Network meta-analysis and cost-effectiveness analysis of infliximab, cyclosporine and tacrolimus for ulcerative colitis.

BACKGROUND: Assess the efficiency and cost-effectiveness of infliximab, cyclosporine and tacrolimus for the treatment of ulcerative colitis (UC). METHODS: A literature search identified studies that investigated infliximab, cyclosporine or tacrolimus compared with placebo in UC patients. Short-term, long-term remission rates and response rates were employed to assess efficacy. Odds ratios with 95% confidence intervals were analyzed. A Markov model was constructed to simulate the progression in a cohort of patients with UC, with an over 10 years of time horizon, with a discount rate of 3%, and established threshold of €30,000/quality-adjusted life-year (QALY) or ¥82442/QALY. RESULTS: Results of network meta-analysis showed that the order was cyclosporine, tacrolimus, infliximab and placebo from high rate to low with regard to short-term clinical response. The comparison between infliximab versus cyclosporine achieved an incremental cost effectiveness ratio (ICER) of €184435/QALY and ¥531607/QALY, with a 0.34893 QALYs difference of efficacy, and an incremental cost of €64355 and ¥185494. Tacrolimus versus cyclosporine reached an ICER of €44236/QALY and ¥57494/QALY, with a difference of 0.40963 QALYs in efficacy, and a raising cost to €18120 and ¥23551. The probabilistic sensitivity analysis shows that cyclosporine would be cost-effective in the 75.8% of the simulations, tacrolimus in the 24.2%, and infliximab for the 0%. CONCLUSION: Infliximab, cyclosporine and tacrolimus as salvage therapies are efficacious. For long-term of clinical remission, the order of pharmacological agents was tacrolimus, infliximab and cyclosporine from high efficacy to low while no significant difference is seen. In cost-effectiveness analysis, the cyclosporine versus infliximab or tacrolimus is expected to be at best.

Impact of emissions controls on ambient carbonyls during the Asia-Pacific Economic Cooperation summit in Beijing, China.

Beijing and its surrounding areas implemented a series of stringent measures to ensure good air quality during the Asia-Pacific Economic Cooperation (APEC) summit. These measures included restrictions on traffic, constructions, and industrial activities. The diurnal variations of carbonyls, 24-h PM2.5, and its chemical species were investigated before, during, after APEC, and the 2015 summer. The average concentrations of carbonyls, formaldehyde, acetaldehyde, and acetone were decreased by 65.2%, 78.6%, 41.5%, and 55.6% during APEC, respectively. The concentrations of propene equivalent, the ozone formation potential, and the contribution to OH· removal by carbonyls during APEC were approximately 27-33% of those during the preceding interval. The temporal variation of carbonyls during APEC was similar to that of other air pollutants, except for O3; however, the diurnal variation of carbonyls was consistent with that of O3, with the highest values at noon and the lowest ones at night during APEC. Large variations in C1/C2 (0.95-9.41) and C2/C3 (5.70-15.71) were observed during the sampling period. The correlations analysis, diagnostical ratios, and diurnal variations of carbonyls indicated that primary sources were not an important source and secondary formation was the dominant source of atmospheric carbonyls during the entire period. The control measures not only reduced primary carbonyl emissions but also dramatically reduced secondary carbonyl precursors, such as NOx and volatile organic compounds (VOCs), resulting in the low level of carbonyls during APEC. In addition, the potential health effects of carbonyls were evaluated and the cancer risk from formaldehyde and acetaldehyde was significantly higher before APEC than during the other intervals.