respectively. Regardless of whether patients switched treatments, mean 12-month total healthcare costs were significantly lower among those initiating apremilast vs those initiating biologics (all: $28,423 vs 41,178, P<0.0001; switched: $39,803 vs $51,517, P<0.004; did not switch: $25,984 vs $37,717, P<0.0001). CONCLUSIONS: Biologic-naive patients treated with apremilast vs biologics trended towards lower switch rates and significantly lower healthcare costs, even if they switched to a biologic during the 12-month post-index period. Future studies with larger sample sizes are needed to increase our understanding of switch rates.OBJECTIVES: Vertebrogenic disease is the second most common disease that patients are visiting their general practitioner and/or rehabilitation facilities with. Besides direct costs, there are indirect costs incurred during the disease that are often higher than direct costs; hence, they are affecting the results of cost analyses. The aim of this study is to calculate the direct and indirect costs in patients with vertebral algic syndrome, and to analyse the impact of indirect costs on calculations carried out as a part of Health Technology Assessment. METHODS: Quantitative research was conducted using questionnaires distributed to 150 patients, followed by cost of treatment calculation for four selected standard patients according to the type of occupation. The cost analysis consisted of direct and indirect costs calculations from the perspectives of the patient, payer, and healthcare provider. An adjusted Human Capital Approach method was used to calculate indirect costs from the patient's perspective. RESULTS: The indirect costs were higher than the direct costs, ranging from 79.9% to 99% of total costs from the patient's perspective. The lowest indirect costs were CZK 1,966 and the highest ones were CZK 60,989. The indirect costs were studied from the healthcare provider's perspective only if the patient was not questioned out of rehabilitation. These costs were figured out at 61% of the total costs and amounted to CZK 706 for a 30-minute therapy. The direct costs of a rehabilitation cycle per patient were shown to be CZK 7,766 from the payer's perspective. Indirect costs from the perspective of the payer did not arise. CONCLUSIONS: Indirect costs represent a large part of the total costs associated with the provision of health care services, particularly from patient's perspective. Not including these costs into the Health Technology Assessment calculations can greatly influence the results of the analyses.OBJECTIVES: Tofacitinib (TFC) is an oral Janus kinase inhibitor for the treatment of moderately to severely active rheumatoid arthritis (RA). This study was aimed to estimate the cost-effectiveness of tofacitinib versus adalimumab (ADA) from a payer perspective in RA patients for whom with inadequate response or intolerance to methotrexate (MTX) in Iran. METHODS: A cohort-based Markov model was developed using TreeAge pro 2018 to evaluate the lifetime cost-effectiveness of TFC (5 mg...

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The objective of this study was to estimate the costs associated with the management and treatment of osteoporosis in order to assess the economic burden in Italy for 2017, in terms of direct medical costs and social security costs. Methods: A Cost of Illness model was developed to estimate the average cost per year sustained by the NHS and Social Security Sistem in Italy. A Systematic Literature Review was performed to obtain epidemiological, direct and indirect costs parameters where available. Hospitalization costs were calculated considering the administrative database of Hospitalization available in Italy between 2008-2016. Data were extrapolated considering ICD9-CM 733.0 (Osteoporosis) in the primary or secondary diagnosis of each hospitalization. Costs were estimated considering the DRG national tariff associated with each hospitalisation. Finally, the administrative databases of the National Social Security Institute (INPS) (2009-2015) were analysed for the estimate the pension and disability costs from the social perspective. Results: The model estimated an average annual economic burden of osteoporosis in Italy of V 2.2 billion. Of these cost, 79% (V 1.7 billion) was associated to hospitalizations, 17% (V 0.35 billion) for pharmacological treatments, 3% (V 0.07 billion) to outpatients visits, and 1% (V 0.01 billion) to social security costs. The average yearly cost per patient was equal to V 17.557 (V 8.706 for hospitalizations). Analysing severe patients, hospitalization costs increase to V 12,159 (+40% if compared to general osteoporosis patients). Conclusions: The analysis showed that osteoporosis represents one of the main health problems in Italy and the ability to maintain patients in a non-severe health state could decrease the economic burden from both NHS and social perspective.

Objectives: Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatologic disease and can result in life-long disability. New treatments have the potential to alter disease course, however at a potential high cost. Cost-utility analysis (CUA) weighs costs and benefits of interventions to inform decision-making, and is the type of economic evaluation recommended by most HTA guidelines. Health state utility values (HSUV) are used to calculate quality-adjusted life-years (QALYs), the outcome used in CUAs to assess benefit. This systematic review aims to identity papers reporting HSUV to inform parameter inputs for model-based CUA for JIA treatment. Methods: Medline, EMBASE, PsyINFO, EconLit and CINAHL were searched. Inclusion criteria: studies reporting HSUV, targeting children or adults with JIA, and in English language. Abstracts and full-texts were screened independently by two reviewers. A descriptive analysis was conducted, including assessment on whether studies report HSUV stratified by potential treatment-related health states (e.g. disease activity, treatment status) or population subgroup. Results: From 324 identified articles, nine publications were included. Six studies targeted children, and three reported on adults with history of JIA. Children's HSUV were assessed using standard gamble, HUI-3, EQ5D-Y, and EQ5D-3L. Three studies elicited self-reported HSUV from children, and three reported only parent-proxy values. One study reported HSUV for etanercept treatment, and one reported HSUV stratified by disease severity. However, in the latter, HSUV were not distinct between groups. Adult HSUV were measured using EQ5D-3L in all studies. Only one study stratified HSUV by the presence of uveitis, but found no difference between groups. Conclusions: Few studies reporting HSUV were identified, and the majority did not stratify HSUV to allow parameter input for different treatment-related health states. Available data are not sufficient to inform short-term or life-time horizon models. There remains urgent need for rigorous HSUV assessment to inform model-based CUAs in JIA.