Medication adherence and costs of medical care among patients with Parkinson's disease: an observational study using electronic medical records.

BACKGROUND: Adherence to antiparkinsonian drugs (APDs) is critical for patients with Parkinson's disease (PD), for which medication is the main therapeutic strategy. Previous studies have focused on specific disorders in a single system when assessing clinical factors affecting adherence to PD treatment, and no international comparative data are available on the medical costs for Chinese patients with PD. The present study aimed to evaluate medication adherence and its associated factors among Chinese patients with PD using a systematic approach and to explore the impact of adequate medication adherence on direct medical costs. METHODS: A retrospective analysis was conducted using the electronic medical records of patients with PD from a medical center in China. Patients with a minimum of two APD prescriptions from January 1, 2016 to August 15, 2018 were included. Medication possession ratio (MPR) and proportion of days covered were used to measure APD adherence. Multiple linear regression analysis was used to identify factors affecting APD adherence. Gamma regression analysis was used to explore the impact of APD adherence on direct medical costs. RESULTS: In total, 1,712 patients were included in the study, and the mean MPR was 0.68 (± 0.25). Increased number of APDs and all medications, and higher daily levodopa-equivalent doses resulted in higher MPR (mean difference [MD] = 0.04 [0.03-0.05]; MD = 0.02 [0.01-0.03]; MD = 0.03 [0.01-0.04], respectively); combined digestive system diseases, epilepsy, or older age resulted in lower MPR (MD = -0.06 [-0.09 to -0.03]; MD = -0.07 [-0.14 to -0.01]; MD = -0.02 [-0.03 to -0.01], respectively). Higher APD adherence resulted in higher direct medical costs, including APD and other outpatient costs. For a 0.3 increase in MPR, the two costs increased by $34.42 ($25.43-$43.41) and $14.63 ($4.86-$24.39) per year, respectively. CONCLUSIONS: APD adherence rate among Chinese patients with PD was moderate and related primarily to age, comorbidities, and healthcare costs. The factors should be considered when prescribing APDs.

Generation of Environmentally Persistent Free Radicals on Metal-Organic Frameworks.

Environmentally persistent free radicals (EPFRs) have been recognized as one of the important emerging contaminants with biological toxicity, environmental persistence, and global mobility. Previous studies have identified the catalytic role of surface metal oxides in EPFRs formation and illustrated the metal-dependence of EPFRs by studying on various metal oxide nanoparticles and single crystals. However, there is still lack of an understanding on the formation of EPFRs from the point of view of metal sites. Various factors (e.g., crystalline phases and surface species) of metal oxides are regarded to contribute to the generation of EPFRs, which present profound difficulties for scientists to tease apart the impact of metal type. Herein, a laboratory investigation, in terms of the acidity and oxidation strength of metal cations, was conducted by selecting metal-variable isostructural metal-organic frameworks as material platforms. Specifically, we evaluated EPFRs generation on MIL-100(M) (M = Al, Cr, Fe) from chlorine-substituted phenol vapor and catechol under thermal conditions. It is found that high Lewis acidity of metal sites is crucial for capturing the above two phenolic precursors, activating the O-H bond and promoting EPFRs formation. Radical species with half-life as long as 70 days were generated on MIL-100 rich in 5-fold coordinated Al3+ sites. The unpaired electron spin density donation was further confirmed by using 27Al solid-state nuclear magnetic resonance spectroscopy. Despite their higher oxidation power than Al3+, the exposed Cr3+ and Fe3+ sites show undetectable catalytic activity for the formation of EPFRs, because of their insufficient Lewis acidity. Our results suggest that the surface species rather than Lewis acid sites may be a major contributor to the formation of EPFRs on metal oxides like Fe2O3.

Synthesis and antimicrobial activity of the hybrid molecules between amoxicillin and derivatives of benzoic acid.

Due to the increasing problem of bacterial resistance worldwide, the demand for new antibiotics is becoming increasingly urgent. We wished to: (a) prepare hybrid molecules by linking different pharmacophores by chemical bonds; (b) investigate the antib acterial activity of these hybrids using drug-sensitive and drug-resistant pathogens in vitro and vivo. A series of hybrid molecules with a diester structure were designed and synthesized that linked amoxicillin and derivatives of benzoic acid via a methylene bridge. Synthesized compounds were evaluated for activities against Gram-positive bacteria (Staphylococcus aureus American Type Culture Collection [ATCC] 29213, ATCC 11632; methicillin-resistant S. aureus [MRSA] 11; Escherichia coli ATCC 25922) and Gram-negative bacteria (Salmonella LS677, GD836, GD828, GD3625) by microdilution of broth. Synthesized compounds showed good activity against Gram-positive and Gram-negative bacteria in vitro. In particular, amoxicillin-p-nitrobenzoic acid (6d) showed good activity against Salmonella species and had better activity against methicillin-resistant S. aureus (minimum inhibitory concentration [MIC] = 64 µg/ml) than the reference drug, amoxicillin (MIC = 128 µg/ml). Amoxicillin-p-methoxybenzoic acid (6b) had the best antibacterial activity in vivo (ED50 = 13.2496 µg/ml). The hybrid molecules of amoxicillin and derivatives of benzoic acid synthesized based on a diester structure can improve the activity of amoxicillin against Salmonella species and even improve the activity against MRSA.

Oncology from an HTA and Health Economic Perspective.

In this chapter, we will present and discuss the challenges of assessing oncology products from a health economic perspective. We will provide a brief introduction on the need for economic evaluation in health care and focus on cost-effectiveness and comparative aspects of the evaluation of oncology products, which are of paramount interest to HTA decision-making bodies using economic evaluation in their decision-making framework. As the burden of oncology is well-documented, we do not discuss it in detail here. Before we address the specific issue of oncology, we will briefly define the critical aspects of HTA assessment and also define what a cost-effectiveness analysis is and why economic modelling is the most appropriate tool to assess the cost-effectiveness of oncology products. We will touch upon the prices of oncology drugs and the questions that high prices raise regarding funding and availability. We then present an overview of the general structure of an oncology cost-effectiveness model. Usually, this is quite simple, representing response, progression, advanced-stage disease and death. Despite the relative simplicity of these models, some issues may render the evaluation more complex; we will touch upon these in this chapter: Issue with clinical inputs due to the design of randomised clinical trials (e.g. cross-over designs involving a treatment switch) Need for survival extrapolation and limitations of current parametric models Rare conditions with limited economic and comparative evidence available High pace of clinical development Finally, we will conclude with a discussion of the uncertainty around the evaluation of oncology products and the major evolution expected in health economics in oncology.

Prevalence of hepatitis C infection among the general population and high-risk groups in the EU/EEA: a systematic review update.

BACKGROUND: Although significant improvement in efficacy measured by a sustained virological response, the high acquisition costs of direct-acting antivirals limit the access for patients and influence the costs of healthcare resource utilisation in hepatitis C. It is important to have the latest estimates of prevalence, especially in high-risk groups, for cost of illness, cost-effectiveness and budget impact studies. METHODS: Original studies on the estimates of the prevalence among general and high-risk groups in the European Union/European Economic Area (EU/EEA) were retrieved from Medline and Embase for the period from 2015 to 2018. All included studies were evaluated for risk of selection bias and summarised together in a narrative form. Results from previous reviews and updated searches were compared per country among different populations, respectively. RESULTS: Among the 3871 studies identified, 46 studies were included: 20 studies were used for the estimate of the general population; 3 for men who have sex with men (MSM); 6 for prisoners; and 17 for people who inject drugs (PWID). Compared with the results reported in previous systematic reviews, the updated estimates were lower than previously in most available countries. Anti-HCV general population prevalence estimates ranged from 0.54 to 1.50% by country. The highest prevalence of anti-HCV was found among PWID (range of 7.90-82.00%), followed by prisoners (7.00-41.00%), HIV-positive MSM (1.80-7.10%), HIV-negative MSM (0.20-1.80%), pregnant women (0.10-1.32%) and first-time blood donors (0.03-0.09%). CONCLUSIONS: Our study highlights the heterogeneity in anti-HCV prevalence across different population groups in EU/EEA. The prevalence also varies widely between European countries. There are many countries that are not represented in our results, highlighting the need for the development of robust epidemiological studies.

Zinc/Nickel-Doped Hollow Core-Shell Co3 O4 Derived from a Metal-Organic Framework with High Capacity, Stability, and Rate Performance in Lithium/Sodium-Ion Batteries.

Transition-metal oxides are one of the most promising anode materials for energy storage in lithium- and sodium-ion batteries (LIBs and NIBs, respectively). To improve the electrochemical performance of metal oxides (e.g., Co3 O4 ), such as capacity and cyclability, a convenient strategy (with a metal-organic framework as a template) is introduced to generate Zn- or Ni-doped Co3 O4 . The obtained hollow core-shell nanosized Co3 O4 (denoted as Zn/Ni-Co-Oxide) derived from pyrolyzing zinc or nickel co-doped ZIF-67 (Co(mIm)2 ; mIm=methylimidazole) shows a drastically enhanced capacity of 1300 mAh g-1 at a high current density of 5000 mA g-1 , compared with that of pristine cobalt oxide (800 mAh g-1 ) in LIBs. A zinc-doped Zn-Co-Oxide demonstrates a stable capacity of 1600 mAh g-1 at 1000 mA g-1 for 700 cycles and an excellent performance in full coin cells (cycled with LiNi0.5 Co0.3 Mn0.2 O2 ). Moreover, NIB tests show a stable capacity of 300 mAh g-1 for more than 250 cycles.

Acid-suppressive drugs and risk of kidney disease: A systematic review and meta-analysis.

BACKGROUND AND AIM: More concerns had been raised about the risk of kidney disease (KD) associated with acid-suppressive drugs. But whether they could directly increase such risk remained unclear. Meta-analysis was conducted to comprehensively investigate this relationship. METHODS: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and three Chinese databases were searched until April 2017 for observational studies investigating the associations between acid-suppressive drugs and KD. Pooled log (odds ratios [ORs]) or log (hazard ratios [HRs]) with standard errors for KD risk were calculated using the generic inverse variance method and random-effect model. RESULTS: Ten studies involving 128 020 KD patients were included. Proton pump inhibitor (PPI) therapy was associated with higher risks of acute interstitial nephritis (OR, 2.78; 95% confidence interval [CI], 1.25-6.17), acute kidney injury (AKI) (HR, 1.85; 95% CI, 1.33-2.59), chronic kidney disease (CKD) (HR, 1.47; 95% CI, 1.03-2.09), and end-stage renal disease (ESRD) (HR, 1.61; 95% CI, 1.26-2.04) than non-PPI therapy. Additionally, PPI significantly increased the risks of AKI (HR, 1.32; 95% CI, 1.16-1.51), CKD (HR, 1.28; 95% CI, 1.24-1.33), and ESRD (HR, 1.96; 95% CI, 1.21-3.17) compared with histamine 2 receptor antagonist (H2 RA). Relationship between H2 RA therapy and AKI (OR, 0.98; 95% CI, 0.90-1.07) or CKD (OR, 1.00; 95% CI, 0.89-1.11) was not found. CONCLUSIONS: Proton pump inhibitor therapy significantly increased the risks of acute interstitial nephritis, AKI, CKD, and ESRD. Similar risks were not identified for H2 RA therapy. More clinical trials are needed to confirm our findings.

Emerging crystalline porous materials as a multifunctional platform for electrochemical energy storage.

Metal-organic frameworks (MOFs) and covalent-organic frameworks (COFs) are two emerging and explosively growing families of crystalline porous materials (CPMs). These robust frameworks are characterized by their extraordinary porosity, tremendous structural diversity, and versatile functional tunability with precision at the molecular level. In this review, we present recent milestones of MOFs and COFs in the fields of batteries and supercapacitors, two important technologies in electrochemical energy storage (EES), and highlight the functions that a CPM can offer in EES devices, including the storage of electrochemical energy, stabilization of electrode materials, pathways for charge transport, manipulation on mass transport, and promotion of electrochemical reactions. Key requirements for each function are discussed, with future directions provided for further development.

Flexible Films of Covalent Organic Frameworks with Ultralow Dielectric Constants under High Humidity.

Covalent organic framework (COF) films combine the processability of polymers with the porosity and atomic precision of crystalline porous materials, properties that are long-sought-after in electronics yet hard to realize. Herein, we prepared four flexible COF films with different alkoxy side chains via interfacial polymerization. The COF films exhibit an ultralow dielectric constant (κ=1.19±0.04 at 105  Hz), small dielectric loss (<0.02, 103 -106  Hz), high breakdown voltage (>63 kV cm-1 ) and low leakage current (10-10  A cm-2 at 1 kV cm-1 ). They have considerable mechanical strength, and ability to withstand high humidity (RH 70 % for 10 days) and repeated bending (1000 times) without losing their dielectric properties. Extension of the alkoxy chains reduces the film's κ and enhances its moisture resistance, while incorporation of guest molecules further increase the κ value up to 43 times.

Exfoliation of Covalent Organic Frameworks into Few-Layer Redox-Active Nanosheets as Cathode Materials for Lithium-Ion Batteries.

Covalent organic frameworks (COFs) have attracted growing interest by virtue of their structural diversity and tunability. Herein, we present a novel approach for the development of organic rechargeable battery cathodes in which three distinct redox-active COFs were successfully prepared and delaminated into 2D few-layer nanosheets. Compared with the pristine COFs, the exfoliated COFs with shorter Li+ diffusion pathways allow a significant higher utilization efficiency of redox sites and faster kinetics for lithium storage. Unlike diffusion-controlled manners in the bulk COFs, the redox reactions in ECOFs are mainly dominated by charge transfer process. The capacity and potential are further engineered by reticular design of COFs without altering the underlying topology. Specifically, DAAQ-ECOF exhibits excellent rechargeability (98% capacity retention after 1800 cycles) and fast charge-discharge ability (74% retention at 500 mA g-1 as compared to at 20 mA g-1). DABQ-ECOF shows a specific capacity of 210 mA h g-1 and a voltage plateau of 2.8 V.

A Lithium Ion Highway by Surface Coordination Polymerization: In Situ Growth of Metal-Organic Framework Thin Layers on Metal Oxides for Exceptional Rate and Cycling Performance.

A thin layer of a highly porous metal-organic framework material, ZIF-8, is fabricated uniformly on the surface of nanostructured transition metal oxides (ZnO nanoflakes and MnO2 nanorods) to boost the transfer of lithium ions. The novel design and uniform microstructure of the MOF-coated TMOs (ZIF-8@TMOs) exhibit dramatically enhanced rate and cycling performance comparing to their pristine counterparts. The capacities of ZIF-8@ZnO (nanoflakes) and ZIF-8@MnO2 (nanorods) are 28 % and 31 % higher that of the pristine ones at the same current density. The nanorods of ZIF-8@MnO2 show a capacity of 1067 mAh g-1 after 500 cycles at 1 Ag-1 and without any fading. To further improve the conductivity and capacity, the ZIF-8-coated materials are pyrolyzed at 700 °C in an N2 atmosphere (ZIF-8@TMO-700 N). After pyrolysis, a much higher capacity improvement is achieved: ZIF-8@ZnO-700 N and ZIF-8@MnO2 -700 N have 54 % and 69 % capacity increases compared with the pristine TMOs, and at 1 Ag-1 , the capacity of ZIF-8@MnO2 -700 N is 1060 mAh g-1 after cycling for 300 cycles.

Three-Dimensional Anionic Cyclodextrin-Based Covalent Organic Frameworks.

Three-dimensional covalent organic frameworks (3D COFs) are promising crystalline materials with well-defined structures, high porosity, and low density; however, the limited choice of building blocks and synthetic difficulties have hampered their development. Herein, we used a flexible and aliphatic macrocycle, namely γ-cyclodextrin (γ-CD), as the soft struts for the construction of a polymeric and periodic 3D extended network, with the units joined via tetrakis(spiroborate) tetrahedra with various counterions. The inclusion of pliable moieties in the robust open framework endows these CD-COFs with dynamic features, leading to a prominent Li ion conductivity of up to 2.7 mS cm-1 at 30 °C and excellent long-term Li ion stripping/plating stability. Exchanging the counterions within the pores can effectively modulate the interactions between the CD-COF and CO2 molecules.

Preparation of Nanofibrous Metal-Organic Framework Filters for Efficient Air Pollution Control.

Environmental challenges especially air pollution (particulate matter (PM) and toxic gases) pose serious threats to public health globally. Metal-organic frameworks (MOFs) are crystalline materials with high porosity, tunable pore size, and rich functionalities, holding the promise for poisonous pollutants capture. Here, nanocrystals of four unique MOF structures are processed into nanofibrous filters (noted as MOFilter) with high MOF loadings (up to 60 wt %). The MOFilters show high PM removal efficiencies up to 88.33 ± 1.52% and 89.67 ± 1.33% for PM2.5 and PM10, respectively, in the hazy environment, and the performance remains largely unchanged over 48 h of continuous filtration. For the first time, the interactions between such porous crystalline material and particulate pollutants were explored. These thin MOFilters can further selectively capture and retain SO2 when exposed to a stream of SO2/N2 mixture, and their hierarchical nanostructures can easily permeate fresh air at high gas flow rate with the pressure drop <20 Pa.

Partitioning MOF-5 into Confined and Hydrophobic Compartments for Carbon Capture under Humid Conditions.

Metal-organic frameworks (MOFs), by virtue of their remarkable uptake capability, selectivity, and ease of regeneration, hold great promise for carbon capture from fossil fuel combustion. However, their stability toward moisture together with the competitive adsorption of water against CO2 drastically dampens their capacity and selectivity under real humid flue gas conditions. In this work, an effective strategy was developed to tackle the above obstacles by partitioning the channels of MOFs into confined, hydrophobic compartments by in situ polymerization of aromatic acetylenes. Specifically, polynaphthylene was formed via a radical reaction inside the channels of MOF-5 and served as partitions without altering the underlying structure of the framework. Compared with pristine MOF-5, the resultant material (PN@MOF-5) exhibits a doubled CO2 capacity (78 vs 38 cm(3)/g at 273 K and 1 bar), 23 times higher CO2/N2 selectivity (212 vs 9), and significantly improved moisture stability. The dynamic CO2 adsorption capacity can be largely maintained (>90%) under humid conditions during cycles. This strategy can be applied to other MOF materials and may shed light on the design of new MOF-polymer materials with tunable pore sizes and environments to promote their practical applications.

Shaping of Metal-Organic Frameworks: From Fluid to Shaped Bodies and Robust Foams.

The applications of metal-organic frameworks (MOFs) toward industrial separation, catalysis, sensing, and some sophisticated devices are drastically affected by their intrinsic fragility and poor processability. Unlike organic polymers, MOF crystals are insoluble in any solvents and are usually not thermoplastic, which means traditional solvent- or melting-based processing techniques are not applicable for MOFs. Herein, a continuous phase transformation processing strategy is proposed for fabricating and shaping MOFs into processable fluids, shaped bodies, and even MOF foams that are capable of reversible transformation among these states. Based on this strategy, a cup-shaped Cu-MOF composite and hierarchically porous MOF foam were developed for highly efficient catalytic C-H oxidation (conv. 76% and sele. 93% for cup-shaped Cu-MOF composite and conv. 92% and sele. 97% for porous foam) with ease of recycling and dramatically improved kinetics. Furthermore, various MOF-based foams with low densities (<0.1 g cm(-3)) and high MOF loadings (up to 80 wt %) were obtained via this protocol. Imparted with hierarchically porous structures and fully accessible MOFs uniformly distributed, these foams presented low energy penalty (pressure drop <20 Pa, at 500 mL min(-1)) and showed potential applications as efficient membrane reactors.

Adverse effects of incretin-based therapies on major cardiovascular and arrhythmia events: meta-analysis of randomized trials.

BACKGROUND: Recent cardiovascular outcome trials of incretin-based therapies (IBT) in type 2 diabetes have not demonstrated either benefit or harm in terms of major adverse cardiovascular events (MACE). Earlier meta-analyses showed conflicting results but were limited in methodology. We aimed to perform an updated meta-analysis of all available incretin therapies on the incidence of MACE plus arrhythmia and heart failure. METHODS: We identified studies published through November 2014 by searching electronic databases and reference lists. We included RCTs in which the intervention group received incretin-based therapies and the control group received placebo or standard treatment; enrolled >100 participants in each group; interventions lasted >24 weeks; and reported data on one or more primary major adverse cardiovascular events endpoints plus terms for arrhythmia and heart failure. We used the Peto method for each CV event for individual IBT treatment. RESULTS: In this meta-analysis of 100 RCTs involving 54,758 incretin-based therapies users and 48,175 controls, exenatide was associated with increased risk of arrhythmia (OR 2.83; 95% CI, 1.06-7.57); saxagliptin was associated with an increased risk of heart failure (OR 1.23; 95% CI, 1.03-1.46), and sitagliptin was associated with a significantly decreased risk of all cause death compared to active controls (OR 0.39, 95% CI 0.18-0.82). CONCLUSIONS: In type 2 diabetes, exenatide may increase the risk of arrhythmia, and sitagliptin may reduce the risk of all cause death; however, the subgroup of patients most likely to experience harm or benefit is unclear. Copyright © 2016 John Wiley & Sons, Ltd.

A Solvent-Free Hot-Pressing Method for Preparing Metal-Organic-Framework Coatings.

Metal-organic frameworks (MOFs), with their well-defined pores and rich structural diversity and functionality, have drawn a great deal of attention from across the scientific community. However, industrial applications are hampered by their intrinsic fragility and poor processability. Stable and resilient MOF devices with tunable flexibility are highly desirable. Herein, we present a solvent- and binder-free approach for producing stable MOF coatings by a unique hot-pressing (HoP) method, in which temperature and pressure are applied simultaneously to facilitate the rapid growth of MOF nanocrystals onto desired substrates. This strategy was proven to be applicable to carboxylate-based, imidazolate-based, and mixed-metal MOFs. We further successfully obtained superhydrophobic and "Janus" MOF films through layer-by-layer pressing. This HoP method can be scaled up in the form of roll-to-roll production and may push MOFs into unexplored industrial applications.

Estimating Costs Associated with Disease Model States Using Generalized Linear Models: A Tutorial.

Estimates of costs associated with disease states are required to inform decision analytic disease models to evaluate interventions that modify disease trajectory. Increasingly, decision analytic models are developed using patient-level data with a focus on heterogeneity between patients, and there is a demand for costs informing such models to reflect individual patient costs. Statistical models of health care costs need to recognize the specific features of costs data which typically include a large number of zero observations for non-users, and a skewed and heavy right-hand tailed distribution due to a small number of heavy healthcare users. Different methods are available for modelling costs, such as generalized linear models (GLMs), extended estimating equations and latent class approaches. While there are tutorials addressing approaches to decision modelling, there is no practical guidance on the cost estimation to inform such models. Therefore, this tutorial aims to provide a general guidance on estimating healthcare costs associated with disease states in decision analytic models. Specifically, we present a step-by-step guide to how individual participant data can be used to estimate costs over discrete periods for participants with particular characteristics, based on the GLM framework. We focus on the practical aspects of cost modelling from the conceptualization of the research question to the derivation of costs for an individual in particular disease states. We provide a practical example with step-by-step R code illustrating the process of modelling the hospital costs associated with disease states for a cardiovascular disease model.

Efficacy and dose-response relationships of antidepressants in the acute treatment of major depressive disorders: a systematic review and network meta-analysis.

BACKGROUND: The optimal antidepressant dosages remain controversial. This study aimed to analyze the efficacy of antidepressants and characterize their dose-response relationships in the treatments of major depressive disorders (MDD). METHODS: We searched multiple databases, including the Embase, Cochrane Central Register of Controlled Trials, PubMed, and Web of Science, for the studies that were conducted between January 8, 2016, and April 30, 2023. The studies are double-blinded, randomized controlled trials (RCTs) involving the adults (≥18 years) with MDD. The primary outcomes were efficacy of antidepressant and the dose-response relationships. A frequentist network meta-analysis was conducted, treating participants with various dosages of the same antidepressant as a single therapy. We also implemented the model-based meta-analysis (MBMA) using a Bayesian method to explore the dose-response relationships. RESULTS: The network meta-analysis comprised 135,180 participants from 602 studies. All the antidepressants were more effective than the placebo; toludesvenlafaxine had the highest odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.65-7.72), and reboxetine had the lowest OR of 1.34 (95%CI: 1.14-1.57). Moreover, amitriptyline, clomipramine, and reboxetine showed a linear increase in effect size from low to high doses. The effect size of toludesvenlafaxine increased significantly up to 80 mg/day and subsequently maintained the maximal dose up to 160 mg/day while the predictive curves of nefazodone were fairly flat in different dosages. CONCLUSIONS: Although most antidepressants were more efficacious than placebo in treating MDD, no consistent dose-response relationship between any antidepressants was observed. For most antidepressants, the maximum efficacy was achieved at lower or middle prescribed doses, rather than at the upper limit.

Lifetime effects and cost-effectiveness of standard and higher-intensity statin therapy across population categories in the UK: a microsimulation modelling study.

Background: Cardiovascular disease incidence and mortality have declined across developed economies and granular up-to-date cost-effectiveness evidence is required for treatments targeting large populations. To assess the health benefits and cost-effectiveness of standard and higher intensity statin therapy in the contemporary UK population 40-70 years old. Methods: A cardiovascular disease microsimulation model, developed using the Cholesterol Treatment Trialists' Collaboration data (117,896 participants; 5 years follow-up), and calibrated in the UK Biobank cohort (501,854 participants; 9 years follow-up), projected risks of myocardial infarction, stroke, coronary revascularization, diabetes, cancer and vascular and nonvascular death for all UK Biobank participants without and with statin treatment. Meta-analyses of trials and cohort studies informed statins' relative effects on cardiovascular events, incident diabetes, myopathy and rhabdomyolysis. UK healthcare perspective was taken (2020/2021 UK£) with costs per 28 tablets of £1.10 for standard (35%-45% LDL cholesterol (LDL-C) reduction) and £1.68 for higher intensity (≥45% LDL-C reduction) generic statin. Findings: Across categories by sex, age, LDL-C, and cardiovascular disease history/10-year cardiovascular risk, lifetime standard statin increased survival by 0.28-1.85 years (0.20-1.09 quality-adjusted life years (QALYs)), and higher intensity statin by further 0.06-0.40 years (0.03-0.20 QALYs) per person. Standard statin was cost-effective across all categories with incremental cost per QALY from £280 to £8530, with higher intensity statin cost-effective at higher cardiovascular risks and higher LDL-C levels. Stopping statin early reduced benefits and was not cost-effective. Interpretation: Lifetime low-cost statin therapy is cost-effective across all 40-70 years old in UK. Strengthening and widening statin treatment could cost-effectively improve population health. Funding: UK NIHR Health Technology Assessment Programme (17/140/02).