , Medicamentos para o Sistema Respiratório/uso terapêutico , Tomada de Decisão Clínica , Análise Custo-Benefício , Fibrose Cística/diagnóstico , Fibrose Cística/fisiopatologia , Técnicas de Apoio para a Decisão , Combinação de Medicamentos , Volume Expiratório Forçado , Humanos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: To forecast lifetime outcomes and cost of lumacaftor/ivacaftor combination therapy in patients with cystic fibrosis (CF) with homozygous phe508del mutation from the US payer perspective. METHODS: A lifetime Markov model was developed from a US payer perspective. The model included five health states: 1) mild lung disease (percent predicted forced expiratory volume in 1 second [FEV1] >70%), 2) moderate lung disease (40% ≤ FEV1 ≤ 70%), 3) severe lung disease (FEV1 < 40%), 4) lung transplantation, and 5) death. All inputs were derived from published literature. We estimated lumacaftor/ivacaftor's improvement in outcomes compared with a non-CF referent population as well as CF-specific mortality estimates. RESULTS: Lumacaftor/ivacaftor was associated with additional 2.91 life-years (95% credible interval 2.55-3.56) and additional 2.42 quality-adjusted life-years (QALYs) (95% credible interval 2.10-2.98). Lumacaftor/ivacaftor was associated with improvements in survival and QALYs equivalent to 27.6% and 20.7%, respectively, for the survival and QALY gaps between CF usual care and their non-CF peers. The incremental lifetime cost was $2,632,249. CONCLUSIONS: Lumacaftor/ivacaftor increased life-years and QALYs in CF patients with the homozygous phe508del mutation and moved morbidity and mortality closer to that of their non-CF peers but it came with higher cost.
Assuntos
Aminofenóis/administração & dosagem , Aminopiridinas/administração & dosagem , Benzodioxóis/administração & dosagem , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida , Quinolonas/administração & dosagem , Adulto , Aminofenóis/economia , Aminopiridinas/economia , Benzodioxóis/economia , Fibrose Cística/genética , Fibrose Cística/fisiopatologia , Combinação de Medicamentos , Volume Expiratório Forçado , Homozigoto , Humanos , Cadeias de Markov , Mutação , Quinolonas/economia , Índice de Gravidade de Doença , Resultado do Tratamento , Estados UnidosRESUMO
In Ireland, Ivacaftor is reimbursed, on the High-Tech Drug Scheme, for the treatment of cystic fibrosis in patients age 6 years and older who have the G551D mutation. The aim of this study was to analyse the utilisation and expenditure of Ivacaftor on this scheme in the 12 month period post-reimbursement. All patients who had received Ivacaftor (regardless of General Medical Services Scheme eligibility/ineligibility) were included. A total of 140 individuals (male=74; 53%) received Ivacaftor over the defined 12 month study period (from January 2015 to December 2015 inclusive). The cohort ranged in age from 6 years to 61 years. The mean age was 22 years; a positive skew in age distribution indicated that a greater number of the cohort were in the younger age groups. No statistically significant difference was detected in the mean ages of the male and female subgroups. Drug acquisition expenditure by the Health Services Executive on Ivacaftor over the 12 month study period was 29.81 million.
Assuntos
Aminofenóis/uso terapêutico , Fibrose Cística/tratamento farmacológico , Quinolonas/uso terapêutico , Adolescente , Adulto , Aminofenóis/economia , Criança , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Volume Expiratório Forçado , Gastos em Saúde , Humanos , Irlanda , Masculino , Mutação , Quinolonas/economia , Adulto JovemRESUMO
AIMS: The aim of this study was to determine the pharmacokinetic interaction between ivacaftor and ritonavir. METHODS: A liquid chromatography mass spectrometry (LC-MS) method was developed for the measurement of ivacaftor in plasma. An open-label, sequential, cross-over study was conducted with 12 healthy volunteers. Three pharmacokinetic profiles were assessed for each volunteer: ivacaftor 150 mg alone (study A), ivacaftor 150 mg plus ritonavir 50 mg daily (study B), and ivacaftor 150 mg plus ritonavir 50 mg daily after two weeks of ritonavir 50 mg daily (study C). RESULTS: Addition of ritonavir 50 mg daily to ivacaftor 150 mg resulted in significant inhibition of the metabolism of ivacaftor. Area under the plasma concentration-time curve from time 0 to infinity (AUC0-inf obv ) increased significantly in both studies B and C compared to study A (GMR [95% CI] 19.71 [13.18-31.33] and 19.77 [14.0-27.93] respectively). Elimination half-life (t1/2 ) was significantly longer in both studies B and C compared to study A (GMR [95% CI] 11.14 [8.72-13.62] and 9.72 [6.68-12.85] respectively). There was no significant difference in any of the pharmacokinetic parameters between study B and study C. CONCLUSION: Ritonavir resulted in significant inhibition of the metabolism of ivacaftor. These data suggest that ritonavir may be used to inhibit the metabolism of ivacaftor in patients with cystic fibrosis (CF). Such an approach may increase the effectiveness of ivacaftor in 'poor responders' by maintaining higher plasma concentrations. It also has the potential to significantly reduce the cost of ivacaftor therapy.
Assuntos
Aminofenóis/farmacocinética , Agonistas dos Canais de Cloreto/farmacocinética , Inibidores do Citocromo P-450 CYP3A/farmacocinética , Citocromo P-450 CYP3A/metabolismo , Quinolonas/farmacocinética , Ritonavir/farmacocinética , Adulto , Aminofenóis/economia , Aminofenóis/uso terapêutico , Área Sob a Curva , Agonistas dos Canais de Cloreto/economia , Agonistas dos Canais de Cloreto/uso terapêutico , Cromatografia Líquida/métodos , Estudos Cross-Over , Fibrose Cística/tratamento farmacológico , Esquema de Medicação , Interações Medicamentosas , Feminino , Meia-Vida , Voluntários Saudáveis , Humanos , Masculino , Quinolonas/economia , Quinolonas/uso terapêutico , Espectrometria de Massas em Tandem/métodos , Adulto JovemAssuntos
Aminofenóis/uso terapêutico , Aminopiridinas/uso terapêutico , Benzodioxóis/uso terapêutico , Fibrose Cística/tratamento farmacológico , Quinolonas/uso terapêutico , Medicamentos para o Sistema Respiratório/uso terapêutico , Aminofenóis/economia , Aminopiridinas/economia , Benzodioxóis/economia , Análise Custo-Benefício , Fibrose Cística/economia , Humanos , Quinolonas/economia , Medicamentos para o Sistema Respiratório/economiaAssuntos
Custos de Medicamentos , Terapia Genética/economia , Aminofenóis/economia , Anemia Falciforme/economia , Anemia Falciforme/genética , Anemia Falciforme/terapia , Anticorpos Monoclonais/economia , Anticorpos Monoclonais Humanizados , Biotecnologia/economia , Biotecnologia/tendências , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Indústria Farmacêutica/economia , Terapia Genética/estatística & dados numéricos , Terapia Genética/tendências , Humanos , Seguro Saúde/economia , Neoplasias/economia , Neoplasias/genética , Neoplasias/imunologia , Neoplasias/terapia , Quinolonas/economia , Sofosbuvir/economiaRESUMO
BACKGROUND: The cystic fibrosis drug, Kalydeco, has attracted attention both for its effectiveness in particular CF patients and its substantial price tag. An analysis of newspaper portrayals of Kalydeco provides an opportunity to examine how policy issues associated with rare diseases and orphan drugs are being represented in the popular press. METHODS: We conducted a content analysis of 203 newspaper articles in Canada and the U.S. that mention Kalydeco. Articles were analyzed for their main frame, discussion of Kalydeco, including issues of drug development, patient access, and reimbursement, and overall tone. RESULTS: In Canadian newspaper coverage, 77.4% of articles were framed as human interest stories featuring individual patients seeking public funding for Kalydeco, yet only 7.5% mentioned any budgetary limitations in doing so. In contrast, U.S. newspaper coverage was framed as a financial/economic story in 43.1% of articles and a medical/scientific story in 27.8%. CONCLUSIONS: Newspaper coverage varied significantly between Canada, where Kalydeco is predominantly a story about increasing patient access through full government funding, and the U.S., where Kalydeco is largely a financial story about the economic impact of Kalydeco. The difference in coverage may be due to differences in public funding between the healthcare systems of these two countries.
Assuntos
Aminofenóis , Fibrose Cística , Custos de Medicamentos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Jornais como Assunto , Produção de Droga sem Interesse Comercial/economia , Quinolonas , Aminofenóis/economia , Aminofenóis/uso terapêutico , Canadá , Comparação Transcultural , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Humanos , Jornais como Assunto/estatística & dados numéricos , Quinolonas/economia , Quinolonas/uso terapêutico , Mecanismo de Reembolso/estatística & dados numéricos , Estados UnidosRESUMO
OBJECTIVE: Ivacaftor was approved in 2012 to treat patients with cystic fibrosis (CF) with specific CFTR gene mutations. The objective of this analysis was to analyze the impact of ivacaftor on health resource utilization through analysis of claims data. METHODS: Patients diagnosed with CF aged ≥6 years prescribed ivacaftor between January 1, 2012 and July 31, 2014 with ≥12 months of continuous insurance coverage prior to and following the prescription were identified. All-cause and CF-specific healthcare resource utilization during the pre- and post-prescription periods and ivacaftor adherence levels were studied. RESULTS: The 79 identified patients had a mean age of 20.8 years, and 54% were female. The proportion of patients with inpatient admissions (all-cause and CF-related) was significantly higher in the pre index compared to post index period (p ≤ 0.05). Mean ivacaftor medication possession ratio was 0.8 (SD = 0.3), and 73% of patients had a medication possession ratio >0.80. LIMITATIONS: Only a small number of patients met the inclusion criteria. Additionally, claims data may contain errors or inconsistencies and cannot be used to determine if medications were taken as prescribed. CONCLUSIONS: Ivacaftor therapy was associated with significant reductions in hospitalizations along with high rates of adherence to treatment over 12 months.
Assuntos
Aminofenóis/economia , Agonistas dos Canais de Cloreto/economia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Quinolonas/economia , Adolescente , Adulto , Fatores Etários , Aminofenóis/uso terapêutico , Criança , Agonistas dos Canais de Cloreto/uso terapêutico , Custos e Análise de Custo , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mutação , Quinolonas/uso terapêutico , Estudos Retrospectivos , Fatores Sexuais , Adulto JovemRESUMO
Ivacaftor, a breakthrough treatment for cystic fibrosis (CF) patients with the G551D genetic mutation, lacks long-term clinical and cost projections. This study forecasted outcomes and cost by comparing ivacaftor plus usual care versus usual care alone.A lifetime Markov model was conducted from a US payer perspective. The model consisted of five health states: 1) forced expiratory volume in 1â s (FEV1) % pred ≥70%, 2) 40%≤ FEV1 % pred <70%, 3) FEV1 % pred <40%, 4) lung transplantation and 5) death. All inputs were extracted from published literature. Budget impact was also estimated. We estimated ivacaftor's improvement in outcomes compared with a non-CF referent population.Ivacaftor was associated with 18.25 (95% credible interval (CrI) 13.71-22.20) additional life-years and 15.03 (95% CrI 11.13-18.73) additional quality-adjusted life-years (QALYs). Ivacaftor was associated with improvements in survival and QALYs equivalent to 68% and 56%, respectively, for the survival and QALY gaps between CF usual care and their non-CF peers. The incremental lifetime cost was $3â374â584. The budget impact was $0.087 per member per month.Ivacaftor increased life-years and QALYs in CF patients with the G551D mutation, and moved morbidity and mortality closer to that of their non-CF peers. Ivacaftor costs much more than usual care, but comes at a relatively limited budget impact.