The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

IntroductionOn July 1, 2011, the Chinese government launched a national Action Plan for antibiotic stewardship targeting antibiotic misuse in public hospitals. The aim of this study was to evaluate the impacts of the Action Plan in terms of frequency and intensity of antibiotic utilization and patients costs in public general hospitals.MethodsAdministrative pharmacy data from July 2010 to June 2014 were sampled from 65 public general hospitals and divided into three segments: (1) July 2010 to June 2011 as the preparation period; (2) July 2011 to June 2012 as the intervention period; and (3) July 2012 to June 2014 as the assessment period. The outcome measures included (1) antibiotic prescribing rates; (2) intensity of antibiotic consumption; (3) patients costs; and (4) duration of peri-operative antibiotic treatment in clean surgeries of thyroidectomy, breast, hernia, and orthopedic procedures. Longitudinal and cross-sectional analyses were conducted.ResultsLongitudinal analyses showed significant trend changes in the frequency and intensity of antibiotic consumption, the patients’ costs on antibiotics, and the duration of antibiotic treatment received by surgical patients undergoing the 4 clean procedures during the intervention period. Cross-sectional analyses showed that the antibiotic prescribing rates were reduced to 35.3% and 12.9% in inpatient and outpatient settings, that the intensity of antibiotic consumption was reduced to 35.9 DDD/100 bed-days, that patients’ costs on antibiotics were reduced significantly, and that the duration of peri-operative antibiotic treatment received by surgical patients undergoing the 4 types of clean procedures decreased to less than 24 hour during the assessment period.ConclusionThe Action Plan, as a combination of managerial and professional strategies, was effective in reducing the frequency and intensity of antibiotic consumption, patients’ costs on antibiotics, and the duration of peri-operative antibiotic treatment in the 4 clean surgeries.

Objectives Body mass index (BMI) is commonly used in obesity classification as a surrogate measure and obesity is associated with a cluster of risk factors for cardiovascular disease. The aim of this study was to investigate BMI on short-term outcomes after cardiac surgery. Design A retrospective cohort study. Setting University teaching hospital, two centers. Participants The study consisted of 4,740 patients who underwent cardiac surgery of two hospitals from July 1, 2001 to June 30, 2013 in one hospital and from September 1, 2003 to August 31, 2014 in another hospital were included in this study. Interventions No changes to standard practice were required. Measurements and Main Results They were assigned into six BMI groups as follows: Underweight BMI < 18.5 kg/m2), Normal weight (18.5 ≤ BMI < 25 kg/m2), Overweight (25 ≤ BMI < 30 kg/m2), Class I (30 ≤ BMI < 35 kg/m2), Class II (35 ≤ BMI < 40 kg/m2) and Class III obese (BMI ≥ 40 kg/m2). Short-term major postoperative complications (post-operative stroke, cardiac arrest, new atrial fibrillation/flutter, permanent rhythm device insertion, deep sternal infection, sepsis, prolonged ventilation, pneumonia, renal dialysis, renal failure, ICU readmission, total ICU hours and readmission in 30 days) and mortalities (in-hospital mortality, 30-day mortality, operative mortality) were compared among various BMI groups after cardiac surgery. Age, gender, surgery type, family history of CAD, diabetes, hypertension, heart failure and lipid lowering medication were the risk factors for early outcomes. Multiple logistic regression analysis indicated that being Underweight or Class III obese may present with significant differences of some short-term outcomes, including deep sternal infection, prolonged ventilation, new atrial fibrillation/flutter and renal failure. However, being Overweight or Class I obese has a positive impact on discharge mortality and operative mortality. Conclusions The results of this study demonstrated that extreme obesity and underweight were significantly associated with early major adverse clinical outcomes. However, there was an “obese paradox” in short-term mortality after cardiac surgery.