Scarce blood products must be used wisely. Romiplostim can allow for improved healthcare resource allocation by reserving IVIg for use in other areas of greater need while also providing cost savings for the overall provincial healthcare budget.

BackgroundThe REFINE study examined the efficacy and safety of adding topical corticosteroid therapy to etanercept when stepping down from the initial dose of etanercept to the maintenance dose. Clinical responses were shown to be similar in patients who remained on etanercept 50 mg twice weekly (BIW) and those who received etanercept 50 mg once weekly (QW) plus topical therapies through week 24.ObjectiveThe purpose of this analysis was to evaluate the effect of treatment on health‐related quality of life (HRQoL) for patients in REFINE.MethodsAll patients received etanercept 50 mg BIW for 12 weeks and were then randomized to etanercept 50 mg BIW or etanercept 50 mg QW plus topical corticosteroid as required to clear through week 24. HRQoL measures included the Dermatology Life Quality Index (DLQI), Treatment Satisfaction Questionnaire for Medication (TSQM) and the Economic Implications of Psoriasis Patient Questionnaire. No comparative testing was performed for this descriptive analysis. Missing data were imputed using the last observation carried forward.ResultsFor 287 randomized patients (144 etanercept; 143 etanercept plus topical), the mean change [standard deviation (SD)] in DLQI from baseline to week 24 was 10.7 (7.8) for etanercept and 9.9 (6.9) for etanercept plus topical. Mean change (SD) in TSQM effectiveness, convenience, side‐effects and global satisfaction was 27.1 (36.1), 14.8 (25.9), −0.7 (22.0) and 26.7 (32.5) for the etanercept arm and 32.5 (40.3), 18.5 (29.0), 1.3 (19.4) and 28.4 (35.9) for etanercept plus topical. Economic implications, including healthcare visits, employment status, work productivity, ability to perform daily activities and out‐of‐pocket expenses were similar between treatment arms.ConclusionAt week 24 of REFINE, measures of HRQoL were numerically similar in patients who stayed on etanercept 50 mg BIW and patients who received etanercept 50 mg QW plus topical therapies.

Objective:To compare anti-TNF dose escalation, DMARD and/or glucocorticoid intensification, switches to another biologic, and drug and drug-related costs over 12 and 18 months for rheumatoid arthritis (RA) patients initiating etanercept (ETN), adalimumab (ADA), or infliximab (IFX) in routine clinical practice across Canada.Methods:A retrospective chart review of biologic-naïve adult RA patients newly initiating ADA, ETN, or IFX between January 01, 2006 and December 31, 2012 from 11 practices across Canada.Results:There were 314 patients in the 12-month analysis and 217 in the 18-month analysis. No dose escalation occurred with ETN over 12 and 18 months versus 38% and 32% for IFX (p<0.001) and 2% and 2% for ADA (p=0.199, p=0.218). Over 18 months, dose escalation and/or DMARD and/or glucocorticoid intensification was less frequent among ETN (16%) versus IFX (44%, p=0.005) and ADA (34%, p=0.004). By 18 months, 22% of patients initiating ADA had switched to another biologic compared with 6% of ETN patients (p=0.001).Patients initiating ETN had lower total (drug and drug-related) costs over 12 and 18 months compared to IFX, and no difference compared to ADA when adjusted for potential confounders. Patients with dose escalation had higher costs compared to those with no dose escalation.Conclusion:Physicians were more likely to escalate the dose of IFX, but optimize co-therapy with ADA and ETN. ETN patients had no dose escalation and were less likely to have DMARD and/or glucocorticoid intensification than ADA patients. ETN-treated patients had lower costs compared to IFX patients.

The hospitals included in this analysis were mainly urban (n= 4) and non-academic (n= 4), with two in the South, two in the Northeast, and one in the West; each hospital 187-465 THA patients who received BLIS (total 1,534) and 353-585 controls (total 2,295). Gender and Charlson Comorbidity Index (CCI) were similar but the BLIS group had more whites (82.5% vs. 57.3%) and was younger (72.0 vs. 73.1). In univariate analyses, total hospital costs were $552 lower ($16,268 vs. $16,820; p< 0.001) with BLIS. In GLMM using hospital for random effects as well as age, gender, race, and CCI, total hospital costs were estimated to be $919 lower (p< 0.001) in the BLIS group. ConClusions: Total hospital costs for THA were significantly lower when using BLIS to manage postsurgical pain in Medicare patients. Use of BLIS could contribute to reducing total hospital costs under the new CJR program starting 4/1/2016.

exceeding the FDA label recommendations of ADA 40 mg biweekly, ETN 50 mg weekly, and UST 45 mg every 12 weeks. RESULTS: In total, 15,400 PsA patients and 40,545 PSO patients met the inclusion criteria. The number (proportion) of patients receiving increased maintenance doses for PsA was1,603 of 8,908 (18%) for ADA and 1,300 of 7,647 (17%) for ETN. The number (proportion) of patients receiving increased maintenance doses for PSO was 3,187 of 21,234 (15%) for ADA; 5,201 of 16,318 (32%) for ETN; and 3,136 of 6,915 (45%) for UST. CONCLUSIONS: A large subgroup of patients treated with commonly used biologic agents is maintained on increased maintenance doses.