Cost-effectiveness of secukinumab as first biologic treatment, compared with other biologics, for moderate to severe psoriasis in Germany.

BACKGROUND: Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin 17A, has demonstrated strong and sustained efficacy in adults with moderate to severe psoriasis in clinical trials. OBJECTIVE: This analysis compared the cost per responder of secukinumab as first biologic treatment of moderate to severe psoriasis, with adalimumab, infliximab, etanercept and ustekinumab in Germany. METHODS: A 52-week decision-tree model was developed. Response to treatment was assessed based on the likelihood of achieving a predefined Psoriasis Area and Severity Index (PASI) response to separate the cohort into responders (PASI ≥75), partial responders (PASI 50 to 74) and non-responders (PASI <50). Responders at week 16 continued initial treatment, whereas partial responders and non-responders were switched to standard of care, which included methotrexate, cyclosporine, phototherapy and topical corticosteroids. Sustained response was defined as 16-week response maintained at week 52. A German healthcare system perspective was adopted. Clinical efficacy data were obtained from a mixed-treatment comparison; 2016 resource unit costs from national sources; and adverse events and discontinuation rates from the literature. We calculated cost per PASI 90 responder over week 16 and week 52, as well as cost per sustained responder between weeks 16 and 52. RESULTS: Secukinumab had the lowest cost per PASI 90 responder over 16 weeks (€18 026) compared with ustekinumab (€18 080), adalimumab (€23 499), infliximab (€29 599) and etanercept (€34 037). Over 52 weeks, costs per PASI 90 responder ranged from €42 409 (secukinumab) to €70 363 (etanercept). Likewise, secukinumab had the lowest cost per sustained 52-week PASI 90 responder (€22 690) compared with other biologic treatments. Sensitivity analyses, excluding patient copayments, showed similar results. CONCLUSIONS: First biologic treatment with secukinumab for moderate to severe psoriasis is cost-effective, with lowest cost per responder compared with other biologic treatments in Germany.

Increasing density and Borrelia burgdorferi infection of deer-infesting Ixodes dammini (Acari: Ixodidae) in Maryland.

A statewide survey of Ixodes dammini Spielman was done in November 1991 as a follow-up to a study in 1989. In total, 3,434 adult ticks were collected from 922 hunter-killed white-tailed deer processed at 22 check stations (1 per county in 22 of 23 counties in the state). Significantly more male than female ticks were collected. Tick infestation was significantly heavier on male than female deer. The pattern of tick distribution was similar to that in 1989, with low prevalence (percentage tick-infested deer) and abundance (mean ticks per deer) in the Appalachian region, moderate values in the Piedmont, and high values in the western and eastern Coastal Plains regions. The pattern of tick infection with Borrelia burgdorferi spirochetes (determined by polyclonal immunofluorescence assay) was similar to the tick distributional pattern. Overall, tick prevalence and abundance were higher in 1991 than in 1989, as was the spirochete infection rate in ticks. Multiple regression analysis of tick prevalence against six selected physical and biotic parameters (elevation, rainfall, summer and winter temperature, percentage of forest land, deer density) showed a significant relationship with rainfall and elevation in 1989 and elevation alone in 1991. A more extensive study in Caroline and Dorchester counties in the eastern Coastal Plains region (which showed exceptionally low tick density indices in a generally tick-abundant region in 1989) demonstrated that I. dammini was well established in Caroline but not in Dorchester County.

Field evaluation of two formulations of cyfluthrin for control of Ixodes dammini and Amblyomma americanum (Acari: Ixodidae).

Liquid or granular cyfluthrin was applied in the spring and fall to different test plots at a rate of 0.41 (AI) kg/ha to control Ixodes dammini Spielman, Clifford, Piesman & Corwin and Amblyomma americanum (L.). Spring application of liquid cyfluthrin showed the most significant decreases of both species. I. dammini nymphs were reduced 97% at 10 d, 100% at 2 mo, and 100% at 1 yr; and A. americanum adults and nymphs were reduced 91-93% at 10 d and 100% at 2 mo posttreatment. Granular cyfluthrin applied in the spring gave 97 and 87% control of nymphal I. dammini 10 d and 2 mo posttreatment, respectively.

Cluster of tick-borne infections at Fort Chaffee, Arkansas: Rickettsiae and Borrelia burgdorferi in ixodid ticks.

Human intrusion into pristine habitats increases the likelihood of acquiring infectious agents from potentially infective ticks. As part of a larger human serological investigation into tick-borne illnesses, 3,000 ixodid ticks were collected during May, August, and November 1990 at Fort Chaffee, Arkansas. Ticks were examined to determine whether they harbor rickettsiae, ehrlichiae, and Borrelia burgdorferi, and to assess relationship to human exposure to tick-borne infections at Fort Chaffee, Ark. The overall tick infection rates with SFG rickettsiae, B. burgdorferi, and ehrlichiae were 4.8, 0.1, and 0.3%, respectively.

Quantitative evaluation of sampling methods for Ixodes dammini and Amblyomma americanum (Acari: Ixodidae).

Three tick-sampling methods (dry ice-baited tick traps, cloth drags, and ambulatory human host) were evaluated to determine which technique yielded the greatest capture of host-seeking stages of Ixodes dammini Spielman, Clifford, Piesman & Corwin and Amblyomma americanum (L.). The most reliable method, catching more stages and significantly more numbers of I. dammini and A. americanum; was dry ice-baited tick traps. There were no significant differences between the drag and human-host methods for any stage of ticks (I. dammini and A. americanum) collected. The numbers of ticks caught during the study were 5,052 by dry ice-baited tick traps, 199 by cloth drags, and 89 by ambulatory human host.

Distribution, density, and Lyme disease spirochete infection in Ixodes dammini (Acari: Ixodidae) on white-tailed deer in Maryland.

A Statewide survey of ticks parasitizing white-tailed deer was carried out in Maryland during November 1989 to assess the status of the deer tick, Ixodes dammini Spielman, Clifford, Piesman & Corwin, the major vector of Lyme disease in the northeastern United States. Ticks were collected from deer carcasses brought in by hunters at 23 check stations (one per county). A total of 3,437 I. dammini were collected from 538 of 1,281 deer (42%), together with 2,013 Dermacentor albipictus (Packard) and 23 Amblyomma americanum (L.) from 34 and 0.5% of deer respectively. I. dammini prevalence ranged from 0 to 79% of deer and mean abundance from 0 to 7.3 ticks per deer at different check stations. Lyme spirochete, Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner, infection rates in ticks ranged from 0 to 21%, with a mean of 8%. Deer-tick density and spirochete infection rates varied with physiographic region and were low in the Appalachian, intermediate in the Piedmont, and high in the Western and Eastern Coastal Plains regions. County-based human case rates correlated positively with I. dammini abundance. We concluded that I. dammini was well established except in the mountainous western region of Maryland and was involved in Lyme disease transmission.

Reduction of the Amblyomma americanum (Acari: Ixodidae) population at Fort A.P. Hill, Virginia, by aerial application of diazinon granules: correlation of percentage control with received dose.

Habitat (280 ha) of lone star tick, Amblyomma americanum (L.), was aerially treated with 14% diazinon granules. Concentration of acaricide reaching the forest floor ranged from 0.02 to 1.25 kg (AI)/ha. Greater than 85% control was achieved at study plots receiving the highest dose. A positive correlation was shown between dose received at the forest floor and percentage of control of adults (r = 0.91) and nymphs (r = 0.86).