Cost-effectiveness analysis of atezolizumab plus bevacizumab compared with sorafenib as first-line treatment in advanced hepatocellular carcinoma in Singapore.

OBJECTIVES: This study aims to explore the cost-effectiveness of atezolizumab plus bevacizumab against sorafenib for first-line treatment of locally advanced or metastatic hepatocellular carcinoma (HCC) in Singapore. METHODS: A partitioned survival model was developed from a healthcare system perspective, with a 10-year lifetime horizon. Clinical inputs and utilities were obtained from the IMbrave150 trial. Healthcare resource use costs were obtained from published local sources; drug costs reflected the most recent public hospital selling prices. Outcomes included life years, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to assess the model's robustness. RESULTS: Atezolizumab plus bevacizumab offered an additional 1.42 life years and 1.09 QALYs, with an additional cost of S$111,847; the ICER was S$102,988/QALY. The World Health Organization considers interventions with ICERs <1 gross domestic product (GDP)/capita to be highly cost-effective. At a willingness-to-pay (WTP) threshold of S$114,165/QALY (Singapore's 2022 GDP/capita), atezolizumab plus bevacizumab is cost-effective compared with sorafenib. The ICER was most sensitive to variations in utilities, but all parameter variations had no significant impact on the model outcomes. CONCLUSION: At a WTP threshold of Singapore's GDP/capita, atezolizumab plus bevacizumab is cost-effective compared with sorafenib.

Cost-effectiveness analysis of add-on pertuzumab to trastuzumab biosimilar and chemotherapy as neoadjuvant treatment for human epidermal growth receptor 2-positive early breast cancer patients in Singapore.

OBJECTIVES: The Asian PEONY trial showed that add-on pertuzumab to trastuzumab and chemotherapy significantly improved pathological complete response in the neoadjuvant treatment of patients with human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC). This study evaluated the cost-effectiveness of pertuzumab as an add-on therapy to trastuzumab and chemotherapy for neoadjuvant treatment of patients with HER2+ EBC in Singapore. METHODS: A six-state Markov model was developed from the Singapore healthcare system perspective, with a lifetime time horizon. Model outputs were: costs; life-years (LYs); quality-adjusted LYs (QALYs); incremental cost-effectiveness ratios (ICERs). Sensitivity/scenario analyses explored model uncertainties. RESULTS: The base case projected the addition of pertuzumab to be associated with improved outcomes by 0.277 LYs and 0.271 QALYs, increased costs by S$1,387, and an ICER of S$5,121/QALY. The ICER was most sensitive to the pCR rate, and the probabilistic sensitivity analysis showed that add-on pertuzumab had an 81.3% probability of being cost-effective at a willingness-to-pay threshold of S$45,000/QALY gained. CONCLUSIONS: This model demonstrated that the long-term clinical impact of early pertuzumab use, particularly the avoidance of metastatic disease and thus avoidance of higher costs and mortality rates, make neoadjuvant pertuzumab a cost-effective option in the management of patients with HER2+ breast cancer in Singapore.

Case Report: J-Shaped External Fixator for Treatment of Mayo Type II Olecranon Fractures - A Novel Surgical Technique and Report of Clinical Applications.

Purpose: We designed a J-shaped external fixator (J-EF) to provide a minimally invasive, one-step surgical method for olecranon fractures. The aim of this study is to retrospectively review the method and the outcomes in 14 patients treated with J-EF fixation. Methods: Biomechanical comparative study was performed to test the tensile properties of the J-EF using a universal testing machine. Between January 2002 and December 2005, 14 patients (age range: 25-67 years) with Mayo type II olecranon fractures were treated using the external fixation technique. Follow-up was done by standard measures (radiography, range of motion, and complications monitoring) and patient-reported outcomes (Mayo Elbow Performance Score [MEPS] and Disabilities of the Arm, Shoulder, and Hand [DASH] scores) 6 months after surgery. Eight of the patients were reviewed 15 years after the surgery. Results: Results from biomechanical studies indicate the non-inferiority of J-EF to tension-band wiring (TBW) in tensile properties. At the time of release, the mean elbow flexion arc was 132.5° and the mean forearm rotation arc was 173.6°. The mean DASH score was 14.1 points, and the mean MEPS was 93.9 points. Operative time and intraoperative blood loss were decreased by 41.3% and 64.6%, respectively, in J-EF patients than those in a comparable group treated by TBW. All eight patients are still alive after the surgery and maintaining the original outcome. Conclusions: External fixation using the J-EF could be considered as an alternative treatment for Mayo type II olecranon fractures as it appears to be a reliable, minimally invasive, and time-saving. Level of Evidence: Therapeutic Level IV.

Biomechanical and clinical evaluation of interlocking hip screw in Pauwels â ¢ femoral neck fractures: A comparison with inverted triangle cannulated screws.

Purpose: To compare biomechanical and clinical properties of the novel internal fixation Interlocking Hip Screw (IHS) and conventional inverted triangle cannulated screws (ITCS) for treatment of Pauwels Ⅲ femoral neck fractures. Methods: Twenty synthetic femurs were osteotomized to simulate 70° Pauwels Ⅲ femoral neck fractures and randomly divided into two groups: Group IHS and Group ITCS. Specimens were loaded in quasi-static ramped and cyclical compression testing in 25° adduction to analyze for axial stiffness, failure load, and interfragmentary displacement. 21 matched patients with Pauwels Ⅲ femoral neck fracture who received closed reduction and internal fixation from January 2020 to January 2021 in both Group IHS and Group ITCS. Demographic data, time to surgery, operating duration, intraoperative blood loss, number of fluoroscopies, length of hospital stay, fracture healing time, Harris Hip Score (HHS), the score of Visual Analogue Scale (VAS) and complications such as nonunion, avascular necrosis, and femoral neck shortening were compared. Results: All specimens in the two groups survived in the axial and cyclical compression test. The axial stiffness was significantly higher for Group IHS (277.80 ± 26.58 N/mm) versus Group ITCS (205.33 ± 10.46 N/mm), p < 0.05. The maximum failure loading in Group IHS performed significantly higher than in Group ITCS (1,400.48 ± 71.60 N versus 996.76 ± 49.73 N, p < 0.05). The interfragmentary displacement of the cyclic loading test for Groups IHS and Group ITCS was 1.15 ± 0.11 mm and 1.89 ± 0.14 mm, respectively, p < 0.05. No significant difference was found in terms of demographic data, time to surgery, intraoperative blood loss, length of hospital stay and the occurrence of nonunion and avascular necrosis between groups. Shorter operating duration and fewer intraoperative fluoroscopic views were noticed using IHS compare to ITCS, p < 0.05. The HHS was 72.14 ± 5.76 and 86.62 ± 5.01 in Group IHS, and was 67.29 ± 5.27 and 81.76 ± 5.13 in Group ITCS at 3-month and 6-month follow-up, respectively, p < 0.05. The magnitude of femoral neck shortening was significantly lower in Group IHS compared to Group ITCS (4.80 ± 1.03 mm versus 5.56 ± 1.21 mm, p < 0.05). Conclusion: Our study demonstrated that IHS provided better biomechanical and clinical performance due to its unique biological and biomechanical mechanisms, compared with ITCS. Thus, IHS is a feasible alternative to ITCS for the fixation of Pauwels Ⅲ femoral neck fractures.

Flexible 5-in-1 Microsensor Embedded in the Proton Battery for Real-Time Microscopic Diagnosis.

The proton battery possesses water electrolysis, proton storage and discharging functions simultaneously, and it can be manufactured without expensive metals. Use the principle of proton exchange membrane water electrolysis for charging, store it in the activated carbon on the hydrogen side and use the principle of proton exchange membrane fuel cell for discharge when needed. According to the latest literature, it is difficult to obtain the exact important physical parameters inside the proton battery (e.g., voltage, current, temperature, humidity and flow), and the important physical parameters are correlated with each other, which have critical influence on the performance, lifetime and health status of the proton battery. At present, the condition of the proton battery is judged indirectly only by external measurement, the actual situation inside the proton battery cannot be obtained accurately and instantly. Therefore, this study uses micro-electro-mechanical systems (MEMS) technology to develop a flexible 5-in-1 microsensor, which is embedded in the proton battery to obtain five important physical parameters instantly, so that the condition inside the proton battery can be mastered more precisely, so as to prolong the battery life and enhance the proton battery performance.

Flexible Five-in-One Microsensor for Real-Time Wireless Microscopic Diagnosis inside Electric Motorcycle Fuel Cell Stack Range Extender.

The focus of research and development on electric motorcycle range extender are system integration and energy regulation and management but the present fuel cell stack range extender still has defects, such as large volume, heavy weight and high cost. Its volume and weight will have a strong impact on the endurance of electric motorcycle. The bipolar plate takes most volume and weight of a proton exchange membrane fuel cell (PEMFC) stack and it is the key component influencing the overall power density and cost. Therefore, how to thin and lighten the bipolar plate and to enhance the performance and life of PEMFC stack is an urgent research subject to be solved for the moment and will be the key to whether the PEMFC stack range extender can be put in the electric motorcycle or not. In addition, the internal temperature, humidity, flow, voltage and current in the operation of PEMFC stack will influence its performance and life and the overall performance and life of fuel cell stack will be directly influenced by different external operating conditions. As nonuniform distribution of temperature, humidity, flow, voltage and current will occur in various regions inside the fuel cell stack, this study will use micro-electro-mechanical systems (MEMS) technology to develop a flexible five-in-one microsensor, which is embedded in the PEMFC stack range extender for real-time wireless microscopic diagnosis and the reliability test is performed, so that the actual operating condition inside the fuel cell stack range extender can be mastered instantly and correctly and the internal information is fed back instantly, the fuel cell stack range extender control system can be modified to the optimum operating parameters immediately, so as to enhance the performance and prolong the lifetime effectively.

Low-Temperature Flexible Micro Hydrogen Sensor Embedded in a Proton Battery for Real-Time Microscopic Diagnosis.

The proton battery is a very novel emerging research area with practicability. The proton battery has charging and discharging functions. It not only electrolyzes water: the electrolyzed protons can be stored but also released, which are combined with oxygen to generate electricity, and the hydrogen is not required; the hydrogen ions will be released from the battery. According to the latest document, the multiple important physical parameters (e.g., hydrogen, voltage, current, temperature, humidity, and flow) inside the proton battery are unlikely to be obtained accurately and the multiple important physical parameters mutually influence the data; they have critical effects on the performance, life, and health status of the proton battery. At present, the proton battery is measured only from the outside to indirectly diagnose the health status of battery; the actual situation inside the proton battery cannot be obtained instantly and accurately. This study uses micro-electro-mechanical systems (MEMS) technology to develop a low-temperature micro hydrogen sensor, which is used for monitoring the internal condition of the proton battery and judging whether or not there is hydrogen leakage, so as to enhance the safety.

Flexible 6-in-1 Microsensor for Real-Time Microscopic Monitoring of Proton Battery.

According to the comparison between a proton battery and a proton exchange membrane fuel cell (PEMFC), the PEMFC requires oxygen and hydrogen for generating electricity, so a hydrogen tank is required, leading to larger volume of PEMFC. The proton battery can store hydrogen in the carbon layer, combined with the oxygen in the air to form water to generate electricity; thus, the battery cost and the space for a hydrogen tank can be reduced a lot, and it is used more extensively. As the proton battery is a new research area, multiple important physical quantities inside the proton battery should be further understood and monitored so as to enhance the performance of battery. The proton battery has the potential for practical applications, as well as water electrolysis, proton storage and discharge functions, and it can be produced without expensive metals. Therefore, in this study, we use micro-electro-mechanical systems (MEMS) technology to develop a diagnostic tool for the proton battery based on the developed microhydrogen sensor, integrated with the voltage, current, temperature, humidity and flow microsensors developed by this laboratory to complete a flexible integrated 6-in-1 microsensor, which is embedded in the proton battery to measure internal important physical parameters simultaneously so that the reaction condition in the proton battery can be mastered more accurately. In addition, the interaction of physical quantities of the proton battery are discussed so as to enhance the proton battery's performance.