Quantify Research (Sweden)

PurposeReal-world data on healthcare costs associated with SGLT2 inhibitor use during its early adoption remains limited, particularly across heart failure (HF) phenotypes. This study assessed trends in healthcare resource utilization (HCRU) and costs among HF patients, stratified by SGLT2 inhibitor use and left ventricular ejection fraction (LVEF).Patients and methodsUsing Finnish specialty care registry data, adults with a first HF diagnosis between January 1, 2016, and June 30, 2022 were identified and categorized by LVEF as reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) LVEF. Annual SGLT2 inhibitor uptake (2016–2022) was assessed. Patients were stratified by SGLT2 inhibitor use within 365 days of HF diagnosis to assess HCRU and costs trends (2016–2021).ResultsAmong 119,314 patients, 7,626 (6.4%) initiated SGLT2 inhibitors within a year. Among those with LVEF data (n=16,312/119,314 [13.7%]), HFpEF predominated (58%). SGLT2 inhibitor use in HFrEF increased from 14.4% (2020) to 50.1% (2022). Patients receiving SGLT2 inhibitors were younger (70.8 vs 78.6 years), more often male (65.0% vs 47.2%), and had higher prevalence of type 2 diabetes (72.4% vs 28.5%) compared with those without SGLT2 inhibitor use. From 2016 to 2021, inpatient admissions declined modestly across all groups, with consistently shorter stays among patients with SGLT2 inhibitors compared with those not using them (mean: 20.0 vs 26.3 days [2016]; 17.2 vs 21.7 days [2021]). Outpatient visits and drug dispensations were higher in the SGLT2 inhibitor group. Total annual HCRU costs declined over time, remaining lower for SGLT2 inhibitor users (€30,742 vs €34,235 in 2021), driven by reduced inpatient admission costs.ConclusionSGLT2 inhibitor uptake increased notably following regulatory approvals. Patients who received SGLT2 inhibitors had lower healthcare costs driven by reduced hospitalization costs, suggesting economic benefits of early SGLT2 inhibitor initiation in HF management and supporting further research evaluation of long-term cost-effectiveness.

Asthma severity is influenced by complex immunologic and environmental factors. While allergic asthma is linked to increased susceptibility to respiratory infections, the combined role of allergy and antibiotic-treated infections in progression to severe asthma has not been fully evaluated. To evaluate whether allergic asthma and recurrent respiratory infections (RRI) requiring antibiotics are associated with increased risk of developing severe asthma. We conducted a registry-based cohort study using Swedish national registry data. Adults with mild-to-moderate asthma were identified in 2014 (baseline) based on prescription records and absence of severe disease indicators. During a two-year exposure window (2015-2016), RRI was defined as ≥ 2 antibiotic prescriptions for lower respiratory tract infections. The outcome was development of severe asthma during 2017-2019, based on ERS/ATS treatment criteria. Allergic asthma was defined by ≥ 2 prescriptions for anti-allergic medications at baseline. Among 113,393 patients, 24,692 (21.8%) had allergic asthma. RRI occurred more frequently in allergic versus non-allergic asthma (7.5% vs. 5.9%, p < 0.001). A total of 869 patients (0.77%) developed severe asthma. Incidence was higher in those with RRI and highest among patients with both allergic asthma and RRI (2.0%), corresponding to a relative risk of 3.47 (95% CI: 2.49-4.83) versus patients with neither exposure. Results were consistent after adjustment for age, sex and comorbidities. Allergic asthma and antibiotic-treated respiratory infections were independent and additive predictors of severe asthma progression. These findings support a clinically actionable risk profile and may inform targeted preventive strategies in asthma management.

Abstract BackgroundRecent advances in Alzheimer’s Disease (AD) disease modifying therapies (DMTs) emphasize the need of an early, timely and accurate diagnosis to initiate treatment and improve patient outcomes. Clinicians must confirm amyloid pathology through cerebrospinal fluid (CSF) testing or amyloid positron emission tomography (PET) scan to qualify patients. As a result, the demand for confirmatory CSF or imaging biomarker testing is predicted to rise significantly.MethodWe developed a model to analyze diagnostic capacity for patients with mild cognitive impairment (MCI) seeking care in the US. We assessed amyloid PET and CSF testing from a payer’s perspective over 5 years. It was assumed that CSF testing is constrained by the number of lumbar puncture procedures rather than laboratory capacity. Of all currently available PET capacity per year, about 5% is used for AD diagnosis; this is assumed to increase approximately 7% per year. We compare four scenarios: 1) currently observed CSF (about 3.5%) and amyloid PET (&lt; 1%) usage based on Medicare data; 2) increasing CSF use to meet the increasing demand for confirmatory testing, while PET remains as in scenario 1; 3) 100% amyloid PET 4) 100% CSF usage.ResultCurrent usage of CSF and amyloid PET testing (scenario 1) cannot meet the increasing demand for AD confirmatory testing: Assuming 50% of patients with MCI seek care annually, there would be an excess demand of about 10 times in year 1. Increasing CSF usage in scenario 2 would lead to timely diagnosis of up to 55% of beta amyloid positive patients in 5 years, of which 45% is attributed to CSF testing and the remaining to PET use. The more extreme scenarios 3 and 4 of 100% use of either PET or CSF, result in &lt;1% patients and 12.6% patients being diagnosed in year 1, respectively.ConclusionIncreasing CSF use and capacity could meet the demand for confirmatory testing the quickest, reduce wait times and increase the number of timely diagnosed patients, especially during the time where more amyloid PET capacity is being instituted. Efforts to increase CSF usage and capacity could positively impact patient outcomes.

Abstract BackgroundNew disease modifying treatments (DMTs) offer a new treatment paradigm in mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease (AD). This likely requires significant changes in patient management and need for added capacity for diagnosis, treatment and monitoring.MethodWe surveyed eight selected memory clinics in the three largest and two smaller regions of Sweden, plus one in each of Denmark, Finland and Norway on their current practice, number of patients by diagnosis and available resources. Findings were compared to clinic assumptions on a future scenario where eligible patients with MCI or mild dementia due to AD are offered DMT.ResultUp to 3, but most often less than 1, incident patients in 1000 inhabitants per year are seen at surveyed memory clinics, of which on average about 40% have MCI or mild dementia due to AD. This constitutes not more than a few percent of the 10‐30 persons in 1000 inhabitants expected to have AD at this stage in the Nordics today. Most patients get amyloid biomarker confirmation as part of their diagnosis, while there are long wait times for radiology, in particular magnetic resonance imaging.ConclusionMost patients expected to be eligible for DMTs in AD are not referred to memory clinics today, but are managed in primary care or are not presenting with cognitive complaints to health care at all. Therefore, the main challenge is likely not to treat patients already seen at memory clinics, but to manage a potential increase in patients that would benefit from DMTs. New referral patterns and health care seeking behaviors are therefore expected to determine the need for investments in additional capacity to diagnose and treat eligible patients.

<bold>Background:</bold> The link between use of oral corticosteroids (OCS) and serious adverse events (SAEs) in asthma is well-described. In contrast, whether use of high-dose inhaled corticosteroids (ICS) has a risk on these is not clear. <bold>Aim:</bold> Using Swedish data from the NORdic Dataset for aSThmA Research (NORDSTAR) cohort we examined whether current high-dose ICS exposure is associated with incident CS-related SAEs <bold>Methods:</bold> This was an observational cohort study including asthma patients ≥18 years between 2009-19. We used Cox regression models to examine the association between current ICS exposure (daily µg budesonide as a time-dependent predictor) and CS-related SAEs including osteoporosis, type-2 diabetes (T2D), cataract and pneumonia with patients using no ICS as reference. Age, sex, and OCS dose were included as covariates. <bold>Results:</bold> Overall, 529,203 asthma patients were included. We found a dose-response association between SAEs and increasing daily ICS doses. HRs of osteoporosis increased if ICS dose >800 µg: HR 1.23 (95%CI 1.16-1.30) if 800-1599 µg and HR 1.4 (95%CI 1.24-1.58) with >2400µg per day. T2D HR increased from 1.11 (95%CI 1.06-1.16) if 800-1599µg to HR 1.58 (95%CI 1.42-1.77) with >2400µg daily. Likewise, cataract risk increased with higher ICS doses. Lastly, pneumonia risk increased from HR 1.65 (95%CI 1.58-1.72) to 2.91 (95%CI 2.68-3.16) if dose increased from 800-1599 to >2400µg. <bold>Conclusion:</bold> We identified a dose-dependent added risk of current high-dose ICS use on several CS-related SAEs. This highlights the importance for clinicians to consider this risk in patients treated with high-dose ICS. More studies are needed to further investigate this association.

Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.

&lt;p dir="ltr"&gt;&lt;u&gt;Objective&lt;/u&gt;: Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALO), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is synergistic effect of accumulating MetS traits on future MALO risk.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;u&gt;Research Design and Methods&lt;/u&gt;: Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until Oct 31, 2022. Data were analyzed using Cox regression models.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;u&gt;Results&lt;/u&gt;: In total 230,992 patients were identified (median age: 64; 58% male), of which 3,215 (1.39%) developed MALO over a median follow-up of 9.9 years. Compared to patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALO (aHR=2.33, 95% CI=1.53-3.54). The rate of MALO increased progressively with increasing numbers of MetS traits at baseline (aHR=1.28 per added trait, 95% CI=1.23-1.33). During follow-up, patients that acquired additional MetS traits had progressively higher rate of MALO. The MetS trait with the largest association with incident MALO was hypertension (aHR=2.06, 95% CI=1.57-2.71).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;u&gt;Conclusion&lt;/u&gt;: Having or acquiring additional traits of the metabolic syndrome increase the rate of progression to major adverse liver outcomes in patients with type 2 diabetes. These results could be used to inform screening initiatives for liver disease.&lt;/p&gt;