Elicitation of societal preferences for chronic lymphocytic leukemia's treatments: a discrete choice experiment.

The overall value of treatments for chronic lymphocytic leukemia (CLL) depends on several factors, including preferences of the general population, who contributes to the financing of health systems. This study investigated societal preferences for attributes of CLL treatments in Italy. An online large-scale survey was designed using a discrete choice experiment (DCE) methodology and delivered to the Italian adult general population. Ten treatment attributes were identified, covering efficacy, safety, operational aspects and (hypothetical) out-of-pocket cost. DCE data were analyzed using a mixed logit regression model, estimating the willingness-to-pay for attribute levels' change. The general population significantly preferred more effective treatments, with shorter duration, administered orally rather than orally + intravenously. Changes in therapy duration, frequency of checkups and organ damage risk had the greatest impact on preferences. The integration of societal preferences in the value judgments of CLL therapies may help health authorities in establishing priority setting and taking pricing-reimbursement decisions.

An enlarging distal tibia osteochondroma in the adult patient.

The extensive enlargement of a solitary osteochondroma in a skeletally mature patient is rare and might result from malignant transformation. Excision of such a lesion in the distal and lateral aspect of the tibia is difficult because of the risk of injury to the neurovascular structures and the possible functional consequences with respect to ankle stability. We present a case of an active osteochondroma arising from the posterolateral distal tibia in an adult patient. The tumor was successfully excised by using a transfibular approach with fibular reconstruction. No signs of recurrence were noted 2 years after surgery.

Expandable intramedullary nailing and platelet rich plasma to treat long bone non-unions.

BACKGROUND: Roentgenographic and functional outcomes of expandable self locking intramedullary nailing and platelet rich plasma (PRP) gel in the treatment of long bone non-unions are reported. MATERIALS AND METHODS: Twenty-two patients suffering from atrophic diaphyseal long bone non-unions were enrolled in the study. Patients were treated with removal of pre-existing hardware, decortication of non-union fragments, and fixation of pseudoarthrosis with expandable intramedullary nailing (Fixion, Disc'O Tech, Tel Aviv, Israel). At surgery, PRP was placed in the pseudoarthrosis rim. RESULTS: The thirteen-month follow-up showed 91% (20/22 patients) of patients attaining bony union. The average time to union was 21.5 weeks. No infection, neurovascular complication, rotational malalignment, or limb shortening >4 mm were observed. The healing rate of non-unions was comparable to that observed in previous studies but with a lower complication frequency. CONCLUSIONS: The combined use of self locking intramedullary nailing and PRP in the management of atrophic diaphyseal long bone non-unions seems to produce comparable results with less complications than previously reported. Further data are warranted to investigate the single contribution of PRP gel and Fixion nail.

Minimum 25-year outcome and functional assessment of lumbar discectomy.

STUDY DESIGN: A retrospective, follow-up cohort study. OBJECTIVE: To evaluate the 25-year (or longer) outcome of discectomy for lumbar disc herniation by validated instruments. SUMMARY OF BACKGROUND DATA: A comprehensive patient-oriented evaluation should include measurements of pain and disability along with a reliable evaluation of the general health status. There is a paucity of data from validated measuring instruments on the very long-term outcome of lumbar discectomy. METHODS: We conducted a follow-up study of 201 patients an average of 27.8 years (range 25-32) after lumbar discectomy. The patient-oriented assessment included a Short Form-36 Health Survey questionnaire, Oswestry Disability Index, Cumulative Illness Rating Scale, and a study specific questionnaire dealing with daily life activities and satisfaction with the surgery. RESULTS: The Short Form-36 Health Survey physical scales and summary scores were similar to the normative values for healthy subjects and were better than the scores of patients with untreated sciatica with respect to reported pain. The mean Oswestry disability score was 17.5. Satisfaction with surgery was expressed by 181 of 201 patients (90%). CONCLUSIONS: Patients who had undergone lumbar discectomy a minimum of 25 years earlier have a satisfactory self-reported health-related quality of life and less pain than nonsurgically treated subjects.