Costs associated with psoriasis present a considerable economic burden. A previously published review was lacking comprehensive data on biologics. Therefore, a systematic literature review was performed to gain a comprehensive understanding of the economic burden of psoriasis throughout the world. Studies published in the English language between January 2001 and May 2013 reporting the direct and indirect economic burden of psoriasis were identified from PubMed and conference proceedings. Thirty-five studies from 11 countries met the inclusion criteria. In 2004, the annual total cost (direct and indirect) in the USA alone was approximately US$1.40 billion. Among the European countries, the most recent studies reported an annual total cost per patient of €11,928 in Sweden, €8372 in Italy, €2866-6707 in Germany and CDN$7999 in Canada, based on treatment type. Costs associated with psoriasis are high in many countries, indicating a continued need for treatments that offer good value for money.

ObjectivesPatient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases.MethodsA global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible.ResultsOf 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68–3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20–6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36–3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00–3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16–4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group.ConclusionsPatient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.

BackgroundTo understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).MethodsWe conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.ResultsA total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.ConclusionsThere is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

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Background: With recent advances in CML management, newly-diagnosed chronic phase (CP)-CML patients may expect near-normal life expectancy on TKI treatment. However, patients resistant to prior TKIs and those with advanced disease may face a much poorer prognosis and higher likelihood of CML-related death. Objective: To estimate the proportion of deaths in treatment-resistant and advanced-stage CML attributed to disease progression versus treatment-related adverse events (AEs) and unrelated (background) causes. Methods: We conducted a systematic literature review of PubMed, conference proceedings, and grey literature for relevant articles published between January 1999 and January 2014, reporting cause of death in CML patients treated with an approved TKI after failing 1 (2nd-line) or 2 (3rd-line) prior lines of therapy in CP, or those with advanced or blast-phase disease (AP/BP). We excluded studies that did not report results by disease phase or therapy line and those with poor data quality for investigator-reported cause of death, which was categorized as "CML-related” disease progression, "treatment-related” AE, "unrelated” AE, and "unspecified” AE. Results: We identified 60 studies that qualified for systematic assessment. Among these, 7 reporting 2nd-line (n=1,926 patients), 2 reporting 3rd-line (n=144), and 6 reporting AP/BP (n=634) results met all selection criteria. Overall, 5%, 10% and 21% of 2nd-line, 3rd-line and AP/BP patients, respectively, died during study follow-up. For 2nd-line patients, CML-related was the investigator-reported cause of 44% of deaths, compared with 2% dying of treatment-related causes and the remainder of unrelated (3%) or unspecified (51%) AEs (Figure 1). In 3rd line, 71% of patients died of CML, versus 7% treatment–related, 14% unrelated and 7% unspecified. Similarly, for AP/BP patients, death from disease comprised 54%, versus 5% treatment-related (10% unrelated; 31% unspecified). Although we lacked patient-level follow-up data, we estimated overall yearly death rates of 2%, 6% and 13% for 2nd-line, 3rd-line and AP/BP, respectively, versus US census estimates of <1% for ages 55-64 (Figure 2), indicating substantial excess deaths in these CML populations. In CP, our estimated yearly rate of death from background causes (unrelated or unspecified AEs) was consistent with census estimates, suggesting that misclassification of treatment-related AEs as unrelated did not bias results in CP; background deaths in AP/BP were higher than expected, given shorter on-study survival. Conclusions: Published data suggest the frequency of death due to CML is nearly 10 times that from treatment-related AEs in patients with resistant and advanced disease. Potential benefits of effective treatment for these patients may outweigh potential risks of treatment-induced AEs. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures McGarry: ARIAD Pharmaceuticals, Inc.: Employment, Equity Ownership. Burudpakdee:ARIAD Pharmaceuticals, Inc.: Consultancy. Gala:ARIAD Pharmaceuticals, Inc: Consultancy. Seetasith:ARIAD Pharmaceuticals, Inc: Consultancy. Nanavaty:ARIAD Pharmaceuticals, Inc: Consultancy. Huang:ARIAD Pharmaceuticals, Inc.: Employment, Equity Ownership.