Incremental cost-effectiveness ratios for Parkinson’s disease patients comparing advanced therapies to best medical treatment 

Katarzyna Smilowska PhD, Tomasz Pietrzykowski PhD, Alexander Calvano, K Ray Chaudhuri DSc, Daniel J van Wamelen PhD

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The advanced stage of Parkinson’s disease (PD) manifests with progressively increasing disabilities. These usually present as fluctuations between akinetic periods (off phenomenon) and mobile periods (on phenomenon) with or without dyskinesia. At this stage of the disease, treatment aims should shift from oral medication to more  continuous dopaminergic stimulation in the form of device-aided therapies, not in the least as these therapies also have a positive effect on many non-motor symptoms, and thus improve quality of life for PD patients. Currently available device-aided therapies are Deep brain stimulation (DBS), intrajejunal Levodopa-carbidopa infusion (IJLI) and continuous subcutaneous apomorphine infusion (CSAI). Here, we aimed to perform a systematic review of the available literature on economic analyses of device-aided therapies in patients with PD in order to assess the cost-effectiveness of these therapies. 

 

Guideline development: Percutaneous Endoscopic gastrostomy in advance dementia patients

Colonna I., Carvalho V.

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Research question: In patients with dementia, does percutaneous endoscopic gastrostomy, when compared to oral feeding, reduces mortality? 

Guideline: use of cholinesterase inhibitors and memantine in vascular dementia

Cabreira V., Massano J.

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Research question: Our PICO question was whether ChEI or memantine rather than standard of care (no pharmacological treatment) should be used in patients with vascular dementia to improve important clinically meaningful outcomes such as cognitive functioning, global clinical impression, behaviour and performance of ADL. 
The guideline developers prioritised this question. 
Perspective: Population. 
Guideline development followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. Several outcomes were identified and judgements were made in relation to its importance. Overall, outcomes for cognitive functioning, ADL and global clinical impression were considered to be of critical importance (rating 7-9) while outcomes for behaviour were classified as important (mean rating of 6). Outcomes related to adverse events were also rated and globally were considered to be important, while number of deaths was classified as a critical outcome. 

Rituximab and Cyclophosphamide as Second-line Immunotherapy for Autoimmune Encephalitis

Antonia Lefter, Liviu Cozma, Bogdan Ovidiu Popescu

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The PICO question was the following:
For adult patients (at least 18 years old) with  Autoimmune encephalitis (AE), does treatment with rituximab (375 mg/ once a week for at least 4 weeks or 1 g infused twice, 2 weeks apart), cyclophosphamide (750 mg/ once a month for at least 4 months), or both regimens combined, as opposed to absence of intervention, lead to a better clinical outcome (decrease in the mRS of at least 1 point from onset), or absence of relapses, i.e. exacerbation of previous symptoms or the occurrence of new symptoms.

Guideline: use of pharmacological therapy in the treatment of diabetic peripheral neuropathic pain

Nadezhda Ruzhdii 

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PICO question: wheather pregabalin or gabapentin or duloxetine should be used as first-line treatment instead of standard of treatment (amitriptilin) of diabetic peripheral neuropathic pain.Population: diabetic peripheral neuropatic pain individuals 2) Intervention: pregabalin or gabapentin or duloxetine treatment or standart AMT treatment ; 3) Setting: all countries; 4) Outcome: reduced neuropatic pain. Side symptoms reported in the studies: diarrhoea, dizziness, headache, somnolence and nausea considered as adverse events (AE). Outcomes related to adverse events were rated and considered to be important. Number of deaths was classified as a critical outcome. Guideline development followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group recommendations in population perspective. 

Neuromodulation versus standard care for migraine prophylaxis

Federico Emanuele Pozzi, Nina Vashchenko

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PICO question: should neuromodulation be used in patients with migraine for prophylactic therapy? 
Through a Delphi procedure, we agreed on a set of 6 outcomes for our search, 3 of which were rated critical (days without migraine, intensity of migraine and acute drugs intake) and 3 important (side effects, functional disability and patients’ satisfaction). Guideline development was carried through according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. 

  • Incremental cost-effectiveness ratios for Parkinson’s disease patients comparing advanced therapies to best medical treatment 

  • Guideline development: Percutaneous Endoscopic gastrostomy in advance dementia patients

  • Guideline: use of cholinesterase inhibitors and memantine in vascular dementia

  • Rituximab and Cyclophosphamide as Second-line Immunotherapy for Autoimmune Encephalitis

  • Guideline: use of pharmacological therapy in the treatment of diabetic peripheral neuropathic pain

  • Neuromodulation versus standard care for migraine prophylaxis