Ebola epidemics constitute serious public health emergencies. Multiple vaccines are under development to prevent these epidemics and avoid the associated morbidity and mortality. Assessing the potential impact of these vaccines on morbidity and mortality of Ebola is essential for devising prevention strategies. A mean-field compartmental stochastic model was developed for this purpose and validated by simulating the 2014 Sierra Leone epidemic. We assessed the impacts of prophylactic vaccination of healthcare workers (HCW) both alone and in combination with the vaccination of the general population (entire susceptible population other than HCW). The model simulated 8,706 (95% confidence intervals [CI]: 478-21,942) cases and 3,575 (95%CI: 179-9,031) deaths in Sierra Leone, in line with WHO-reported statistics for the 2014 epidemic (8,704 cases and 3,587 deaths). Relative to this base case, the model then estimated that prophylactic vaccination of only 10% of HCW will avert 12% (95% CI: 6%-14%) of overall cases and deaths, while vaccination of 30% of HCW will avert 34% of overall cases (95% CI: 30%-64%) and deaths (95% CI: 30%-65%). Prophylactic vaccination of 1% and 5% of the general population in addition to vaccinating 30% of HCW was estimated to result in reduction in cases by 44% (95% CI: 39%-61%) and 72% (95% CI: 68%-84%) respectively, and deaths by 45% (95% CI: 40%-61%) and 74% (95% CI: 70%-85%) respectively. Prophylactic vaccination of even small proportions of HCW is estimated to significantly reduce incidence of Ebola and associated mortality. The effect is greatly enhanced by the additional vaccination even of small percentages of the general population. These findings could be used to inform the planning of prevention strategies.

Background: Currently available injectable agents are inadequate to address the high drug-resistant tuberculosis (DR-TB) burden in China. Regimens including the oral agent bedaquiline have been shown to be efficacious and safe, leading to its incorporation into multiple national TB treatment programs. This analysis evaluated the impact of increased adoption of bedaquiline-containing regimens on the DR-TB burden in China. Methods: A state-transition model was developed that permits movement and interaction between susceptible, latent, and active TB disease states, while distinguishing between drug-sensitive (DS) and DR-TB. Model inputs were obtained from the published literature or derived such that model metrics approximated those published by the WHO. Expected improvements in infrastructure were built into the model to forecast the epidemiology of DR-TB in China through 2040 in the absence of bedaquiline (baseline forecast). The impact of higher utilization of bedaquiline-containing regimens (85% peak share) was then assessed in two scenarios that differed with regard to treatment success rates of the regimens: 61% (reflecting findings of clinical trials) and 80% (reflecting data from observational studies), versus the 44% success rate associated with standard-of-care treatment. Results: In the baseline scenario, the model predicted increases in annual incidence of DR-TB by 6-8% during each five-year period between 2020 and 2040, with an increase of 30% over the entire study duration. Adoption of bedaquiline-based regimens limits the incidence increases to only 1-3% in each five-year period and to 8% over the study duration in the 61% success rate scenario. Incidence declines by 1-6% during each five-year period and by 12% over the study duration in the 80% success rate scenario. Similar effects on DR-TB prevalence (4-5% increase in baseline, 0-7% decline in scenario 1, and 4-19% decline in scenario 2) and mortality (5-7% increase in baseline, 0-16% decline in scenario 1, and 6-40% decline in scenario 2) were seen following bedaquiline adoption. Conclusions: Incorporation of bedaquiline into DR-TB treatment regimens will significantly reduce the DR-TB burden in China, helping to counter the expected increase in burden in the absence of bedaquiline. The study will provide valuable information to public health policy planners.

Background Monoclonal antibodies targeting the cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) (e.g., ipilimumab [IPI]) and the programmed cell death-1 (PD1) receptor (e.g., nivolumab [NIVO]) represent significant breakthroughs in the treatment of advanced melanoma. A combination of the 2 agents has demonstrated efficacy and survival benefits over NIVO or IPI monotherapy in treating advanced melanoma. We compared melanoma-specific costs following treatment with NIVO + IPI, NIVO monotherapy, or IPI monotherapy from the UK and German perspectives to ascertain whether these clinical benefits resulted in a cost advantage. Methods Patient-level resource utilization data for the three treatment cohorts were obtained from the CheckMate 067 trial (NCT01844505). All melanoma-specific resources, including drugs (index, concomitant and subsequent melanoma medications), office visits, emergency room visits, hospitalizations, lab tests, procedures and surgeries, utilized over a 48-month evaluation period after start of index treatment were included. Unit costs specific to each geography were applied from external sources. Mean costs per surviving patients were calculated for each successive 30-day period from treatment start and aggregated over the evaluation period. Results The total per-patient costs incurred by advanced melanoma patients over the 48-month period following treatment initiation with NIVO + IPI were 9% lower than NIVO monotherapy (£226k vs £248k) and 3% lower compared to IPI monotherapy (£226k vs. £233k) in the UK. In Germany, the total costs incurred by NIVO + IPI cohort were 5% lower than NIVO monotherapy (€258k vs €271k) and 4% lower compared to IPI monotherapy (€258k vs. €268k). Drug costs accounted for > 85% of total costs. Non-drug costs were slightly higher for NIVO + IPI and IPI monotherapy because of higher hospitalization rates. Costs incurred on subsequent drugs post progression were about 45% and 65% lower in NIVO + IPI cohort compared with NIVO and IPI monotherapy cohorts respectively. Conclusions The total costs incurred by a patient over a 48-month period following treatment initiation with NIVO + IPI are lower when compared with patients initiating monotherapies; further, the cost advantage is seen to be increasing over time. The clinical benefits offered by the regimen are thus supplemented by a cost advantage, as patients receiving either monotherapy treatment experience faster progression and, consequently, higher subsequent treatment costs. (Note: The cost results reported here are specific to the UK, and Germany, and may not be generalizable to other geographies). Electronic supplementary material The online version of this article (10.1186/s40164-019-0138-9) contains supplementary material, which is available to authorized users.

Objectives: To evaluate treatment sequences and associated costs among patients with relapsed/refractory multiple myeloma (RRMM). MethOds: Patients with RRMM between January 2007 and September 2013 were identified from US MarketScan databases. Outcomes included treatment regimen per line (L; 2-4L), sequences of treatment regimens, and cost per line and of progression (2L vs > 2L). All-cause and MM-specific monthly costs captured inpatient, outpatient, emergency department, and drug-related costs, adjusted for censoring. Results: 4449 MM patients initiated a 2L regimen, of whom 38% (n= 1696) progressed to 3L and 15% (n= 689) progressed to 4L. Median follow-up was 14 months (range 1-83). The most frequent 2L regimens were lenalidomide (18%), lenalidomide-dexamethasone (12%), bortezomib-dexamethasone (12%), bortezomib-lenalidomide-dexamethasone (10%), and bortezomib (7%). Of patients whose prior therapy included an immunomodulatory drug (IMiD) (n= 1752), bortezomib-dexamethasone was the most common 2L regimen (17%); for those with no prior IMiD exposure (n= 2697), lenalidomide was the most common 2L (23%). Median time to start of 3L was 5.8 months. Among the 27% of lenalidomide 2L patients who progressed to 3L, 64% had bortezomib-based regimens in 3L. Among the 47% of bortezomib-dexamethasone 2L patients who progressed to 3L, 63% had lenalidomide-based regimens in 3L. MM-specific costs were highest for all patients during the first year of 2L: $122,960 versus $74,573 (12-24 mths), $68,940 (24-36 mths), $59,327 (36+ mths). Drug-related costs accounted for 39-62%, and were dependent on regimen and treatment line. During 0-36 mths, MM-specific costs after progression from 2L were higher by $122,823 compared with costs incurred on 2L. cOnclusiOns: In this study of RRMM patients, 38% progressed to subsequent treatment lines, with variability in 2L regimens and treatment sequences. Highest costs were incurred during the first 12 months of follow-up. The cost of managing progressive disease in RRMM is high, as observed by the difference in costs before and after progression. PCN119 TreaTmeNT STraTegieS, healTh Care reSourCe uSe aNd CoSTS of aggreSSive hiSTologiCal TyPeS of NoN-hodgkiN lymPhomaS iN The Slovak rePubliC. reSulTS from The CroSS-SeCTioNal Survey iN The haemaTology-oNCologiCal CeNTerS

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