IntroductionPsoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients.MethodsThis is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement).ResultsA total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). “Anxiety and depression” and “pain and discomfort” were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for “symptoms and feelings” [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%.ConclusionsResults evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment.FundingNovartis Biociências S.A.Electronic supplementary materialThe online version of this article (10.1007/s12325-019-01049-7) contains supplementary material, which is available to authorized users.

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Objectives: Ixekizumab (IXE) is a high-affinity monoclonal antibody that selectively targets interleukin-17A and has demonstrated superiority to ustekinumab (UST) at 12 weeks. Bothersome symptoms through 24 weeks are presented. MethOds: In this trial (IXORA-S, NCT02561806), patients were randomized (1:1) to receive either IXE (160-mg starting dose, then 80-mg every 2 weeks for 12 weeks followed by 80-mg every 4 weeks; N= 136) or UST (45-mg/90-mg weight-based dosing per label; N= 166). At Week 12 and 24, categorical data were assessed using non-responder imputation (NRI). Itch and skin pain were measured using a 0-10 numeric rating scale (0= no itch, 10= worst itch imaginable) and 100mm visual analog scale (VAS) (0= no pain; 100 worst pain imaginable) in previous 24 hours, respectively. The proportions reaching 0 for itch and skin pain between treatment groups at each time point (except week 12 and week 24) were compared using Fisher's Exact test (NRI). Results: At baseline, 2.2% of IXE-treated and 2.4% of UST-treated patients reported no itching; and no skin pain for 8.8% of IXE and 12% of UST patients was reported. At weeks 4, 8 and 16, statistically, significantly greater proportions of IXEtreated patients vs. UST patients achieved complete reduction in itching. By week 24, the proportions of IXE vs. UST patients who indicated no itching were 46.3% vs. 33.7% (p= 0.051). For skin pain, at weeks 2, 4, 8 and 16, statistically significantly greater proportions of IXE patients reported no skin pain compared to UST patients; while by week 24 the proportions of patients indicating no pain were 48.5% (IXE) vs. 36.1% (UST) (p= 0.051). cOnclusiOns: Psoriasis symptoms of itching and skin pain were resolved early with IXE treatment compared to UST, while the proportions with complete resolution between treatments converged by week 24.

Objectives: Universal childhood vaccination (UVV) against varicella has not been implemented in Chile. The benefits and costs of introducing UVV under various possible vaccination scenarios were explored through modelling. MethOds: A dynamic transmission model of varicella infection, with proportionate mixing in a static population, and with time, age, and vaccination-status varying force of infection, was calibrated based on the Chilean population and Argentinean seroprevalence data. Rates of healthcare utilization and costs were from a recent observational study. Five vaccination strategies based on the current vaccination visits in the pediatric vaccination programme were considered, with first dose given at either 12 months (90% coverage) or 18 months (85% coverage), and a second dose either not administered, or given at 18 months (85% coverage)or 6 years (85% coverage). Three different types of varicella vaccines (highly-, moderately-, and weakly-effective) were hypothesized. The resulting 15 vaccination scenarios were compared to a novaccination scenario. Benefits and costs were calculated from the payer and societal perspectives over a 25-year time horizon, and discounted at 3% annually. Results: The model estimated over 200,000 varicella cases annually in Chile in the absence of varicella vaccination. All vaccination scenarios reduced the number of cases by 86.0-99.7% and all were cost-saving. One-dose strategies with a highly-or moderatelyeffective vaccine were the most cost-saving scenarios, saving $239M-$252M over 25 years. Cost-benefit ratios were 2.63-3.53 for one-dose and 1.92-2.52 for two-dose scenarios. The optimum vaccination scenario from a cost perspective was one dose at 12 months with 90% coverage; two doses given at 12 and 18 months reduced morbidity and mortality the most. cOnclusiOns: Both one-and two-dose UVV programs are predicted to be cost-saving in Chile. The optimum strategy based on cost-benefit ratios from a societal perspective is vaccination with a single dose of a highly-or moderately-effective varicella vaccine at 12 months.

Introduction. Multiple sclerosis (MS) is an autoimmune disease that leads to demyelination of the central nervous system, compromising its functions. Although the course of MS is variable, it is a naturally progressive disease, which has accelerated neurological deterioration in most patients. Treatment pattern studies are important to understand the real-world practice and clinical outcomes. Objective. The aim of this study was to describe treatment patterns among patients with MS in the Brazilian public healthcare system. Method. A retrospective cohort study was carried out through the analysis of secondary data from 2008 to 2020. To compare the clinical practice with that recommended by the Clinical Protocols and Therapeutic Guidelines (PCDT) over the years, the treatment analyzes were fragmented into 2008-2014, 2015-2017, and 2018-2020. The data was obtained from Brazilian National Health System, which is a real-world anonymized database. Results. MS patients were identified by the G35 code on International Classification of the Diseases 10th edition and with code 340 on 9th edition. The incidence and prevalence rates were calculated by years, in 2020 the incidence rate was 1.7 per 100,000 population. Conclusions. Regarding the treatment patterns, beta-interferon was the most common first-line prescribed medication for MS in all the three analyzed periods, followed by glatiramer acetate. Glatiramer was the most frequently prescribed second-line treatment only in the first extracted period (2008–2014).