Cost-Utility Analysis of Biologic Disease-Modifying Antirheumatic Drugs for Patients With Psoriatic Arthritis in Thailand.

OBJECTIVES: This study aimed to assess the cost-effectiveness of biologic disease-modifying antirheumatic drugs (bDMARDs) for treating patients with psoriatic arthritis who failed conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). METHODS: A decision tree and Markov model were constructed to capture long-term costs and outcomes from a societal perspective. Patients with psoriatic arthritis who failed 2 previous csDMARDs were modeled over a 3-month cycle with a lifetime horizon. Clinical probabilities were derived from a published meta-analysis. Prices of bDMARDs were proposed by pharmaceutical companies. Other costs and utilities were based on data in Thailand. All costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratio and a series of sensitivity analyses were performed. RESULTS: All 11 bDMARDs (3 infliximab originator and biosimilars, 2 etanercept originator and biosimilar, golimumab, 2 secukinumab 150 mg and 300 mg, 3 adalimumab biosimilars) gained better quality-adjusted life-years (QALYs) with more costly than csDMARDs. Infliximab had the highest QALYs compared with other bDMARDs. Only secukinumab 150 mg showed the incremental cost-effectiveness ratio below the Thai threshold of 5152 US dollars per QALY. Cost of bDMARDs was the most influential factor. CONCLUSIONS: At the current price, secukinumab 150 mg shows the value for money in the Thai context. Price negotiation is of great importance for other bDMARDs.

Disease activity and functional status associated with health-related quality of life and patient-acceptable symptom state in patients with psoriatic arthritis in Thailand: A cross-sectional study.

AIM: To identify factors associated with the EuroQol-5 Dimensions-5 levels (EQ-5D-5L) and patient acceptable symptom state (PASS) and to estimate health utility (HU) in Thai patients with psoriatic arthritis (PsA). METHODS: A cross-sectional study of consecutive PsA patients visiting Siriraj Hospital was performed between 31 May, 2012 and 31 March, 2016. Data of patient demographics, HU outcomes (Thai EQ-5D-5L), disease activity (Disease Activity Index for Psoriatic Arthritis [DAPSA], the Clinical DAPSA [cDAPSA], the minimal disease activity [MDA]), and the Health Assessment Questionnaire (HAQ) were collected. Regression analyses were used to explore factors associated with each EQ-5D domain, HU, and PASS. RESULTS: Of 129 PsA patients, the mean age was 47.6 years; 53.5% were male. The mean HU was 0.76. Univariable analysis showed lower disease activity and less impaired function were significantly associated with higher HU and no to mild problem in each EQ-5D domain. Multivariable analysis showed HAQ and disease activity indices (cDAPSA, DAPSA, MDA) adjusting for age, had good goodness-of-fit to HU (adjusted R2 : 0.63-0.65). Patients answering "yes" to PASS had significantly longer disease duration of PsA, higher HU, lower disease activity, less disability, and were more often married than those answering "no" to PASS. Pain problem was the most important association to PASS adjusting for other domains and age. CONCLUSIONS: Disease activity and functional status in PsA patients were significant factors related to HU and PASS. To improve quality of life, the goal of treatment should be achieving remission, improving function, and controlling pain.

Improving sixth year medical students' performance in knee arthrocentesis using a synthetic knee model.

AIM: A knee arthrocentesis (KA) workshop using synthetic knee model was arranged for all sixth-year medical students (MS) in our institute to ensure equity in receiving training. We evaluated confidence level and knowledge of KA and synovial fluid analysis testing pre- and post-workshop for MS. METHODS: The workshop was divided into two parts. The first part was to provide knowledge in arthrocentesis and synovial fluid interpretation and the second was a practice session on the synthetic model under supervision. This is a report of pre-and post-workshop self-evaluation about the confidence in performing KA (0-10 scales), improvement of knowledge in KA, and synovial fluid analysis earned from attending the workshop. Pearson χ(2) test or Fisher's exact test was used to compare categorical variables, where appropriate. RESULTS: There were 247 MS attended and 228 (92.3%) evaluated the workshops. Ninety-six (42.1%) MS had experience in KA prior to this workshop. The mean (SD) levels of confidence in performing the procedure before and after the workshop were 3.6 (2.5) and 7.5 (1.7), respectively, P < 0.001. Improvement was shown regardless of previous exposure to KA. Knowledge of appropriate testing for synovial fluid was significantly improved in all items explored after the workshop and extended to the better scores earned from a competency examination. CONCLUSIONS: A hands-on structured workshop using a synthetic knee model for KA is a successful model for improving medical students' confidence in performing the procedure with evidence of sustaining knowledge in short-term follow-up.