Clinical findings, surgical techniques, prognostic factors for short-term survival and long-term outcome in horses with acquired inguinal hernias: Ninety-eight cases (2005-2020).

OBJECTIVE: To report findings, outcome and determine variables associated with survival in horses with acquired inguinal hernia (AIH). STUDY DESIGN: Retrospective study. ANIMALS: A total of 98 cases in 97 horses. METHODS: The medical records (2005-2020) of horses diagnosed with AIH were reviewed. Retrieved data included signalment, history, clinical variables, surgical aspects, postoperative complications, and short- and long-term outcomes. Logistic regression analyses were used to determine factors associated with short-term survival (p < .05). RESULTS: Manual reduction was attempted in a third of the cases (32/98, 33%) and emergency surgery to reduce the hernia was performed in 64 of 98 (65%) cases. Concurrent small intestinal (SI) volvulus was identified in 26 (26/98, 27%) cases. Castration was the most common technique used to prevent recurrence (64/94, 68%). Overall AIH recurrence rate was 11% (11/98). A total of 59 (59/98, 60%) cases survived to hospital discharge and 49 of 52 (94%) cases were still alive after 12 months. Cases admitted within 10 h of colic signs had increased odds of survival (72%) compared to those admitted after 10 h (26%; p < .001). Draft breeds (p = .021), high heart rate on admission (p = .001) and concurrent SI volvulus (p = .048) were associated with reduced survival to hospital discharge. CONCLUSIONS: Horses with AIH had a higher risk of concurrent SI volvulus and lower survival than reported. Draft breeds, high heart rate on admission and concurrent SI volvulus were associated with reduced short-term survival. CLINICAL SIGNIFICANCE: The results of this study should help in prognostication for horses with AIH.

Relationship between the Cycle Threshold Value (Ct) of a Salmonella spp. qPCR Performed on Feces and Clinical Signs and Outcome in Horses.

The objective of this retrospective study was to evaluate the clinical significance of fecal quantitative real-time polymerase chain reaction (qPCR) Salmonella results when taking the cycle threshold values (Ct) into account. The study included 120 Salmonella qPCR-positive fecal samples obtained from 88 hospitalized horses over a 2-year period. The mean Ct of the qPCR test was evaluated in regard to (1) clinical outcome and (2) systemic inflammatory response syndrome (SIRS) status (no SIRS, moderate SIRS, or severe SIRS) of the sampled horses. An ROC analysis was performed to establish the optimal cut-off Ct values associated with severe SIRS. The mean ± SD Ct value was significantly lower in samples (1) from horses with a fatal issue (27.87 ± 5.15 cycles) than in surviving horses (31.75 ± 3.60 cycles), and (2) from horses with severe SIRS (27.87 ± 2.78 cycles) than from horses with no (32.51 ± 3.59 cycles) or moderate (31.54 ± 3.02 cycles) SIRS. In the ROC analysis, the optimal cut-off value of Ct associated with a severe SIRS was 30.40 cycles, with an AUC value of 0.84 [95% confidence interval 0.76-0.91] and an OR of 0.64 [0.51-0.79]. Results suggest that including the Ct value in the interpretation of fecal qPCR results could improve the diagnostic value of this test for clinical salmonellosis in horses.

Health Technology Assessment of Different Glucosamine Formulations and Preparations Currently Marketed in Thailand.

OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of different glucosamine formulations and preparations used for the management of osteoarthritis in Thailand compared with placebo. METHODS: We used a validated model to simulate the individual patient Utility score from aggregated data available from 10 different clinical trials. We then used the Utility score to calculate the quality-adjusted life year (QALY) over 3 and 6 months treatment period. We used the public costs of glucosamine products available in Thailand in 2019 to calculate the incremental cost-effectiveness ratio. We separated the analyses for prescription-grade crystalline glucosamine sulfate (pCGS) and other formulations of glucosamine. A cost-effectiveness cut-off of 3.260 USD/QALY was considered. RESULTS: Irrespective of the glucosamine preparation (tablet or powder/capsule), the data show that pCGS is cost-effective compared with placebo over a 3 and 6 months. However, the other glucosamine formulations (e.g., glucosamine hydrochloride) never reached the breakeven point at any time. CONCLUSIONS: Our data show that pCGS is cost-effective for the management of osteoarthritis in the Thai context while other glucosamine formulations are not.

Effect of housefly (Musca domestica) larvae on the growth performance and carcass characteristics of local chickens in Niger.

Background and Aim: The meat supply of local poultry for human consumption is greater than that of fast-growing poultry in Niger. However, meeting the protein needs of these local chickens is a major challenge due to the availability of protein sources and their cost. Nowadays, insect larvae such as houseflies are used and even recommended as animal feed; hence, the need to evaluate the effect of housefly (Musca domestica) larvae on the growth performance of local chickens. This study investigated the feeding effects of housefly larvae on the growth performance and carcass characteristics of local Nigerien chickens and determined the rate of fish meal substitution, in fresh or dry larvae form, whichever would be preferable. Materials and Methods: A total of 165 3-week-old local unsexed chickens of the salmon variety, weighing 120.3 ± 15.43 g, were used to evaluate the effect of housefly (M. domestica) larvae on their growth performance and carcass yield (CY). The experiment consisted of five treatments with three replicates, that is, 15 batches of 11 animals each. Five iso-protein-caloric diets were developed with 25%, and then 50% fish meal substitution with fresh and dried housefly larvae. The chicks were reared together during the first 3 weeks for their adaptation, during which they were fed an imported starter commercial feed, ad libitum. After that, they were weighed weekly for 12 weeks. Next, the body weights (BWs) were taken weekly for all chicks, feed daily intake and mortality were recorded daily, and average daily gain, feed conversion ratio (FCR), and viability rate were calculated. In the end, four chickens (two males and two females) per batch were slaughtered for the CY evaluation, breast meat, drumstick and tight (legs), and wings. Statistical analyses were performed using a linear mixed model for repeated data. Results: The weight, FCR, and carcass traits were unaffected by either the rate or larvae state. Conversely, the growth rate was improved, and feed consumption was increased. Notably, the chickens consumed more feed but grew faster with fresh larvae and at a higher substitution rate. Conclusion: This study reported that 50% fresh or dried housefly larvae substituted into the fish meal in growing local chicken's diets had no effect on their BW, FCR, and carcass traits but increased the growth rate and feed consumption.

Effects of Feeding Housefly (Musca domestica) Larvae on the Butchery Skills and Meat Sensory Characteristics of Local Chickens in Niger.

The purpose of this work was to study the effects of substitution of fishmeal by housefly larvae at different rates and different physical states in the diet of local chickens. Five diets consisted of LFD, 25DL, 50DL, 25FL and 50FL, respectively, larval-free, 25%-dried-larvae, 50%-dried-larvae, 25%-fresh-larvae and 50%-fresh-larvae diet, in which 0, 25 and 50% of fishmeal was replaced by dried and fresh larvae, was formulated. A total of 165 local chickens of three weeks old, divided into 15 boxes in batches of 11 animals were raised. The experiment consists of three replications of five treatments. At 14 weeks of age, sixty chickens were slaughtered. Butchery skills and sensory characteristics were evaluated. Thus, a small variation of the ultimate pH from 5.63 to 5.55 between the different types of meat, and a carcass yield around 66%, was recorded. Any effects of substitution rate and physical state of housefly larvae on growth performance was not observed. Feet and proventriculus percentages increased in chickens fed 25% substitution. Liver and spleen percentage, and redder breast meat, increased in chicken fed dried larvae. Yellowness of the breast, thigh-and-drumstick meat and juiciness increased with 50% substitution. There is need of an investigation for liver and spleen enlargement and housefly larvae containing pigments. Thus, housefly larvae up to 50% substitution can be a suitable alternative to fishmeal in local chicken diets.

Ultrasound measurements of uterine height, horns diameter and presence of intraluminal fluid to investigate uterine involution in lactating sows housed in farrowing crates.

The uterine involution of sows housed in farrowing crates was investigated during lactation using B-mode trans-abdominal ultrasonography. The objectives were to describe uterine involution, detect any delay or uterine disorders and assess possible associations between involution and subsequent reproductive performance. Three parameters were measured: uterine height (H), horns diameter (D) and the percentage of sows with intraluminal fluid (F). During lactation (3-4 weeks), H decreased from 11.0±1.6 the first week to 5.9±1.5 cm the last week (p<0.001), and D from 2.6±0.7 to 1.4±0.2 cm (p<0.001). Between days 1-7, H and D decreased significantly faster, i.e. respectively 0.38 cm (p<0.0001) and 0.20 cm (p<0.0001) per day than between days 22-28, i.e. respectively 0.02 cm (p=0.49) and 0.00 cm (p=0.75) per day. F decreased significantly (p<0.0001) from 78% at the beginning to 16% at the end of lactation. Between days 1-7, F decreased significantly (p<0.001) faster than during the last week of lactation (p=0.41). Between days 22-28, H of sows from parity ≥3 were significantly higher than those of sows from parity 1 and 2 (p=0.007). During that period, F was significantly higher in sows of higher parity. This effect of parity on F was significantly higher during the entire lactation period in sows of parity ≥6. Some sows were monitored after weaning. There was no significant relationship between the 3 parameters measured at the end of lactation and the subsequent performance. A small number of sows was suspected of endometritis (2%) and one case of fœtoplacental retention was detected. In conclusion, B-mode ultrasonography is a suitable tool to monitor uterine involution in lactating sows. When examination is conducted during the last week of lactation, it may help the farmer to verify whether uterine involution is complete, and to decide whether a sow should be either culled or maintained on farm.

Can Insect Meal Replace Fishmeal? A Meta-Analysis of the Effects of Black Soldier Fly on Fish Growth Performances and Nutritional Values.

The search for quality alternatives to fishmeal and fish oil in the fish feed industry has occupied many researchers worldwide. The use of black soldier fly meal (BSFM) as a substitute has increased. This study evaluated the effect of this substitution on fish growth and nutritional quality through a meta-analysis of the literature. A list of studies was selected after an exhaustive literature search followed by the extraction of growth and nutritional parameters. Two random-effects models were used to estimate the differences between the experimental parameters and the controls. The results showed significant heterogeneity between studies for all parameters. The sources of heterogeneity between studies were mainly fish species and protein substitution rate. High substitutions can be considered without necessarily worrying about an adverse effect. Financial profitability studies of the fish production chain from BSFM should be carried out to validate or invalidate the economic viability of this substitution.

In Vitro and In Vivo Assessments of Two Newly Isolated Bacteriophages against an ST13 Urinary Tract Infection Klebsiella pneumoniae.

Antibiotic resistance represents a major public health concern requiring new alternatives including phage therapy. Klebsiella pneumoniae belongs to the ESKAPE bacteria and can cause urinary tract infections (UTIs). The aims of this study were to isolate and characterize new bacteriophages against a K. pneumoniae strain isolated from UTIs and to assess their efficacy in vitro and in vivo in a Galleria (G.) mellonella larvae model. For this purpose, two bacteriophages were newly isolated against an ST13 K. pneumoniae strain isolated from a UTI and identified as K3 capsular types by wzi gene PCR. Genomic analysis showed that these bacteriophages, named vB_KpnP_K3-ULINTkp1 and vB_KpnP_K3-ULINTkp2, belong to the Drulisvirus genus. Bacteriophage vB_KpnP_K3-ULINTkp1 had the narrowest host spectrum (targeting only K3), while vB_KpnP_K3-ULINTkp2 also infected other Klebsiella types. Short adsorption times and latent periods were observed for both bacteriophages. In vivo experiments showed their ability to replicate in G. mellonella larvae and to decrease host bacterial titers. Moreover, both bacteriophages improved the survival of the infected larvae. In conclusion, these two bacteriophages had different in vitro properties and showed in vivo efficacy in a G. mellonella model with a better efficiency for vB_KpnP_K3-ULINTkp2.

A Probabilistic Structural Equation Model to Evaluate Links between Gut Microbiota and Body Weights of Chicken Fed or Not Fed Insect Larvae.

Feeding chicken with black soldier fly larvae (BSF) may influence their rates of growth via effects on the composition of their gut microbiota. To verify this hypothesis, we aim to evaluate a probabilistic structural equation model because it can unravel the complex web of relationships that exist between the bacteria involved in digestion and evaluate whether these influence bird growth. We followed 90 chickens fed diets supplemented with 0%, 5% or 10% BSF and measured the strength of the relationship between their weight and the relative abundance of bacteria (OTU) present in their cecum or cloaca at 16, 28, 39, 67 or 73 days of age, while adjusting for potential confounding effects of their age and sex. Results showed that OTUs (62 genera) could be combined into ten latent constructs with distinctive metabolic attributes. Links were discovered between these constructs that suggest nutritional relationships. Age directly influenced weights and microbiotal composition, and three constructs indirectly influenced weights via their dependencies on age. The proposed methodology was able to simplify dependencies among OTUs into knowledgeable constructs and to highlight links potentially important to understand the role of insect feed and of microbiota in chicken growth.

Effects of a Single Opioid Dose on Gastrointestinal Motility in Rabbits (Oryctolagus cuniculus): Comparisons among Morphine, Butorphanol, and Tramadol.

The aim of this study was to evaluate and compare the effects of single doses of butorphanol, morphine, and tramadol on gastrointestinal motility in rabbits (Oryctolagus cuniculus) using non-invasive imaging methods, such as radiographic barium follow through and ultrasonographic contraction counts. Time-lapse radiographic and ultrasound examinations were performed before and after a single intramuscular dose of 5 mg kg-1 butorphanol, 10 mg kg-1 morphine, or 10 mg kg-1 tramadol. Pyloric and duodenal contraction counts by ultrasonography and radiographic repletion scores for the stomach and caecum were analysed using a mixed linear model. No significant effect was noted on ultrasound examinations of pyloric and duodenal contractions after administration of an opioid treatment. Morphine had a significant effect on the stomach and the caecum repletion scores, whereas butorphanol had a significant effect only on the caecum repletion score. Tramadol had no significant effect on the stomach or caecum repletion scores. The present findings suggest that a single dose of 5 mg kg-1 butorphanol or 10 mg kg-1 morphine temporarily slows gastrointestinal transit in healthy rabbits, preventing physiological progression of the alimentary bolus without the induction of ileus. In contrast, a single dose of 10 mg kg-1 tramadol has no such effects.

Comparison of single-breath continuous positive airway pressure manoeuvre with inhaled salbutamol to improve oxygenation in horses anaesthetized for laparotomy.

OBJECTIVE: To compare the efficacy of single-breath continuous positive airway pressure manoeuvre (CPAP-M) with inhaled salbutamol, and a combination of both. STUDY DESIGN: Randomized, clinical study. ANIMALS: A total of 62 client-owned horses (American Society of Anesthesiologists status III-V) anaesthetized for laparotomy. METHODS: Horses were premedicated with intravenous (IV) xylazine (0.4-0.6 mg kg-1), anaesthesia was induced with midazolam (0.06 mg kg-1 IV) and ketamine (2.2 mg kg-1 IV) and maintained with isoflurane in oxygen using volume-controlled ventilation without positive end-expiratory pressure. If PaO2 was < 100 mmHg (13.3 kPa), either a CPAP-M (50 cmH2O for 45 seconds) or salbutamol (0.002 mg kg-1) was administered. The intervention was considered successful if PaO2 reached 100 mmHg (13.3 kPa). If PaO2 remained < 100 mmHg (13.3 kPa), treatments were switched. PaO2/FiO2 ratio and estimated shunt fraction (F-shunt) were derived from data obtained from arterial blood gas measurements. Dynamic compliance (Cdyn) was calculated from variables recorded at the moment of arterial blood analysis. Fisher's exact tests compared success rates between treatments, and linear models were performed to test whether the treatment modified the values of the measurements; p < 0.05. RESULTS: Salbutamol was the first intervention in 28 horses and was effective in 22 horses. CPAP-M was the first intervention in 34 horses and was effective in 26 horses. CPAP-M after salbutamol was performed in six horses, with four responders, and salbutamol after CPAP-M was administered to eight horses, with one responder. Salbutamol, but not CPAP-M, significantly decreased F-shunt. Both salbutamol and CPAP-M significantly increased Cdyn. CONCLUSIONS AND CLINICAL RELEVANCE: Salbutamol and CPAP-M were comparably effective in improving oxygenation and Cdyn in anaesthetized horses with PaO2 < 100 mmHg (13.3 kPa). Whether combining both treatments might be beneficial needs to be confirmed on a larger number of horses.

Effect of Fentanyl Infusion on Heart Rate Variability and Anaesthetic Requirements in Isoflurane-Anaesthetized Horses.

Controversy continues to surround the use of opioids in equine anaesthesia, with variable effects reported. This blinded clinical study aimed to investigate the influence of a low-dose fentanyl continuous rate infusion (CRI) on isoflurane requirements, parasympathetic tone activity (PTA), and anaesthetic parameters in horses during general anaesthesia. All of the twenty-two horses included in the research underwent a standard anaesthetic protocol. Eleven horses in the fentanyl group (Group F) received a loading dose of fentanyl at 6 µg/kg, followed by a CRI of 0.1 µg/kg/min during anaesthesia. A further 11 horses in the control group (Group C) received equivalent volumes of normal saline. Anaesthetic parameters and PTA index were recorded during anaesthesia. The achieved mean fentanyl plasma concentration was 6.2 ± 0.83 ng/mL. No statistically significant differences between groups were found in isoflurane requirements, MAP values, and mean dobutamine requirements. However, horses in Group F required a significantly lower dose of additional ketamine to maintain a sufficient depth of anaesthesia. Significantly higher PTA values were found in the fentanyl group. Further research is warranted to determine the limitations of PTA monitoring, and the influence of various anaesthetics on its values.

Cost-Effectiveness Assessment of Different Glucosamines in Patients with Knee Osteoarthritis: A Simulation Model Adapted to Germany.

BACKGROUND: The use of symptomatic slow-acting drugs for osteoarthritis (OA) (e.g., glucosamine, chondroitin) is largely debated in the scientific literature. Indeed, multiple formulations of these agents are available, both as pharmaceutical-grade products and as nutritional supplements , but while all preparations may claim to deliver a therapeutic effect, not all are supported by clinical evidence. Moreover, few data are available regarding the cost-effectiveness of all these formulations. Usually, access to individual patient data is required to perform economic evaluations of treatments, but it can be challenging to obtain. We previously developed a model to simulate individual health utility scores from aggregated data obtained from published OA trials. OBJECTIVE: In the present study, using our new simulation model, we investigated the costeffectiveness of different glucosamines used in Germany. METHODS: We used our validated model to simulate the utility scores of 10 published trials that used different glucosamine preparations. Using the simulated utility scores, the quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. We used the 2018 public costs of glucosamine products available in Germany to calculate the Incremental Cost/Effectiveness Ratio (ICER). We performed analyses for pharmaceutical-grade Crystalline Glucosamine Sulfate (pCGS) and other formulations of glucosamine (OFG). A cost-effectiveness cut-off of 30,000 €/QALY was considered. RESULTS: Of 10 studies in which utility was simulated, four used pCGS, and six used OFG. The ICER analyses showed that pCGS was cost-effective compared to a placebo, with an ICER of 4489 €/QALY at month 3, 4112 €/QALY at month 6, and 9983 €/QALY at year 3. The use of OFG was not cost-effective at any of the time points considered. CONCLUSION: Using our previously published model to simulate the individual health utility scores of patients, we showed that, in the German context, the use of pCGS could be considered costeffective, while the use of OFG could not. These results highlight the importance of the formulation of glucosamine.

Study design synopsis: Battle in the stable: Bayesianism versus Frequentism.

Frequentism dominates scientific practice although Bayesianism may provide an alternative, especially when analysing data from complex, high-dimensional models. The key differences between Bayesianism and Frequentism are highlighted in the introduction. Next, I review the different stages of Bayesian statistical reasoning in a research setting, explain the key concepts and illustrate them with toy examples taken in equine veterinary medicine. An extension to more complex models (Bayes network) is introduced and guidelines are offered as a conclusion.

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies.

OBJECTIVES: (1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses. METHODS: Occurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM. RESULTS: The IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases. CONCLUSIONS: These results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

A Leaky Noisy-OR Bayesian Network Applied to Genetic Counseling in Dogs.

Genetic disorders are very frequent in dogs but evaluating individualized risks of their occurrence can be uncertain. Bayesian networks are tools to characterize and analyze such events. The paper illustrates their benefits and challenges in answering two typical questions in genetic counselling: (1) What is the probability of a test-positive animal showing clinical signs of the disease? (2) What is the risk of testing positive for the mutant allele when one parent presents clinical signs? Current limited knowledge on the hereditary mode of transmission of degenerative myelopathy and on the effects of sex, diet, exercise regimen and age on the occurrence of clinical signs concurrent with the finding of the deleterious mutation was retrieved from the scientific literature. Uncertainty on this information was converted into prior Beta distributions and leaky-noisy OR models were used to construct the conditional probability tables necessary to answer the questions. Results showed the network is appropriate to answer objectively and transparently both questions under a variety of scenarios. Once users of the network have agreed with its structure and the values of the priors, computations are straightforward. The network can be updated automatically and can be represented visually so interactive discussion are easy between the veterinarian and his/her interlocutor.

Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort.

BACKGROUND: Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time. OBJECTIVES: To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years. DESIGN: Three-year longitudinal observational study. SETTING: Subjects of the SENIOR cohort. SUBJECTS: Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years. METHODS: Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups. RESULTS: Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34-2.26) and 1.37 (95% CI = 1.10-1.66), respectively. CONCLUSIONS: PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

A Meta-Analysis of the Effects of Insects in Feed on Poultry Growth Performances.

We investigated and summarized results from studies evaluating the effects of feeding poultry with insects on their growth performances. After a systematic review of studies published since 2000, two independent reviewers assessed the eligibility of each one based on predefined inclusion criteria. We extracted information on the study design, insects, avian species, and growth performances, i.e., average daily gain, feed intake, and feed conversion ratio. Next, we estimated pooled differences between performances of poultry fed a diet with vs. without insects through random-effects meta-analysis models. Additionally, these models evaluated the effects of potential sources of heterogeneity across studies. Of the 75 studies reviewed, 41 met the inclusion criteria and included 174 trials. With respect to diets without insects, pooled differences in growth performances were statistically not different from the null, but heterogeneity was marked across studies. Average daily gain decreased with increasing inclusion rates of insects, going below the null for rates of 10% and more. Grasshoppers were negatively associated with the average daily gain and positively associated with feed intake. The country of publication was another source of heterogeneity across publications. Overall, our results show insects should substitute only partially conventional protein sources and not be grasshoppers to guarantee the appropriate growth of birds.

Cost-effectiveness evaluation of glucosamine for osteoarthritis based on simulation of individual patient data obtained from aggregated data in published studies.

BACKGROUND: The economic evaluation of treatments usually requires access to individual patient data, which is difficult to obtain. Moreover, in osteoarthritis, health utility scores are unavailable and can be assessed only using a validated equation model based on various clinical data. We aimed to develop and validate a methodology to simulate individual health utility scores from aggregated clinical data available in published studies to calculate the cost-effectiveness of different glucosamine preparations (i.e., crystalline glucosamine sulfate, glucosamine sulfate, and glucosamine hydrochloride) used for osteoarthritis. METHODS: We developed a method to simulate individual utility values and validated the model by comparing the results obtained with the simulation and the results of one trial where the utility scores are available. Then, we simulated the utility scores of 10 published trials that used different glucosamine preparations. The utility estimates were used to calculate the quality-adjusted life year (QALY) using the area-under-the-curve method. Costs were for the glucosamine product only. The incremental cost/effectiveness ratio (ICER) was then calculated. RESULTS: The values of utility scores calculated from data sources and those simulated with the model were similar. From 10 studies where utility was simulated, four used crystalline glucosamine sulfate, and six used other formulations. The ICER revealed that compared to placebo, crystalline glucosamine sulfate only was cost-effective at all time points and up to 3 years with a median ICER of 5347.2 €/QALY at month 3, 4807.2 €/QALY at month 6 and 11535.5 €/QALY at year 3. The use of other formulations was not cost-effective. CONCLUSION: Using a new model to simulate individual health utility scores of patients included in ten published trials, ICER analysis showed that the use of crystalline glucosamine sulfate is cost-effective, while other formulations were not. The results confirm the importance of the formulation of glucosamine products.