Cost-effectiveness of nivolumab in the treatment of head and neck cancer.

BACKGROUND: Until recently, no second-line treatment for recurrent and/or metastatic head and neck squamous cell cancer (r/mHNSCC) was able to improve overall survival (OS). Nivolumab has become a promising treatment for r/mHNSCC. The CheckMate-141 trial showed that nivolumab improves OS compared to investigator's choice (IC) (cetuximab, methotrexate, docetaxel). Treatment with immune checkpoint inhibitors is however expensive. The aim of this analysis was to assess the cost-effectiveness of nivolumab as second-line treatment for r/mHNSCC in Switzerland. METHODS: Based on the CheckMate-141 trial, we constructed a Markov model comparing nivolumab to IC, including follow-up data up to 24 months. We assessed costs for treatments from the perspective of the Swiss health system with a 60 months' time horizon. PD-L1 and p16 testing were considered in scenarios. Incremental cost-effectiveness ratios (ICER) were compared to an informal willingness-to-pay of CHF (Swiss Francs) 100,000 per QALY gained. RESULTS: For the base case we estimated an incremental effectiveness of 0.35 QALYs and incremental costs of CHF 35,562 with nivolumab, resulting in an ICER of CHF 102,957 per QALY gained. Most influential drivers for the ICER were the price of nivolumab and the progressive disease state utility weights. In 45.5% of probabilistic sensitivity analysis simulations nivolumab was estimated below 100,000 CHF/QALY. Reducing the price of nivolumab according to a consented payback by 4.75%, resulted in an ICER of CHF 98,325/QALY gained. CONCLUSIONS: At current prices nivolumab has an ICER of around CHF 100,000 per QALY gained in the second line treatment of r/mHNSCC patients in Switzerland.

[Assessment of ligament and tendon injuries of the elbow using magnetic resonance imaging]. / Band- und Sehnenverletzungen des Ellenbogens in der Magnetresonanztomographie.

An overview about the normal anatomy and frequent pathologies of tendons and ligaments of the elbow using MRI will be provided. The unique joint configuration and articulation, as well as passive ligamentous and active muscle structures as well as the unique configuration of the articulating components of the elbow contribute to joint stabilization. MRI is an essential imaging modality in patients with ligamentous injuries including the sequelae of joint dislocation as well as chronic pathologies such as long-standing and refractory tendinopathies. Ideally, when reporting MRI of the elbow, the joint is separated into its four compartments, anterior, posterior, medial and lateral, allowing precise, comprehensive and structured reporting.

The Genovese grading scale is not reliable for MR assessment of collagen meniscus implants.

BACKGROUND: The purpose of the study was to evaluate the intra- and inter-observer reliabilities of the Genovese grading on MRI in patients after collagen meniscus substitution. METHODS: 84 MRI images of 74 consecutive patients who underwent partial meniscus substitution using collagen meniscus implant (CMI) were assessed. MRIs were evaluated using the Genovese grading system. Furthermore, meniscal extrusion was assessed. Two observers performed the grading twice, blinded to each other and to the previous results, with a six weeks interval. The inter- and intra-observer reliabilities were assessed using kappa and weighted kappa values. RESULTS: The criterion "morphology/size" showed a weighted kappa value inter-observer reliability of 0.069 (rater 1)/0.352 (rater 2) and intra-observer reliability of 0.170 (1st rating)/0.582 (2nd rating). The criterion "signal intensity" showed a weighted kappa value inter-observer reliability of 0.175/0.284 and intra-observer reliability of 0.294/0.458. The criterion "cartilage lesions" showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. The criterion "bone marrow edema" showed a kappa value inter-observer reliability of 0.667/0.808 and intra-observer reliability of 0.702/0.715. The criterion "cartilage lesions" showed a kappa value inter-observer reliability of 0.091/0.525 and intra-observer reliability of 0.409/0.413. Regarding meniscal extrusion kappa values for the inter-observer reliability were 0.625/0.940 and 0.625/0.889 for intra-observer reliability. CONCLUSIONS: Three of the four Genovese grading items showed only slight to moderate inter- and intra-observer reliabilities in evaluating CMI on MRI. Hence, such grading results need to be considered with all due care. Only the criteria "bone marrow edema" and "meniscal extrusion" showed a good agreement for both inter- and intra-observer reliabilities.

[Women of Guatemala City: facilitating AIDS prevention in a vulnerable group]. / Mujeres de la Ciudad de Guatemala: facultando a un grupo vulnerable para la prevencion del SIDA.

PIP: Despite the mistaken belief in Central America that AIDS is primarily a disease of male homosexuals, some 21% of reported cases in Guatemala have been women 15-44 years old. Many Guatemalan women are at risk of AIDS and other sexually transmitted diseases (STDs) because of their lack of sexual bargaining power and negotiating skills, the widespread acceptance of male infidelity in marriage, tolerance of bisexual relations and frequenting of prostitutes, and ignorance of women about sexuality. Condom use is infrequent in Guatemala. Most men and women lack knowledge of AIDS and other STDs and have no perception of their own vulnerability. Male alcohol use and violence against women diminishes the ability of women to protect themselves. Sex education and information about STDs should be provided for both men and women to slow the spread of AIDS. AIDS educators should direct their messages to women toward promoting condom use, increasing knowledge of AIDS and STDs, providing basic sex education, questioning stereotypes of AIDS patients as persons with disordered lifestyles, encouraging realistic assessment of risks, and assisting women to increase their negotiating ability in sexual relations. Three crucial ways of helping women protect themselves are by making them aware of the influence of gender roles in their reproductive lives, teaching them communication and negotiating skills, and providing strategies for them to confront alcohol abuse and gender violence. Survey results indicate that Guatemalan women were extremely motivated to protect their children and secondarily to maintain their homes and be good wives. Motivational messages for AIDS prevention should be related to children and the family. Men were found to be concerned about their families as well and to fear the stigma of HIV infection. Educational techniques for AIDS prevention should be accessible to the illiterate and should focus on life stories or similar methods that make AIDS seem less abstract to those who have had no direct experience with the disease.^ieng