Background: Belimumab use for the management of systemic lupus erythematosus (SLE) has been limited, in part due to its high acquisition cost relative to the standard of care (SoC) and the uncertainties about its cost-effectiveness. Therefore, the aim of this study was to compare the cost and effectiveness of belimumab versus the SoC alone for the management of SLE using real-world data from the perspective of public healthcare payers in Saudi Arabia. Methods: Data were retrieved from a national prospective cohort of SLE, Saudi Arabia. Adult SLE patients (≥18 yrs.) treated with belimumab plus the SoC or the SoC alone for at least six months were recruited. The effectiveness was measured using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). Unit costs for health services and prescription drugs were retrieved from the Saudi ministry of health. Nonparametric bootstrapping with inverse probability weighting was conducted to generate the 95% confidence limits for the cost and effectiveness. Results: A total of 15 patients on belimumab plus the SoC and 41 patients on the SoC alone met the inclusion criteria and were included in the analysis. The majority of patients were females (91.07%) with a mean age of 38 years. The mean difference in cost and SLEDAI-2K score reduction between belimumab versus the SoC were USD 5303.16 [95% CI: USD 2735.61–USD 7802.52] and 3.378 [95% CI: 1.769–6.831], respectively. Belimumab demonstrated better effectiveness but higher cost in 96% of the bootstrap cost-effectiveness distributions. Conclusion: Future studies should use more robust research designs and a larger sample size to confirm the findings of this study.

Background: Managing hypercholesterolemia is essential for reducing health risks and costs. Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors are recommended for patients with high low-density lipoprotein cholesterol (LDL-C) levels at risk for cardiovascular disease, especially those on maximum doses of statins and ezetimibe. However, their cost-effectiveness is unclear, particularly in Saudi Arabia, where cardiovascular disease is prevalent. The main objective of this study was to evaluate the costs and outcomes of PCSK9 inhibitors versus statins and ezetimibe. Methods: A multicenter retrospective study reviewed charts of adults (≥18 years) with hypercholesterolemia treated with PCSK9 inhibitors (evolocumab or alirocumab) for at least 12 months. Outcomes included LDL-C reduction and cardiovascular-related hospitalizations, with direct medical costs estimated via micro-costing and adjusted for confounders. Results: The analysis included 118 patients on PCSK9 inhibitors and 304 on statins plus ezetimibe. Mean LDL-C reductions were 1.432 mmol/L [95% CI: 0.964 to 1.899] for PCSK9 inhibitors and 0.644 mmol/L [95% CI: 0.464 to 0.823] for the other group. Cardiovascular-related hospitalizations averaged 0.645 for PCSK9 inhibitors compared to 0.808 for statins plus ezetimibe. The annual cost for PCSK9 inhibitors ranged from USD 4024 [95% CI: 3786.80 to 7947.91] to USD 7559 [95% CI: 7331.35 to 11,509.66]. In 99.13% and 98.78% of bootstrap distributions, PCSK9 inhibitors led to greater LDL-C reductions and fewer hospitalizations. Conclusions: The use of PCSK9 inhibitors for managing hypercholesterolemia was associated with a greater reduction in LDL-C levels and fewer cardiovascular-related hospitalizations. However, the more modest LDL-C reduction compared to clinical trials, combined with the high acquisition cost of PCSK9 inhibitors, underscores the need to provide significant price reductions to improve patient access to these lipid-lowering agents.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that impacts multiple organs. In Saudi Arabia, the prevalence of SLE is about 19 per 100,000 people, primarily affecting women at a 9:1 ratio. This study aimed to estimate the direct medical costs of managing SLE in Saudi Arabia. Methods: Data were collected from electronic medical records at a university-affiliated tertiary care center using a micro-costing approach over a 12-month period, encompassing the costs for laboratory tests, imaging, medications, and outpatient visits. A Generalized Linear Model (GLM) was used to assess the relationship between costs and patient characteristics. Results: A total of 103 patients were observed, who were primarily female (90.23%), Saudi nationals (97.09%), and married (53.40%). The average age was 41.27 years (±12.01), with an illness duration of 13.37 years (±6.64). Approximately 44% had lupus nephritis, 13% had thrombocytopenia, 20% had leukopenia, 9% had neuropsychiatric lupus, 44% had arthritis, and 20% had chronic cutaneous lupus. Approximately 60% exhibited mild or no disease activity, as per the SLEDAI-2K score. The mean annual medical cost associated with the management of systemic lupus erythematosus (SLE) was USD 12,760.65. However, after adjusting for various covariates using the Generalized Linear Model (GLM), the estimated annual medical costs were USD 23,041 for patients treated with biologics and USD 47,793 for those with high disease activity. Both high disease activity (SLEDAI-2K score > 11) and the use of biologics were identified as significant predictors of increased annual medical costs. Conclusions: This study is the first to estimate the costs of SLE management in Saudi Arabia from a public healthcare perspective. Future research should include a larger, more representative sample and consider the productivity losses associated with SLE.

Objective: Investigate patient characteristics, treatments used, treatment response, and factors associated with outcomes when managing SE in a pediatric population admitted to the emergency department (ED). Methods: This retrospective observational study included pediatric patients (age ≤ 18 years) with SE admitted to the ED at King Khalid University Hospital between 2015 and 2023. SE and refractory SE (RSE) were diagnosed according to the American Epilepsy Society (AES) definitions. The data included demographics, home medications, treatment sequences, medication dosing, and clinical outcomes. To assess appropriateness, the administered doses were compared with the AES standards for pediatric patients. Results: The study included 487 episodes of SE. The mean patient age was 6.1 ± 4.1 years, and most patients were males (57.3%) with a history of epilepsy (74.1%). Benzodiazepines (BDZs) were administered first in 83.0% of cases, with a 10.9% success rate, whereas anti-seizure medications (ASMs) were administered first in 17.0% of cases, with a 66.3% success rate (p < 0.0001). Surprisingly, medications administered at appropriate doses during the first round were significantly less effective compared to those that were underdosed (18.2% vs. 28.4%; p = 0.0222), mainly because of poor response to BDZs. Younger patients and those who received BDZs on their first medication round had higher hospital admission rates. Conclusions: ASMs were more effective than BDZs in managing pediatric patients with SE, regardless of the dosing precision. These findings point toward the adoption of personalized treatment strategies and may warrant early initiation of ASMs. National multicenter studies are needed to define a standardized pediatric SE protocol.