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We aimed to evaluate the cost-effectiveness of certolizumab pegol (CZP), a pegylated fc-free anti-TNF, as add-on therapy to methotrexate (MTX) versus etanercept, adalimumab, or golimumab in patients with moderate-to-severe active rheumatoid arthritis (RA) not responding to the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). A Markov model (6-month cycle length) assessed health and cost outcomes of CZP versus other anti-TNFs recommended for RA in Greece over a patient's lifetime. Following discontinuation of first-line anti-TNF, patients switched to second anti-TNF and then to a biologic with another mode of action. Sequential use of csDMARDs followed third biologic. Clinical data and utilities were extracted from published literature. Analysis was conducted from third-party payer perspective in Greece. Costs (drug acquisition, administration, monitoring, and patient management) were considered for 2014. Results presented are incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY). Probabilistic sensitivity analysis (PSA) ascertained robustness of base-case findings. Base-case analysis indicated that CZP+MTX was more costly and more effective compared with Etanercept+MTX (base-case ICER: €3,177 per QALY), whilst versus adalimumab/golimumab, CZP was dominant (less costly, more effective). For all comparisons, CZP treatment resulted in greater improvements in life expectancy and QALYs. PSA indicated that at the willingness-to-pay threshold of €34,000/QALY, CZP+MTX was associated with a 71.6, 97.9, or 99.2% probability of being cost-effective versus etanercept, golimumab, or adalimumab, respectively, in combination with MTX. This analysis demonstrates CZP+MTX to be a cost-effective alternative over Etanercept+MTX and a dominant option over Adalimumab+MTX and Golimumab+MTX for management of RA in Greece.

Natural stone is a durable construction material which has been used through centuries for various types of structures. These structures are exposed to corrosive and degradation factors such as climate change and pollution, natural ageing, earthquake actions, increasing urbanization and even human negligence, potentially exposing them to irreversible structural damage and loss. Considering the large number of traditional structures and the historic value of a great number of stone masonry structures, the necessity of maintenance, repair, retrofit and restoration of stone masonry structures is imposed. The process which leads to the preservation of such structures consists of three stages: 1) the in-situ and laboratory study of the degree of damage and of the factors which cause the natural damages on the materials of these buildings, 2) the detailed drawing of the layout and the elevations. This stage also includes the selection of the appropriate measures for the maintenance and retrofits according to the special characteristics of the structure and the design of the intervention method, and 3) the execution of all the intervention works. This paper presents a description of various types of natural stones found in Cyprus, the most commonly used construction methods as well as methods for the retrofit of stone masonry structures.