scholarly journals Exploring drug cost and disease outcome in rheumatoid arthritis patients treated with biologic and targeted synthetic DMARDs in Norway in 2010–2019 – a country with a national tender system for prescription of costly drugs

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Alen Brkic ◽  
Andreas P. Diamantopoulos ◽  
Espen Andre Haavardsholm ◽  
Bjørg Tilde Svanes Fevang ◽  
Lene Kristin Brekke ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Annual Cost ◽  
Treatment Costs ◽  
Disease Outcomes ◽  
Health Authorities ◽  
Das28 Remission ◽  
Synthetic Dmards ◽  
Data Files ◽  
The Mean ◽  
The Cost

Abstract Background In Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system. Methods RA patients monitored in ordinary clinical practice were recruited from 10 Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process. Results The number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39% in 2010 and 45% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 42 to 67%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47%, from 13.1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75% (13.0 thousand EUR in 2010 and 3.2 thousand EUR in 2019). Conclusions In the period 2010–2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

scholarly journals Exploring Drug Cost and Disease Outcome in Rheumatoid Arthritis Patients Treated With Biologic and Targeted Synthetic DMARDs in Norway in 2010-2019 – a Country With a National Tender System for Prescription of Costly Drugs

2021 ◽  
Author(s):  
Alen Brkic ◽  
Andreas P Diamantopoulos ◽  
Espen Andre Haavardsholm ◽  
Bjørg Tilde Svanes Fevang ◽  
Lene Kristin Brekke ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Annual Cost ◽  
Treatment Costs ◽  
Disease Outcomes ◽  
Health Authorities ◽  
Das28 Remission ◽  
Synthetic Dmards ◽  
Data Files ◽  
The Mean ◽  
The Cost

Abstract BACKGROUND: In Norway, an annual tender system for the prescription of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) has been used since 2007. This study aimed to explore annual b/tsDMARDs costs and disease outcomes in Norwegian rheumatoid arthritis (RA) patients between 2010 and 2019 under the influence of the tender system.METHODS: RA patients monitored in ordinary clinical practice were recruited from ten Norwegian centers. Data files from each center for each year were collected to explore demographics, disease outcomes, and the prescribed treatment. The cost of b/tsDMARDs was calculated based on the drug price given in the annual tender process.RESULTS: The number of registered RA patients increased from 4909 in 2010 to 9335 in 2019. The percentage of patients receiving a b/tsDMARD was 39.4% in 2010 and 44.5% in 2019. The proportion of b/tsDMARDs treated patients achieving DAS28 remission increased from 34.8% to 61.3%. The estimated mean annual cost to treat a patient on b/tsDMARDs fell by 47.3%, from 13,1 thousand euros (EUR) in 2010 to 6.9 thousand EUR in 2019. The mean annual cost to treat b/tsDMARDs naïve patients was reduced by 75.4% (13,0 thousand EUR in 2010 and 3.2 thousand EUR in 2019).CONCLUSIONS: In the period 2010-2019, b/tsDMARD treatment costs for Norwegian RA patients were significantly reduced, whereas DAS28 remission rates increased. Our data may indicate that the health authorities’ intention to reduce treatment costs by implementing a tender system has been successful.

scholarly journals Self-Reported Productivity Losses of People with Rheumatoid Arthritis in Alberta, Canada

2013 ◽  
Vol 5 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Nguyen Xuan Thanh ◽  
Arto Ohinmaa ◽  
Cheryl Barnabe ◽  
Joanne Homik ◽  
Susan G. Barr ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Economic Impact ◽  
Annual Cost ◽  
Quantile Regressions ◽  
Productivity Losses ◽  
Observational Cohort ◽  
The Mean ◽  
Using Data ◽  
The Cost

Objectives: To estimate the annual cost of productivity losses per person with RA by 0.5 increment in HAQscore, and the annual cost of productivity losses for Alberta province. Methods: Using data from the Alberta Biologics Registry - a prospective observational cohort of consecutive patients receiving DMARD or anti-TNF therapies created in 2004, we compared the mean and median costs of productivity losses per patient per year between HAQ-score categories using multiple linear and quantile regressions, respectively. We used a prevalence-based approach to estimate the cost (in 2010 CA$) of productivity losses of RA for Alberta. Results: In total there were 1222 patients with RA interviewed at the baseline. Of this, 358 were the “current employees” and 204 were the “previous employees” totalling 563 patients for analyses. For all HAQ-score categories, the mean (median) of the cost per patient per year was estimated at $18,242 ($3,840). The cost was increasing along with the HAQscore increase. The lowest cost ($6,295) was found in category HAQ<=0.5 and the highest ($31,095) in category HAQ>2.0. The significant differences were found between the worse categories (HAQ>1.5) and the better categories (HAQ<=1.5). The mean costs of productivity losses of RA for the province of Alberta were estimated at $270 million. Conservatively, if median was used for mean, the costs for province would be $57 million. Conclusion: The results suggest that an improvement in the controlling of RA could have a significant economic impact in Alberta and that preventing HAQ-score from the worse categories may be associated with substantial savings in terms of productivity losses.

scholarly journals Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Ahmad Gholami ◽  
Jassem Azizpoor ◽  
Elham Aflaki ◽  
Mehdi Rezaee ◽  
Khosro Keshavarz
Keyword(s):  
Rheumatoid Arthritis ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The Other ◽  
Cost Data ◽  
Fars Province ◽  
Study Results ◽  
The Mean ◽  
The Cost

Introduction. Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods. This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results. The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion. According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.

scholarly journals AB0290 HERPES ZOSTER INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS EXPOSED TO BIOLOGICAL AGENTS AND JAK INHIBITORS. REAL-WORLD EVIDENCE.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1444.2-1444
Author(s):  
D. Freites Nuñez ◽  
L. Abasolo ◽  
M. Peñuelas ◽  
F. J. Candel ◽  
J. Font ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Herpes Zoster ◽  
Tertiary Hospital ◽  
Jak Inhibitors ◽  
Prednisone Dose ◽  
Real World Evidence ◽  
Synthetic Dmards ◽  
The Mean ◽  
The Moment

Background:The overall occurrence of Herpes zoster (HZ) infections in patients with rheumatoid arthritis (RA) is greater than in the general population although is controversial whether the use of the different disease-modifying antirheumatic drugs (DMARDs) increases this risk.Objectives:To investigate the incidence and factors associate to HZ infections in patients with RA exposed to biologic agents (BA) and small molecule JAK inhibitors (JAKi), and to describe RA disease features at the moment of HZ infection.Methods:Retrospective longitudinal study was conducted. We included RA patients seen at the rheumatology outpatient clinic of tertiary hospital, commencing BA (anti-TNF therapy and no anti-TNF therapy) or JAKi from Jan 2007 until Dec 2017, and followed up until end of study (Dec 2019). The outcome of interest was the occurrence of HZ infection, the diagnosis of HZ events was based on the rheumatologist’s report. Covariables: sociodemographic, clinical, and concomitant treatments including glucocorticoids, conventional synthetic DMARDs (csDMARDs). Survival techniques were used to estimate the incidence of HZ (IR), per 1000 patient-year (PYs) with the respective Confidence Interval [95%CI]. Cox multivariate regression model to compare the risk of HZ was performed. Results were expressed in Hazard ratio (HR).Results:474 RA patients were included, starting 881 different courses of treatment (1954.86 patients-years of follow-up). 382 (80.6%) were women with a mean (SD) age of 56.9 (15.0) years at first BA. Across all groups of treatments, a total 18 HZ were recorded, events were non-serious and involved 1 or 2 dermatomes. The mean age (SD) at moment of the infection was 62 (11) years and 10 cases were on prednisone > 7.5 mg/day. 13 HZ cases (72.2%) occurred on treatment with anti-TNF treatment (6 with adalimumab, 4 with certolizumab and 1 with infliximab), 4 (22.2%) cases were on treatment with rituximab one occurred during tocilizumab prescription. The overall incidence of HZ was 9.20 cases per 1000PYs [5.80-14.61]. The crude IR was similar between gender, increased with age (Patients < 46 years: 2.17 [0.3-15.4]; >70 years 14.1 [5.8-33.8]), was higher with concomitant use of two csDMARDs (IR: 15.68 [7.8-31.7], and was similar between anti-TNF and non anti-TNF therapy. None HZ event was recorded in patients exposed to JAKi. In the multivariate analysis, age (HR: 1.05, p: 0.006), prednisone dose > 7.5 mg/day (HR: 2.83, p: 0.02) and the concomitant use of two csDMARDs (HR: 2.34 p: 0.039) increase the risk for HZ. Lymphopenia (HR: 2.6; p=0.06) achieved a trend and BA therapy dropped from the model.Conclusion:HZ incidence rate was 9.20 cases per 1000PYs, HZ occurrence in RA patients cannot be attributed solely to the current BA or JAKi treatment and other factors involved must be taking in count as age, concomitant DMARDs prescriptions, and use of glucocorticoids. Our data suggest that preventive strategies for HZ should be developed for patients with RA.Disclosure of Interests:None declared

Sarilumab: Review of a Second IL-6 Receptor Antagonist Indicated for the Treatment of Rheumatoid Arthritis

2018 ◽  
Vol 52 (8) ◽  
pp. 780-791 ◽  
Author(s):  
Eric G. Boyce ◽  
Edward L. Rogan ◽  
Deepti Vyas ◽  
Neel Prasad ◽  
Yvonne Mai
Keyword(s):  
Rheumatoid Arthritis ◽  
Receptor Antagonist ◽  
Data Extraction ◽  
Safety Data ◽  
Health Assessment ◽  
Response Rates ◽  
Double Blind ◽  
Biologic Dmards ◽  
Das28 Remission ◽  
Synthetic Dmards

Major Objectives: To review the efficacy, safety, and economics of sarilumab, an interleukin-6 (IL-6) receptor antagonist, in the treatment of rheumatoid arthritis (RA). Data Sources: PubMed (1966 to January 2018), Clinicaltrials.gov (January 2018), and Scopus (1970 to January 2018) were searched using sarilumab, Kevzara, REGN88, and SAR153191. Study Selection and Data Extraction: Human studies published in peer-reviewed publications in English were the primary sources for efficacy and safety. Data Synthesis: Data from randomized, double-blind, controlled, published clinical studies weeks demonstrated statistically significantly higher American College of Rheumatology (ACR) 20, ACR50, and Disease Activity Score-28 (DAS28) remission response rates and improvements in DAS28 and Health Assessment Questionnaire–Disability Index scores for sarilumab monotherapy versus adalimumab monotherapy (P < 0.05) and for sarilumab versus placebo in patients receiving methotrexate or other conventional synthetic disease-modifying antirheumatic drugs (DMARDs); P < 0.05. The ACR20 and ACR50 response rates were, respectively, 56-72% and 35-46% for sarilumab, 58% and 30% for adalimumab, and 33-34% and 15-18% for placebo. DAS28 remission rates were 20-34% for sarilumab, 7% for adalimumab, and 7-10% for placebo. Sarilumab has a higher risk for neutropenia than tocilizumab, the other IL-6 inhibitor, but a lower risk for dyslipidemia, injection site reactions, and gastrointestinal perforation. The acquisition costs of sarilumab are expected to be similar to those of most other biologic DMARDs. Conclusion: Sarilumab is an alternative to biologic DMARDs or targeted synthetic DMARDs in patients with moderate to severely active RA who have not responded adequately to prior conventional synthetic DMARDs or tumor necrosis factor-α inhibitors.

HYPEROESTROGENISMUS AND RHEUMATOID ARTHRITIS

1960 ◽  
Vol XXXIV (I) ◽  
pp. 45-50 ◽  
Author(s):  
J. L. Kalliomäki ◽  
Lauri Rauramo
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Cancer ◽  
Urine Samples ◽  
Menstrual Bleeding ◽  
Menstrual Phase ◽  
Joint Symptoms ◽  
The Mean

ABSTRACT The authors have endeavoured to clarify the frequency of the hyperoestrogenismus syndrome in women with rheumatoid arthritis, aged 17–38 years, by means of clinical and cytologic studies, and by hormonal analyses. The material comprises 32 patients. Of these, 30 were suitable for cytologic observation. In 5 (17 %) of these 30 patients, the hyperoestrogenismus syndrome (17 %) may be considered definitely established. Aggravation of the joint symptoms in the pre-menstrual phase was reported by 41 % of the patients. Values for excretion of oestrogen exceeding 200 mouse units/24 hours were noted one week before menstrual bleeding in 8 of 19 women; the mean for oestrogen excretion was 268 mouse units/24 hours. Gonadotrophins were studied in the same urine samples, and the mean excretion was 22 mouse units/24 hours (range 7–65 m. u.). The excretion mean for 17-ketosteroids, simultaneously studied, was 9.1 mg/24 hours (range 2.3–18.0 mg). Side-finding in the material were made: incipient cervical cancer in one patient, ovarial tumour in one, and trichomoniasis in seven.

Design and development of manually operated gladiolus planter

2018 ◽  
Vol 5 (01) ◽  
Author(s):  
TAPAN K. KHURA ◽  
H. L. KUSHWAHA ◽  
SATISH D LANDE ◽  
PKSAHOO . ◽  
INDRA L . KUSHWAHA
Keyword(s):  
Coefficient Of Variation ◽  
Field Capacity ◽  
Power Source ◽  
Forward Speed ◽  
Cereal Crop ◽  
Maximum Coefficient ◽  
Coefficient Of Uniformity ◽  
The Mean ◽  
The Cost ◽  
Immense Potential

Floriculture is an age-old farming activity in India having immense potential for generating selfemployment and income to farmers. However, the cost of cultivation of flower is high as compared to cereal crop. Level of mechanization for different field operations is one but foremost reason for the higher cost of cultivation. As most of the Indian farmers are marginal and small, a need for manually operated gladiolus planter was felt. The geometric properties of gladiolus corm were determined for designing the seed metering system and seed hopper of the planter. The planter was evaluated in the field when pulled by two persons as a power source and guided by a person. The coefficient of variation and highest deviation from the mean spacing was observed as 12.93% and 2.65cm respectively. The maximum coefficient of uniformity of 90.59% was observed for a nominal corm spacing of 15cm at 0.56 kmh-1 forward speed. An average MISS percentage was observed as 2.65 and 2.25 for nominal corm spacing of 15 and 20 cm. The multiple index was zero for two levels corm spacing and forward speed of operation. The QFI was found in the range of 97.2 and 97.9 percent. The average field capacity of the planter was observed as 0.02 hah-1.The average draft requirement of the planter was found as 821 ± 50.3 N.

scholarly journals POS0548 OPTIMAL ASSESSMENT OF THE RHEUMATOID ARTHRITIS ANKLE AND HINDFOOT: A COMPARATIVE STUDY BETWEEN CLINICAL EXAMINATION AND ULTRASONOGRAPHY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 508.2-509
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Examination ◽  
Demographic Data ◽  
Power Doppler ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean ◽  
Foot Disease

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

scholarly journals Economic Burden of Colorectal Cancer: A Case of Fars, Iran

2021 ◽  
Vol 28 ◽  
pp. 107327482110099
Author(s):  
Abdosaleh Jafari ◽  
Peyman Mehdi Alamdarloo ◽  
Mehdi Dehghani ◽  
Peivand Bastani ◽  
Ramin Ravangard
Keyword(s):  
Colorectal Cancer ◽  
Economic Burden ◽  
Purchasing Power Parity ◽  
Annual Cost ◽  
Low Cost ◽  
Direct Costs ◽  
Fars Province ◽  
Power Parity ◽  
Medical Sciences ◽  
The Mean

Among cancers, colorectal cancer is the third most common cancer in the world and the fourth leading cause of cancer deaths worldwide. Some studies have shown that the incidence of colorectal cancer is increasing in Iran and in Fars province. The present study aimed to determine the economic burden of colorectal cancer in patients referred to the referral centers affiliated to Iran, Shiraz University of Medical Sciences in 2019 from the patients’ perspective. This is a partial economic evaluation and a cost-of-illness study conducted cross-sectionally in 2019. All the patients with colorectal cancer who had been referred to the referral centers affiliated to Iran, Shiraz University of Medical Sciences, and had medical records were studied through the census method (N = 96). A researcher-made data collection form was used to collect the cost data. The prevalence-based and bottom-up approaches were also used in this study. The human capital approach was applied to calculate indirect costs. The mean annual cost per patient with colorectal cancer in the present study was $10930.98 purchasing power parity (PPP) (equivalent to 5745.29 USD), the main part of which was the medical direct costs (74.86%). Also, among the medical direct costs per patient, the highest were those of surgeries (41.7%). In addition, the mean annual cost per patient with colorectal cancer in the country was $ 116917762 PPP (equivalent to 61451621.84 USD) in 2019. Regarding the considerable economic burden of colorectal cancer and in order to reduce the costs, these suggestions can be made: increasing the number of specialized beds through the cooperation of health donors, establishing free or low-cost accommodation centers for patients and their companions near the medical centers, using the Internet and cyberspace technologies to follow up the treatment of patients, and increasing insurance coverage and government drug subsidies on drug purchase.

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