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Jayne Smith-Palmer,1 Karin Cerri,2 Urbano Sbarigia,2 Eric KH Chan,3 Richard F Pollock,1 William J Valentine,1 Kristien Bonroy2 1Ossian Health Economics and Communications, Basel, Switzerland; 2Janssen Pharmaceutica NV, Beerse, Belgium; 3Janssen Global Services, LLC, Raritan, NJ, USACorrespondence: Jayne Smith-PalmerOssian Health Economics and Communications GmbH, Bäumleingasse 20, Basel 4051, SwitzerlandTel +41 61 271 6214Email smith-palmer@ossianconsulting.comBackground: People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it.Methods: A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted.Results: A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV.Conclusion: HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.Keywords: hepatitis B, stigma, discrimination more...

LK Billings,1,2 M Mocarski,3 A Basse,4 B Hunt,5 WJ Valentine,5 E Jodar6 1Division of Endocrinology and Metabolism, NorthShore University HealthSystem, Skokie, IL, USA; 2Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA; 3Value Evidence and Outcomes, Novo Nordisk Inc., Plainsboro, NJ, USA; 4Market Access- Region AAMEO, Novo Nordisk Pharma Gulf FZ-LLC, Dubai, United Arab Emirates; 5Health Economics, Ossian Health Economics and Communications, Basel, Switzerland; 6Department of Endocrinology and Clinical Nutrition, H.U. Quirón Salud Madrid & Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain Background: Compared with basal-bolus insulin therapy (insulin glargine U100 plus insulin aspart), IDegLira has been shown to be associated with similar improvements in HbA1c, with superior weight loss and reduced hypoglycemia in patients with type 2 diabetes. The present analysis evaluated the cost per patient with type 2 diabetes achieving HbA1c-focused and composite treatment targets with IDegLira and insulin glargine U100 plus insulin aspart (≤4 times daily). Methods: The proportions of patients achieving treatment targets were obtained from the treat-to-target, non-inferiority DUAL VII study (NCT02420262). The annual cost per patient achieving target (cost of control) was analyzed from a US healthcare payer perspective. The annual cost of control was assessed for eight prespecified endpoints and four post-hoc endpoints. Results: The number needed to treat to bring one patient to targets of HbA1c more...

Richard F Pollock,1 Barrie Chubb,2 William J Valentine,1 Simon Heller3 1Health Economics and Outcomes Research, Ossian Health Economics and Communications GmbH, Basel, Switzerland; 2EU-HEOR, Novo Nordisk Limited, Gatwick, UK; 3Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK Background: To estimate the short-term cost-effectiveness of insulin detemir (IDet) versus neutral protamine Hagedorn (NPH) insulin based on the incidence of non-severe hypoglycemia and changes in body weight in subjects with type 1 diabetes (T1D) or type 2 diabetes (T2D) in the UK. Methods: A model was developed to evaluate cost-effectiveness based on non-severe hypoglycemia, body mass index, and pharmacy costs over 1 year. Published rates of non-severe hypoglycemia were employed in the T1D and T2D analyses, while reduced weight gain with IDet was modeled in the T2D analysis only. Effectiveness was calculated in terms of quality-adjusted life expectancy using published utility scores. Pharmacy costs were captured using published prices and defined daily doses. Costs were expressed in 2016 pounds sterling (GBP). Sensitivity analyses were performed (including probabilistic sensitivity analysis). Results: In T1D, IDet was associated with fewer non-severe hypoglycemic events than NPH insulin (126.7 versus 150.8 events per person-year), leading to an improvement of 0.099 quality-adjusted life years (QALYs). Costs with IDet were GBP 60 higher, yielding an incremental cost-effectiveness ratio (ICER) of GBP 610 per QALY gained. In T2D, mean non-severe hypoglycemic event rates and body weight were lower with IDet than NPH insulin, leading to a total incremental utility of 0.120, accompanied by an annual cost increase of GBP 171, yielding an ICER of GBP 1,422 per QALY gained for IDet versus NPH insulin. Conclusion: Short-term health economic evaluation showed IDet to be a cost-effective alternative to NPH insulin in the UK due to lower rates of non-severe hypoglycemia (T1D and T2D) and reduced weight gain (T2D only). Keywords: cost-benefit analysis, insulin, diabetes mellitus type 1, diabetes mellitus type 2, hypoglycemia more...

Jayne Smith-Palmer,1 Jay P Bae,2 Kristina S Boye,2 Kirsi Norrbacka,3 Barnaby Hunt,1 William J Valentine1 1Ossian Health Economics and Communications GmbH, Basel, Switzerland; 2Eli Lilly and Company, Indianapolis, IN, USA; 3Eli Lilly Finland, Helsinki, Finland Background and aims: Type 1 diabetes is a chronic condition associated with micro- and macrovascular complications that have a notable impact on health-related quality of life, the magnitude of which can be quantified via the use of utility values. The aim of this review was to conduct a systematic literature review to identify and compare published health state utility values for adults with type 1 diabetes both, with and without diabetes-related complications.Methods: Literature searches of the PubMed, EMBASE, and Cochrane Library databases were performed to identify English language studies on adults with type 1 diabetes, published from 2000 onward, reporting utility values for patients with or without diabetes-related complications or assessing the impact of changes in HbA1c or body mass index on quality of life. For inclusion, studies were required to report utilities elicited using validated methods.Results: A total of 20 studies were included in the final review that included utility values elicited using the EuroQuol five dimensions questionnaire (n=9), 15D questionnaire (n=2), Quality of Well-Being scale (n=4), time trade-off (n=3), and standard gamble (n=2) methods. For patients with no complications, reported utility values ranged from 0.90 to 0.98. Complications including stroke (reported disutility range, −0.105 to −0.291), neuropathy (range, −0.055 to −0.358), and blindness (range, −0.132 to −0.208) were associated with the largest decrements in utility values. The magnitude of utility values and utility decrements was influenced by the assessment method used.Conclusion: Complications lead to impaired health-related quality of life in patients with type 1 diabetes, the magnitude of which is influenced by the method used to determine utilities. There is currently a lack of utility data for certain complications of type 1 diabetes, meaning that many economic evaluations have relied on a combination of type 1 and type 2 diabetes utilities, despite differences between the conditions and populations, or type 1 diabetes-specific utilities derived from different instruments. Keywords: type 1 diabetes, quality of life, health status, complications more...