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The essence of our administration-cost algorithm is best appreciated when one considers the argument by de la Horie [24] that the reason why biologics are 'so expensive" is because of complex and costly manufacturing, and the need for frequent administration of high doses to be effective.
This provides a platform for a continued and sustained release of the loaded drug to enhance bioavailability, reduce systemic absorption, and the need for frequent administration leading to improved patient compliance [ 30].
Recurrent infections are of particular concern because of the repeated morbidity and necessity for frequent administration of antibiotics with the possible adverse consequences of selection of antimicrobial-resistant strains.
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Intraoperative MRI is also limited by the necessity for frequent administrations of gadolinium (Gd -chelates because of their short blood half-lives, and by the inaccuracies of false-positive contrast enhancement.
Specifically, the ORs reported (compared to no acid suppression) were 1.53 for H2RA therapy, 1.74 for daily PPI therapy and 2.36 for more frequent administration.
Newer pegylated formulations of IFN (PEG-IFN), which are better tolerated and allow for less frequent administration, have renewed interest in IFN as a therapeutic option for patients with PV, including those who are refractory or resistant to HU.
Most of the studies in our network meta-analysis used 4 hourly treatment regimens, and some opted for less frequent administration (6 hourly).
Longer acting compounds, and the use of sustained delivery devices, would allow for less frequent administration and as a consequence could lower the costs and risks associated with repeated intraocular injections.
Performance enhancement might concern providing more options for administration, less frequent administration or simply providing medication that is more acceptable to the user.
This reflects the increased compliance, decreased discontinuation rates, and patient preference for less frequent administrations; this is especially true when the mode of administration is unpleasant, painful, or causes side effects.
The less frequent administration required for oritavancin, and the lack of need for serum level monitoring, would make it possible to treat some of these infections on an outpatient basis, thereby defraying some of the direct costs of the drug.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com