Cost-Effectiveness of Secukinumab Versus Other Biologics in the Treatment of Moderate-to-Severe Plaque Psoriasis: The Chinese Healthcare System Perspective.

INTRODUCTION: This study assessed the cost-effectiveness of secukinumab compared with other biologics (adalimumab, infliximab, ustekinumab, ixekizumab, guselkumab, and Yisaipu [etanercept biosimilar]) for moderate-to-severe plaque psoriasis from the Chinese healthcare system perspective. METHODS: A decision-tree (first year)/Markov model (subsequent years), with an annual cycle, was implemented over a lifetime horizon. The Psoriasis Area and Severity Index (PASI) response rate at week 16 was used for treatment response. Efficacy inputs were obtained from a mixed-treatment comparison conducted using data from randomized controlled trials. Other clinical inputs (adverse events, dropout, and mortality rates), utility weights, and costs were derived from published literature and local Chinese sources. Both costs and outcomes were discounted at 5% per annum. Model outcomes included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were conducted to test the robustness of results. RESULTS: For patients with moderate-to-severe psoriasis, secukinumab generated the highest QALYs (12.334) against all comparators at a lifetime cost of ¥231,477. Secukinumab dominated (higher QALYs at lower costs) all other biologics except ixekizumab in this population. Compared with secukinumab, ixekizumab incurred slightly lower costs (¥228,320) but gained lesser QALYs (12.284). Thus, secukinumab was a cost-effective treatment than ixekizumab at a willingness-to-pay (WTP) threshold of ¥257,094 per QALY gained. In the one-way sensitivity analysis, base-case results were most sensitive to changes in the PASI response at 16 weeks and year 2+ dropout rates. CONCLUSION: Secukinumab is the most cost-effective treatment option for patients with moderate-to-severe psoriasis compared with other commonly used biologics from the Chinese healthcare system perspective.

Serial Follow-Up of Two Surgical Strategies for the Repair of Tetralogy of Fallot.

Adverse events following tetralogy of Fallot repair include arrhythmia, reoperation, and death. While limiting the right ventriculotomy mitigates these events over the short and intermediate term, the impact over the long term is unknown. Children requiring tetralogy of Fallot repair were divided into 2 groups: extended right ventriculotomy vs limited right ventriculotomy with transatrial ventricular septal defect closure. Follow-up office ECGs and Holter monitoring, exercise stress tests, and echocardiograms were obtained in the first, second, and third postoperative decades. The primary outcome was cumulative events defined as reoperation, arrhythmia, or death. The extended and limited right ventriculotomy techniques were used in 21 and 17 children, respectively. Cumulative survival was 93.6% at 30 years and was not different between groups. While 10-year (42.9% vs 5.9%, P = 0.02) event rates favored the limited ventriculotomy technique, there were no significant differences at 20 or 25 years. Cox proportional hazard analysis demonstrated that the limited ventriculotomy technique was independently associated with lower events at 10 years (hazard ratio 0.03, 95% confidence interval 0.0016, 0.5697, P = 0.01). The limited ventriculotomy group had greater exercise capacity in the second decade but not the third. Right ventricular end-diastolic diameter Z score was not different at 10 or 20 years, but was significantly smaller in the limited ventriculotomy group at 30 years (5.55 ± 1.69 vs 4.14 ± 0.63, P = 0.03). Limiting the right ventriculotomy during tetralogy of Fallot repair limits 10-year events, improves exercise capacity at 20 years, and attenuates late right ventricular dilation.

Acute myocardial infarction caused by transient coronary vasospasm in a child with Kawasaki disease and no coronary aneurysms.

We report a 15-month old girl with acute myocardial infarction 3 months after treatment for Kawasaki disease (KD); she had no coronary aneurysms. In the first 2 months after KD, she had normal electrocardiograms (ECGs) and echocardiograms that showed mildly dilated coronary arteries. At 3 months, she was asymptomatic but developed ECG changes of anteroseptal MI and increased troponin levels. Echocardiogram showed regional wall-motion abnormalities and decreased left ventricular function. She was admitted and treated with heparin and nitroglycerin drips. Repeat echocardiogram at 24 h showed resolution of wall-motion abnormalities and improved function. Cardiac catheterization showed normal coronary arteries. Her troponin levels normalized within 36 h, and she was discharged on low molecular-weight heparin and aspirin. She has done well since discharge with normal ECGs and echocardiograms during the following 2.5 years. Although coronary vasospasm has been described in young adults with history of KD, we report the first such presentation in a child. This underscores the fact that vascular endothelial dysfunction occurs despite absence of overt coronary aneurysms in patients with KD as well as the need for close follow-up.