Cost-savings for biosimilars in the United States: a theoretical framework and budget impact case study application using filgrastim

Abstract Background Group A streptococcal (GAS) pharyngitis is common in the United States (US). Each year, approximately 12 million people seek medical care for pharyngitis, accounting for ~2% of ambulatory care visits. The gold standard method for diagnosing GAS is culture. However, because culture is time intensive, rapid antigen detection tests (RADTs), with or without culture confirmation, are commonly used. Although RADTs provide results quickly, test sensitivity has been shown to be sub-optimal, which can lead to inappropriate treatment decisions. Recently, highly sensitive point-of-care nucleic acid amplification tests (POC NAAT), such as the cobas® Liat® System, have emerged. The objective of this study was to evaluate the cost-effectiveness (CE) and budget impact (BI) of adopting POC NAAT compared with RADT+culture confirmation to diagnose GAS pharyngitis from the US third-party payer perspective. Methods A decision-tree economic model was developed in Microsoft Excel to quantify costs and clinical outcomes associated with POC NAAT and RADT+culture over a one-year period. All model inputs were derived from published literature and public databases. Model outputs included costs and clinical effects measured as quality-adjusted life days (QALDs) lost. One-way and probabilistic sensitivity analyses were performed to assess the impact of uncertainty on results. Results CE analysis showed that POC NAAT would cost $44 per patient compared with $78 with RADT+ culture. POC NAAT was associated with fewer QALDs lost relative to RADT+ culture. Therefore, POC NAAT may be considered the “dominant” strategy (i.e., lower costs and higher effectiveness). Findings were robust in sensitivity analyses. BI analysis showed that adopting POC NAAT for diagnosis of GAS could yield cost-savings of 0.3% vs. current budget over 3 years. This is due to savings associated with testing, GAS-related complications, antibiotic treatment and treatment-associated complication costs. Conclusion Results suggest that adopting POC NAAT to diagnose GAS would be considered cost-effective and yield cost-savings for US payers relative to RADT+culture. Access to POC NAAT would be important to optimize appropriate GAS diagnosis and treatment decisions. Disclosures All authors: No reported disclosures.

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Clinical Benefits and Budget Impact of Lenzilumab plus Standard of Care Compared with Standard of Care Alone for the Treatment of Hospitalized Patients with COVID-19 in the United States from the Hospital Perspective

10.1101/2021.10.06.21264651 ◽

2021 ◽

Author(s):

Adrian Kilcoyne ◽

Edward Jordan ◽

Allen Zhou ◽

Kimberly A. Thomas ◽

Alicia N. Pepper ◽

...

Keyword(s):

United States ◽

African American ◽

Budget Impact ◽

Cost Savings ◽

Standard Of Care ◽

The United States ◽

Base Case ◽

Index Hospitalization ◽

Hospital Perspective ◽

Clinical Benefits

Aims: The study estimated the clinical benefits and budget impact of lenzilumab plus standard of care (SOC) compared with SOC alone in the treatment of hospitalized COVID-19 patients from the United States hospital perspective. Materials and Methods: An economic model was developed to estimate the clinical benefits and costs for an average newly hospitalized COVID-19 patient, with a 28-day time horizon for the index hospitalization. Clinical outcomes from the LIVE-AIR trial included failure to achieve survival without ventilation (SWOV), mortality, time to recovery, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) use. Base case costs included drug acquisition and administration for lenzilumab and hospital resource costs based on the level of care required. The inclusion of 1-year rehospitalization costs was examined in a scenario analysis. Results: In the base case and all scenarios, treatment with lenzilumab plus SOC improved all specified clinical outcomes over SOC alone. Adding lenzilumab to SOC was also estimated to result in cost savings of $3,190 per patient in a population aged <85 years with CRP <150 mg/L and receiving remdesivir (base case). Per-patient cost savings were also estimated in the following scenarios: 1) aged <85 years with CRP <150 mg/L, with or without remdesivir ($1,858); 2) Black and African American patients with CRP <150 mg/L ($13,154); and 3) Black and African American patients from the full population ($2,763). In the full mITT population, a budget impact of $4,952 was estimated. When adding rehospitalization costs to the index hospitalization, a total per-patient cost savings of $5,154 was estimated. Conclusions: The results highlight the clinical benefits for SWOV, ventilator use, time to recovery, mortality, time in ICU, and time on IMV, in addition to a favorable budget impact from the United States hospital perspective associated with adding lenzilumab to SOC for patients with COVID-19 pneumonia.

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Gendered differences in emigration and mobility perspectives among European researchers working abroad

MIGRATION LETTERS ◽

10.33182/ml.v7i1.178 ◽

2014 ◽

Vol 7 (1) ◽

pp. 33-41 ◽

Cited By ~ 3

Author(s):

Elisabeth Scheibelhofer

Keyword(s):

United States ◽

Qualitative Research ◽

Qualitative Study ◽

Social Relations ◽

The United States ◽

Research Strategy ◽

The Future ◽

Highly Skilled

This paper focuses on gendered mobilities of highly skilled researchers working abroad. It is based on an empirical qualitative study that explored the mobility aspirations of Austrian scientists who were working in the United States at the time they were interviewed. Supported by a case study, the paper demonstrates how a qualitative research strategy including graphic drawings sketched by the interviewed persons can help us gain a better understanding of the gendered importance of social relations for the future mobility aspirations of scientists working abroad.

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‘A Routh O’ Auld Nick-Nackets’ – the antiquarian collection of John Rae

Scottish Archaeological Journal ◽

10.3366/saj.2014.0054 ◽

2015 ◽

Vol 36-37 (1) ◽

pp. 163-183

Author(s):

Paul Taylor

Keyword(s):

United States ◽

Nineteenth Century ◽

Social Context ◽

Moral Education ◽

The United States ◽

Representative Case ◽

National Museums ◽

The Individual ◽

The University

John Rae, a Scottish antiquarian collector and spirit merchant, played a highly prominent role in the local natural history societies and exhibitions of nineteenth-century Aberdeen. While he modestly described his collection of archaeological lithics and other artefacts, principally drawn from Aberdeenshire but including some items from as far afield as the United States, as a mere ‘routh o’ auld nick-nackets' (abundance of old knick-knacks), a contemporary singled it out as ‘the best known in private hands' (Daily Free Press 4/5/91). After Rae's death, Glasgow Museums, National Museums Scotland, the University of Aberdeen Museum and the Pitt Rivers Museum in Oxford, as well as numerous individual private collectors, purchased items from the collection. Making use of historical and archive materials to explore the individual biography of Rae and his collection, this article examines how Rae's collecting and other antiquarian activities represent and mirror wider developments in both the ‘amateur’ antiquarianism carried out by Rae and his fellow collectors for reasons of self-improvement and moral education, and the ‘professional’ antiquarianism of the museums which purchased his artefacts. Considered in its wider nineteenth-century context, this is a representative case study of the early development of archaeology in the wider intellectual, scientific and social context of the era.

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