Use Of Societal Resources Research Articles

A randomised, two-arm (1:1 ratio), double blind, placebo controlled phase III trial to assess the efficacy, safety, cost and cost-effectiveness of Rituximab in treating de novo or relapsing NS in patients with MCD/FSGS (TURING)

BackgroundMinimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are a spectrum of disease causing the nephrotic syndrome (NS), characterised by proteinuria with debilitating oedema, as well as a high risk of venous thromboembolic disease and infection. Untreated, 50–60% patients with FSGS progress to end stage kidney disease after 5 years. These diseases respond to immunosuppression with high dose glucocorticoids, but 75% will relapse as the glucocorticoids are withdrawn, leading to significant morbidity associated with prolonged use. In children, the B cell depleting monoclonal antibody rituximab reduces relapse risk, but this drug has not been tested in randomised controlled trial in adults.Methods130–150 adults with new or relapsing MCD/FSGS, from UK Renal Units, are being randomised to receive either rituximab (two 1 g infusions two weeks apart) or placebo. Partipicipants are recruited when they present with nephrosis, and all are treated with glucocorticoids as per KDIGO guidelines. Once in remission, prednisolone is withdrawn according to a pre-specified regimen. If in remission at 6 months, participants receive a further dose of trial drug. If they relapse, they are unblinded, and if they have received placebo, they are offered open label rituximab with protocolised prednisolone as in the main phase of the trial. The primary end point is time from remission to relapse. A number of secondary endpoints will be assessed including the effect of rituximab on: (1) NHS and societal resource use and hence cost: (2) safety: (3) other measures of efficacy, such as achievement of partial and complete remission of NS and the preservation of renal function: (4) health status of participant.Trial RegistrationTURING received ethical approval on 14 Jun 2019 - REC reference: 19/LO/0738. It is registered on EudraCT, with ID number: 2018-004611-50, with a start date of 2019-06-14.

Pursuing precision in medicine and nutrition: the rise of electrochemical biosensing at the molecular level.

In the era that we seek personalization in material things, it is becoming increasingly clear that the individualized management of medicine and nutrition plays a key role in life expectancy and quality of life, allowing participation to some extent in our welfare and the use of societal resources in a rationale and equitable way. The implementation of precision medicine and nutrition are highly complex challenges which depend on the development of new technologies able to meet important requirements in terms of cost, simplicity, and versatility, and to determine both individually and simultaneously, almost in real time and with the required sensitivity and reliability, molecular markers of different omics levels in biofluids extracted, secreted (either naturally or stimulated), or circulating in the body. Relying on representative and pioneering examples, this review article critically discusses recent advances driving the position of electrochemical bioplatforms as one of the winning horses for the implementation of suitable tools for advanced diagnostics, therapy, and precision nutrition. In addition to a critical overview of the state of the art, including groundbreaking applications and challenges ahead, the article concludes with a personal vision of the imminent roadmap.

COVID-19 and the Principles of Economics

Several fundamental principles in economics help enhance our understanding of COVID-19, including opacity and externalities. COVID-19 is a contagious disease whose spread has been difficult to manage due to opacity, as the disease is contagious prior to the presence of symptoms and in some instances testing results for the disease require a considerable time lag before they become available. This highlights the importance of alternative testing strategies to limit the extent of opacity and to manage the costs associated with accurate testing. In addition to individual tests, such strategies would include testing employees in small groups and testing for concentration of the disease in wastewater. Diminishing returns to scale, depreciation, and shocks to the underlying disease also all play an important role in understanding the effectiveness of vaccines. Externalities are central to the mechanism for transmitting contagious diseases. The strength of the externality can be reduced potentially by various preventive measures such as social distancing and masking, though quantitative studies of the efficacy of such measures can be enhanced. Further, efforts to undertake randomized trial studies of various questions related to vaccines and prevention would be helpful, especially in light of the magnitude of economic costs that have been imposed by contagious disease, such as COVID-19. COVID-19 and other contagious diseases also have had considerable effects on the structure of the economy. This has resulted in great development of technologies to support online meetings and work and the ability to work remotely, which in turn highlights dramatic challenges to the five-day work week, the potential for stay-at-home work, the relationship between residential and office real estate and the value of contractual flexibility in the face of dramatic shocks. Some of the effects arise during the period of acute societal disease, while other aspects reflect long-term learning. The nature of societal shocks to work and income generation also has led to important questions regarding the use of societal resources and potential shocks to the overall macroeconomy.

Gains and pitfalls of coalitions: Societal resources as sources of trade union power in Croatia and Poland

This article explores the experiences of trade unions in Croatia and Poland with societal power resources as a source of trade union revitalisation in the post-2008 crisis period. In the context of limited structural, organisational and institutional power resources, Croatian and Polish trade unions attempted to build their societal power through the revitalisation strategies of coalition building and political action. The paper compares three similar, partially successful campaigns run in both countries, on pensions, Sunday trading and precarious work. Our findings show that gains in societal power alone cannot fully compensate for the erosion of conventional sources of trade union power. Such a configuration of power resources runs the danger of trade union demands being taken up by populist forces wanting to increase their own legitimacy, rather than furthering workers’ interests. Therefore, what starts as an attempt at union revitalisation based on the novel use of societal resources could easily end up as ‘captured innovation’ by populist forces.

Multiple health complaints in preadolescence and hospital contacts during adolescence: a prospective cohort study.

Multiple health complaints (MHC) is increasing among preadolescents in many countries, but their prognostic effect for individual thriving or societal resource use is scarcely studied. This makes interpreting the significance of this increase challenging. We contribute by examining whether MHC in preadolescence predicts hospital contacts in adolescence by doing a nation-wide population-based cohort-study following preadolescents from the Danish National Birth-Cohort from 2010 to 2018. 96,382 children were invited at age 11. Responses to a modified version of the Health Behaviour in School Children Symptom Checklist (headache, dizziness, stomachache, irritability, feeling nervous, difficulty in getting to sleep and feeling low) was dichotomized into MHC (≥ 2 concurrent symptoms, each with a frequency of at least weekly, yes/no). Hospital contacts were derived from Danish registers from the date of answering the questionnaire to December 31st 2018. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Analyses were further broken down by hospital sector (psychiatric/somatic) and contact type (in-patient/out-patient/emergency room). 47,365 (49.1%) responded. Mean age was 11.2 years, 52% girls. 10.3% of responders reported MHC. For hospital contacts, the unadjusted IRR was 1.74 [95% CI 1.65, 1.83]. Results were robust to adjustment for sociodemographic variables and somatic/psychiatric morbidity diagnosed before baseline, IRR 1.62 [95% CI 1.54–1.71]. In conclusion, MHC in preadolescents are prognostic of hospital contacts. This shows that we cannot ignore MHC, and to prevent potentially unhelpful healthcare use, we must act. Future research should focus on the underlying causes of MHC to understand which changes will be most helpful and thus how to act.

Forest Transitions in the United States, France and Austria: dynamics of forest change and their socio- metabolic drivers

ABSTRACT Understanding the drivers of forest transitions is relevant to inform effective forest conservation. We investigate pathways of forest transitions in the United States (1920–2010), France (1850–2010), and Austria (1830–2010). By combining evidence from forest inventories with the forest model CRAFT, we first quantify how change in forest area (ΔA), maximum biomass density (ΔBdmax ), and actual biomass as fraction of maximum biomass (ΔFmax ) shaped forest dynamics. Second, to investigate the connections between forest change and societal resource use, or social metabolism, we quantify the importance of selected proximate and underlying socio-metabolic drivers. We find that agricultural intensification and reduced forest grazing correlated most with positive ΔA and ΔBdmax . By contrast, change in biomass imports or harvest did not explain forest change. Our findings highlight the importance of forest growth conditions in explaining long-term forest dynamics, and demonstrate the distinct ways in which resource use drove forest change.

Forest carbon sink in the U.S. (1870–2012) driven by substitution of forest ecosystem service flows

Understanding the dynamics behind forest transitions, i.e., shifts from deforestation to forest recovery, is crucial for forest conservation and climate-change mitigation i.e., carbon (C) sequestration. We investigated the drivers of the forest transition in the United States, which was characterized by forest thickening despite surges in industrial wood extraction. We employ the concepts of Human Appropriation of Net Primary Productivity (HANPP) and Material and Energy Flow Analysis (MEFA) to quantitatively assess changes in major provisioning ecosystem services demanded from forests, i.e., industrial wood (comprising biomass used in products such as paper and pulp), grazing, and fuelwood, and analyse substitution processes from 1870-2012 at regional, sectoral, and national scales. The share of industrial wood in total annual forest biomass harvest increased from 23% to 84% over the time-period, while fuelwood and biomass grazed declined from 63% to 13%, and 14% to 3%, respectively. Reductions in demand for fuelwood and biomass grazed were enabled by shifts in feed and energy sources, consequently allowing for increases in both livestock numbers and energy use. Feed crops increased six-fold, alleviating grazing pressure on forest ecosystems, particularly in the Eastern states. Fossil fuels replaced fuelwood, especially in the residential sector. Between 1900-2012 the final energy mix increased seventeen-fold. Thus, the increase in biomass C stocks in U.S. forests was connected to substitution of forest ecosystem services with fossil fuel-based production systems, and with manifold increases in societal resource use and C dynamics. Such shifts need to be considered when assessing the positive environmental effects of forest transitions.

Psychological problems among cancer patients in relation to healthcare and societal costs: A systematic review

ObjectiveThis study systematically reviewed the association of psychological problems among cancer patients with healthcare and societal resource use and costs.MethodsPubMed, PsycINFO, and Embase were searched (until 31 January 2021) for studies on psychological symptoms (anxiety, depression, distress, fear of recurrence) or psychiatric disorders (anxiety, depression, adjustment) and healthcare use (e.g., mental, inpatient healthcare), economic losses by patients and family, economic losses in other sectors (e.g., absence from work), and costs. The search, data extraction, and quality assessment were performed by two authors.ResultsOf the 4157 identified records, 49 articles were included (psychological symptoms (n = 34), psychiatric disorders (n = 14), both (n = 1)) which focused on healthcare use (n = 36), economic losses by patients and family (n = 5), economic losses in other sectors (n = 8) and/or costs (n = 13). In total, for 12 of the 94 associations strong evidence was found. Psychological symptoms and psychiatric disorders were positively associated with increased healthcare use (mental, primary, inpatient, outpatient healthcare), losses in other sectors (absence from work), and costs (inpatient, outpatient, total healthcare costs). Moderate evidence was found for a positive association between (any) psychiatric disorder and depression disorder with inpatient healthcare and medication use, respectively.ConclusionsPsychological problems in cancer patients are associated with increased healthcare use, healthcare costs and economic losses. Further research is needed on psychological problems in relation to understudied healthcare use or costs categories, productivity losses, and informal care costs.

Recalibrating Management Research for the Post‐COVID‐19 Scientific Enterprise

Recalibrating Management Research for the Post‐COVID‐19 Scientific Enterprise

СВІТОВІ ТЕНДЕНЦІЇ ТА СУЧАСНІ МОДЕЛІ СОЦІАЛЬНОЇ ІННОВАЦІЙНОЇ ПОЛІТИКИ

The field of social innovation is developing rapidly all over the world, with new institutions, methods and activities. The article deals with some aspects of the innovative model. The necessity of formation and development of the knowledge economy. Studied the shortcomings of the existing model of innovation, in particular, the impact on it of the world of globalization, the lack of equal international relations, the low efficiency of public administration and regulation of the national economy. In particular, the article highlights the impact of macroeconomic factors on the implementation of innovation policy, state strategic objectives and their financial support in comparison with foreign countries. The dynamics of science financing were analyzed in dependence of their sources. Grounded priorities of innovation policy of the state: the development of high-tech production; ensuring an adequate level of financing of domestic science; increasing the share of innovation-active industrial enterprises, development of new techniques and technologies; development of venture businesses. Exacerbated by the current economic crisis, Europe is confronted with many complex and interrelated socio-economic challenges affecting individuals, firms, sectors and regions. While traditional innovations are of utmost importance for regional development, its impact as regards regional socio-economic challenges seems to be not sufficient. Regional resilience and competitiveness additionally require new ways of thinking, new alliances, new processes and new forms of dialogue. Social innovation as new solutions leading to improved capabilities, new forms of collaboration and a better use of societal resources can help regions to sustainably cope with social challenges. Against this backdrop this paper examines the necessity for new modes of policy production arising from the revitalization of social innovation as means of tackling the socio-economic challenges that regions are facing. It argues that a positive role for the state in stimulating, resourcing and sustaining social innovation means moving beyond traditional ways of designing and delivering public policies and programs.

Cost-effectiveness and pricing of caffeine

In a formal economic evaluation ancillary to the Caffeine for Apnea of Prematurity trial, caffeine was shown to reduce costs while simultaneously improving clinical outcomes. Although these results still apply, the current price of caffeine is substantially higher than when it was introduced. Such pharmaceutical price growth contributes appreciably to medical costs and inflation. In this review, the examples of caffeine and surfactant show how prices are determined for the neonatology formulary. Drivers include small market size, government-imposed barriers to competition designed to encourage innovation, high willingness-to-pay, failure of government buyers to exercise their market power, and asymmetries in knowledge about costs and effects between producers and patients. Many of these factors are exercised at the national policy or market levels. However, by conducting rigorous clinical trials and economic evaluations, neonatologists can still ensure that the drugs they prescribe are both efficacious and represent good use of societal resources.

Corralling culture as a concept in LIS research

AbstractIndividuals' cultural backgrounds influence their use of societal resources, including libraries. A literature search and review was completed on the treatment of culture in library and information science (LIS) in the body of work on information behaviour and use. While much of the literature reviewed cites culture as an important influence, few researchers define culture as a concept, nor do they explore in detail the factors that it comprises. In this body of work culture is primarily used in two ways: (a) to differentiate groups of library users; and (b) to draw attention to questions of integration.

Articulations of feminine voices in Ghana’s parliament: a study of the Hansard from 2010-2011

Women have both a right and an obligation to active participation in political deliberation. Yet, their participation in formal political processes, where decisions regarding the use of societal resources generated by both men and women are made, remains insignificant. Now researchers are looking beyond the number of women in parliament to focus on what they can do in terms of their contributions. This study, therefore investigates female parliamentarians’ contributions during parliamentary proceedings, evaluates how gendered these issues were. To accomplish this task, a textual analysis of the Hansard was done using critical discourse analysis and theory of gender and power. The analysis revealed that although female MPs contribute to a range of issues, they are ardent promoters of pro-women legislations such as issues on women, children and youth, health and education. Again, the study found out that a greater percentage of issues women contribute to are gendered and so reinforces the stereotypical roles given to women by society. Keywords: hansard, Ghana, linguistic, parliament, text, women

Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.

BackgroundMultimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost.MethodsThe Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors.ResultsThe prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs.ConclusionMultimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.

Does age modify the cost-effectiveness of community-based physical activity interventions?

Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion. A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses. Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years. The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.

The importance of image quality: In the eyes of the beholder?

The importance of image quality: In the eyes of the beholder?

Public Policy, Popular Culture, Celebrity, and the Making of a Spiritual-Industrial Marketplace in Postwar America

Public Policy, Popular Culture, Celebrity, and the Making of a Spiritual-Industrial Marketplace in Postwar America Lerone Martin (bio) The Spiritual-Industrial Complex: America’s Religious Battle Against Communism in the Early Cold War. By Jonathan P. Herzog. New York: Oxford University Press. 2011. Oprah: The Gospel of an Icon. By Kathryn Lofton. Berkeley: University of California Press. 2011. Several trends hallmark religion in postwar America. Scholars have identified several major forces including: the increased vitality of “world” religions, suburbanization, the decreasing significance of denominationalism, the political emergence of the religious right, and the increasing popularity of therapeutic spirituality and religious commodities. Traditional sources, including denominational figures and studies, church mapping and architecture, nationwide religion polls, and the activities of iconic figures and commodities such as revivalists Billy Graham, Norman Vincent Peale, and the success of the latter’s best seller, The Power [End Page 53] of Positive Thinking (1952), have been readily implored to describe how religion took shape during the era. However, recently scholars have increasingly turned to under-utilized sources in the study of postwar religion. Jonathan Herzog’s focus on government sources and the influence of public policy on religion following World War II and Kathryn Lofton’s study of the religious and spiritual affect of commercial icon Oprah are two intriguing examples of this trend. It has long been noted that President Eisenhower’s administration was wedded to the Cold War and the military-industrial complex following World War II. In his Presidential Farewell Address, the military hero stated that the dangers of the postwar world required the nation to no longer depend on the “makers of plowshares . . . to make swords.” Rather, in Cold War America, the nation had to “create a permanent armaments industry of vast proportions”: a military-industrial complex.1 This pronouncement and the subsequent influence of the Cold War upon postwar American politics and foreign policy is well known. However, lesser known is the Cold War’s explicit influence in shaping America’s religious landscape. In The Spiritual-Industrial Complex, Jonathan Herzog painstakingly chronicles how the Cold War influenced religion in postwar America via what he refers to as the “spiritual-industrial complex”: the collective and deliberate leveraging of state, federal, commercial, media, and celebrity resources for national religious revitalization. The ultimate goal of this political, commercial, and theological composite was to create a resurgence of religiosity and religious adherence as a means to combat and eventually defeat godless Communism (6). For Herzog, this spiritual mobilization was “sacralization,” not to be confused with “civil religion.” Herzog defines civil religion as the “use of the sacred to legitimatize the secular.” Spiritual “Cold War Warriors,” however, did the opposite; they “used the secular to legitimize the sacred” through a “deliberate and managed use of societal resources to stimulate a religious revival in the late 1940’s and 1950’s” (6, 179). The author traces the genesis of this spiritual complex to the religious and political rhetoric of the successive presidential administrations of Truman and Eisenhower as well as a host of other political and cultural Cold War crusaders. These policy makers, religious professionals, and commercial icons boiled down the intricate nature of the Cold War between American and Soviet ideology into a series of simplistic dichotomies: American freedoms vs. communist slavery; good vs. evil; or faithful vs. faithless (81). Moreover, Communism was defined as a belief that was held by its communicants with “religious” fervor (197). As Herzog points out, President Truman aptly stated in one Christmas Eve address, “We are all joined in the fight against communism. Communism is godless . . . Democracy’s most powerful weapon is not a gun, a tank, or a bomb. It is faith—faith in the brotherhood and dignity of man under God” (79). Accordingly, Herzog displays how policy makers and clergy framed the Cold War not as an “economic and political struggle between the oppressed and the powerful,” but rather a holy war between traditional religious/Christian faith, freedoms, and [End Page 54] American livelihoods in opposition to the godless religious zeal of Communism (81, 126). The Cold War, at heart, was a spiritual battle. In 1933, President Hoover’s research committee noted, “The most fundamental change...

Cost Effectiveness of Fracture Prevention in Postmenopausal Women Who Receive Aromatase Inhibitors for Early Breast Cancer

Aromatase inhibitors (AIs) increase the risk of osteoporosis and related fractures in postmenopausal women who receive adjuvant AIs for hormone receptor (HR) -positive early breast cancer (EBC). We compared the cost effectiveness of alternative screening and treatment strategies for fracture prevention. We developed a Markov state transition model to simulate clinical practice and outcomes in a hypothetical cohort of women age 60 years with HR-positive EBC starting a 5-year course of AI therapy after primary surgery for breast cancer. Outcomes were quality-adjusted life-years (QALYs), lifetime cost, and incremental cost-effectiveness ratio (ICER). We compared the following strategies: no intervention; one-time bone mineral density (BMD) screening and selective bisphosphonate therapy in women with osteoporosis or osteopenia; annual BMD screening and selective bisphosphonate therapy in women with osteoporosis or osteopenia; and universal bisphosphonate therapy. ICERs for annual BMD screening followed by oral bisphosphonates for those with osteoporosis, annual BMD screening followed by oral bisphosphonates for those with osteopenia, and universal treatment with oral bisphosphonates were $87,300, $129,300, and $283,600 per QALY gained, respectively. One-time BMD screening followed by oral bisphosphonates for those with osteoporosis or osteopenia was dominated. Our results were sensitive to age at the initiation of AI therapy, type of bisphosphonates, post-treatment residual effect of bisphosphonates, and a potential adjuvant benefit of intravenous bisphosphonates. In postmenopausal women receiving adjuvant AIs for HR-positive EBC, a policy of baseline and annual BMD screening followed by selective treatment with oral bisphosphonates for those diagnosed with osteoporosis is a cost-effective use of societal resources.

Reduction in Healthcare and Societal Resource Utilization Associated with Cladribine Tablets in Patients with Relapsing-Remitting Multiple Sclerosis

Multiple sclerosis (MS) is a common, chronic, neurodegenerative condition associated with substantial healthcare and societal economic burden. Disease-modifying MS treatments have the potential to reduce health resource utilization (HRU), thereby reducing the attendant socioeconomic burden. This study aimed to compare health and societal resource use and productivity in patients with relapsing-remitting MS (RRMS) receiving cladribine tablets versus placebo over 96 weeks in the CLARITY study. The CLARITY study was a 96-week, randomized, double-blind, placebo-controlled study in patients with RRMS. HRU data, societal resource use and productivity data were collected at baseline and during scheduled patient visits, at 6-month intervals. The recall period for the HRU questionnaire was 3 months. The study was carried out at 155 sites across 32 countries worldwide. The intent-to-treat population comprised 1326 patients with RRMS randomized to cladribine 3.5 mg/kg (n = 433) or 5.25 mg/kg (n = 456) tablets or placebo (n = 437). Patient subgroups with high baseline disease activity were identified based on criteria of ≥2 relapses in the previous year (n = 392); ≥1 T1 gadolinium-enhancing (Gd+) lesion (n = 413); and ≥2 relapses in the previous year plus ≥1 T1 Gd+ lesion (n = 138). Cladribine tablets were administered in two (3.5 mg/kg group) or four (5.25 mg/kg group) short courses given at 4-week intervals at the start of a 48-week treatment period, followed by another two courses at the start of a subsequent 48-week re-treatment period. Interferon-β rescue therapy was permitted from week 24. Intravenous corticosteroids were available for the treatment of neurological relapses. HRU outcomes included mean number of hospital days and emergency room (ER), clinic and home visits during each study period. Societal resource use and productivity outcomes included mean number of hours and days of paid assistance, mean patient and carer work days missed, and self-reported productivity. The mean number of hospital days per patient over 96 weeks was lower in the cladribine tablets groups (3.5 mg/kg group: -3.19 days; 5.25 mg/kg group: -1.54 days [both p < 0.01]) versus placebo. Likewise the mean number of ER visits was lower in both cladribine tablet groups compared with placebo (3.5 mg/kg group: -0.09 visits; 5.25 mg/kg group: -0.11 visits [both p < 0.01]), and the mean number of clinic visits was also lower in both cladribine tablet groups (3.5 mg/kg group: -0.68 visits; 5.25 mg/kg group: -0.66 visits [both p = 0.01]). Furthermore, treatment with cladribine tablets was associated with reduced mean numbers of missed work days for patients (3.5 mg/kg group: -2.42 days [p < 0.01]; 5.25 mg/kg group: -0.60 days [p = 0.50]). Corticosteroid use was lower amongst patients in the cladribine tablet groups than in the placebo group. The reduction in hospital days following treatment with cladribine tablets was also observed in patients with high disease activity at study baseline. This study provides evidence that the efficacy of cladribine tablets observed during the CLARITY study was associated with a reduced consumption of healthcare resources and a decreased need for medical and societal support. ClinicalTrials.gov identifier: NCT00213135; EudraCT number: 2004-005148-28.

Economic aspects of treatment options in rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis

ObjectiveTo review the cost effectiveness of rheumatoid arthritis (RA) treatments and inform the clinical recommendations by the European League Against Rheumatism.MethodsA systematic literature search and review of the health economic...