Determining the burden of infectious diseases caused by carbapenem-resistant gram-negative bacteria in Spain

OBJECTIVE

To estimate the burden of nosocomial infections induced by carbapenem resistant Gram-negative (CRGN) pathogens in Spain, focusing on both the clinical and economic impact.

METHODS

The burden of disease was estimated using data from 2017 according to the availability of data sources. The impact, both clinical and economic, of the most frequent CRGN nosocomial infections (those produced by Klebsiella pneumoniae, Pseudomonasaeruginosa and Acinetobacter baumannii) was analysed. Incidence and mortality of CRGN nosocomial infections were estimated, as well as the direct and indirect costs produced by this health problem.

RESULTS

Approximately 376,346 patients are believed to have suffered a nosocomial infection in Spain in 2017; 3.2% of them due to CRGN bacilli. Infections by carbapenem-resistant P. aeruginosa produced the highest mortality rates (2578 deaths) when compared with A. baumannii (1571) and K. pneumoniae (415). Total economic costs of CRGN nosocomial infections in Spain were estimated to be €472 million in 2017, with 83% of the total cost caused by direct costs.

CONCLUSION

CRGN nosocomial infections have a high clinical impact on patients' lives, high mortality rates, and represent one of the hospitalisation episodes with the most associated costs. Efforts should be focussed to implement preventive policies in order to avoid infections due to CRGN pathogens and the resulting burden, and to reduce direct costs due to morbimortality, specifically in those infections produced by P. aeruginosa.

Determining the value contribution of emicizumab (Hemlibra®) for the prophylaxis of haemophilia A with inhibitors in Spain by multi-criteria decision analysis

Patients with moderate to severe haemophilia A are at a higher risk of developing FVIII inhibitors that require the use of more costly and less effective treatments. The objective of this study was to determine the value of emicizumab for the prophylaxis of haemophilia A with inhibitors compared to the current therapeutic alternatives, activated prothrombin complex concentrate and recombinant factor VIIa through reflective Multi-Criteria Decision Analysis. The EVIDEM framework adapted to orphan drugs and weighted by a sample of 98 national and regional Spanish evaluators was used. Two structured evidence matrices were developed: emicizumab against activated prothrombin complex concentrate and emicizumab against recombinant factor VIIa. A multidisciplinary team of haemophilia experts rated each of the criteria. Mean and standard deviation were calculated by each criterion and discussed among all participants. Haemophilia A with inhibitors was perceived as a severe disease with high unmet needs. Emicizumab was rated with higher efficacy, therapeutic benefit and quality of life than comparators. When administered alone for the prevention of bleeding events, emicizumab had slightly better safety and tolerability profile than activated prothrombin complex concentrate and similar with recombinant factor VIIa. The inclusion of emicizumab in clinical practice guidelines was valued positively by the members of the panel. Overall, value of emicizumab was higher than activated prothrombin complex concentrate and recombinant factor VIIa, mostly because of efficacy and therapeutic benefit in reducing treated haemorrhages. Reflective Multi-Criteria Decision Analysis has proven to be a feasible method to determine the value contribution of comparative therapies in haemophilia.

Analysing criteria for price and reimbursement of orphan drugs in Spain

OBJECTIVE

There are differences between countries regarding data requirements for orphan drug evaluation and it  is also unknown which criteria might determine the price and reimbursement decision. This study aimed to identify the key  criteria for price and reimbursement of orphan drugs in Spain, approved by the European Commission, between January 2012 and June 2018.

METHOD

A descriptive analysis of the orphan drugs and its characteristics was performed. Outcomes criteria assessed  were: therapeutic area, existence of alternative treatment, rarity of the disease, clinical trial outcomes and therapeutic  positioning report assessment. Hypotheses for each variable regarding Spanish pricing and reimbursement were made  and tested with two regression analyses.

RESULTS

Out of 78 orphan drugs approved by the European Commission, 82.1% asked pricing and reimbursement in  Spain. From this, 43.8% had pricing and reimbursement approved and 20.3% rejected. Mean time from Spanish  marketing authorisation approval to pricing and reimbursement approval was 12.1 ± 5.1 months. Having a positive  therapeutic positioning report and no therapeutic alternatives would be associated with a positive pricing and  reimbursement in Spain.

CONCLUSIONS

It remains challenging to establish which are the driving criteria for pricing and reimbursement approval  of orphan drugs in Spain. Further research should be done including other variables that might influence the pricing and  reimbursement final decision in Spain.

Control of a symmetry-breaking process in the course of the morphogenesis of plantlets of Bidens pilosa L

A mechanism involving transport, storage and retrieval of a symmetry-breaking message controls the relative growth rate of the cotyledonary buds of plantlets of Bidens pilosa L. The asymmetry was induced by administering a few needle pricks to one cotyledon of each plant. The storage of the symmetry-breaking message was independent of the number of pricks ("all or nothing" process) and irreversible. However, various treatments could render the plants either able to retrieve the stored symmetry-breaking message (in which case, the bud opposite to the pricked cotyledon began to elongate statistically sooner than the one associated with the stimulated cotyledon) or not (both buds then had an equal chance to be the first to start to grow). The retrieval process was also associated with a temporal oscillation. At the level of the whole plants, bud growth was observed only after the removal of apical dominance, and its degree of asymmetry was expressed by use of a parameter g ranging from zero (symmetrical case) to ± 1 (full asymmetry in favor of one of the cotyledonary buds). The highest g-values observed in the present contribution were of the order of 0.5. At the cellular level, the pricking of one cotyledon caused a number of cells, which were within the meristem of the bud associated with the pricked cotyledon and were in cell-cycle phases S or G2, to undergo cellular division and then be blocked in phase G1, whereas the cells of the opposite bud were practically unchanged.