Cost-effectiveness of trifluridine/tipiracil (TAS102) for heavily pretreated metastatic gastric cancer.

BACKGROUND AND AIM: Trifluridine/tipiracil (TAS102), a novel oral cytotoxic chemotherapy, significantly improved overall survival compared with placebo in heavily pretreated advanced gastric cancer. This study aimed to evaluate the cost-effectiveness of TAS102 in the third-line or later treatment for this population from the US payer perspective. METHODS: A Markov model was developed to simulate advanced gastric cancer, including three health states: progression-free survival (PFS), progressive disease (PD) and death. Model inputs were derived from a randomised, double-blind, placebo-controlled, phase 3 trial (TAGS trial, NCT02500043). Utilities were extracted from public resources. Costs were calculated from an American payer perspective. Sensitivity analyses were conducted to explore the impact of uncertainty. RESULTS: From the US payer perspective, treatment with TAS102 for patients with heavily pretreated advanced gastric cancer was estimated to increase costs by $59,180 compared with the placebo, with a gain of 0.06 quality-adjusted life years (QALYs) for an incremental cost-effectiveness ratio (ICER) of $986,333 per QALY. The costs for progression-free survival of TAS102 group had the greatest impact on the ICERs, as well as the cost of TAS102. CONCLUSION: Trifluridine/tipiracil (TAS102) is not a cost-effective choice for patients with heavily pretreated metastatic gastric cancer from an American payer perspective.

Cost-effectiveness analysis of capecitabine plus bevacizumab versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer from Chinese societal perspective.

PURPOSE: The aim of the study was to evaluate the cost-effectiveness of capecitabine plus bevacizumab compared with capecitabine alone in elderly patients with metastatic colorectal cancer (CRC) from a Chinese societal perspective. METHODS: A decision-analytic Markov model was conducted to simulate the process of metastatic CRC. Three distinct health states: progression-free survival (PFS), progressive disease and death were included. Clinical data were derived from the AVEX trial. Health effectiveness was denoted in quality-adjusted life years (QALYs) and health utilities were derived from previously published studies. Incremental cost-effectiveness ratio (ICER) was regarded as the primary endpoint and willingness-to-pay (WTP) threshold was set at $26,753.37/QALY (3 × per capita GDP of China, 2017). One-way sensitivity analyses and probabilistic sensitivity analysis were also performed to explore the parameters uncertainty in the study. RESULTS: Over a 10-year life horizon, capecitabine plus bevacizumab gained 1.14 QALYs at an average cost of $21,609.48, while the effectiveness and cost of capecitabine group were 0.99 QALYs and $7274.83, respectively. The ICER between the two groups was $95,564.33/QALY. Parameters that mostly influenced the results of the model were utility of PFS state, duration of PFS state for capecitabine plus bevacizumab, total cost of PFS state for capecitabine plus bevacizumab and price of bevacizumab. The probabilities of capecitabine plus bevacizumab and capecitabine as the dominant option were 0% and 100% at the WTP threshold of $26,753.37/QALY. CONCLUSIONS: The results of the study showed that capecitabine plus bevacizumab is unlikely to be a cost-effective treatment option for elderly patients with metastatic CRC.

Assessment of the CKD-EPI equation to estimate glomerular filtration rate in adults from a Chinese CKD population.

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was introduced to estimate glomerular filtration rate (GFR) in chronic kidney disease (CKD) patients based on serum creatinine. The CKD-EPI equation shows better accuracy compared with the current gold standard equation, the Modification of Diet in Renal Disease (MDRD) equation, but it has not been externally validated in Chinese patients. This study compared the CKD-EPI equation with the original MDRD equation and two Chinese MDRD-based equations for estimating GFR in 200 Chinese CKD patients. The (99m)Tc-diethylenetriamine penta-acetate ((99m)Tc-DTPA) method was used to determine actual GFR. The CKD-EPI equation produced GFR estimates that were more consistent with the (99m)Tc-DTPA GFR than did the MDRD equations. The precision and accuracy of the CKD-EPI equation were significantly higher than those of the MDRD equations. In conclusion, the CKD-EPI equation was superior to the existing MDRD equations in terms of estimating GFR and we recommend its clinical use in Chinese CKD patients.

Effect of cigarette tax increase on cigarette consumption in Taiwan.

OBJECTIVES: This study evaluates the effect of a 5 New Taiwan Dollar (NTD 5) Health and Welfare Tax increase on the consumption of domestic and imported cigarettes and cigars. METHODS: Using statistics published annually from 1971 through 2000, we set up a model based on the Central Bureau of Statistics (CBS) demand model to estimate price and expenditure elasticity coefficients of cigarettes and cigars. RESULTS: Our results showed that the price elasticity coefficients for domestic and imported cigarettes were -0.644 and -0.822. The consumption of imported cigarettes was reduced by 7.51 packs per capita, and the consumption of domestic cigarettes was reduced by 15.21 packs per capita. Total per capita consumption of cigarettes was reduced by 22.72 packs (18%). CONCLUSIONS: From the public health and financial perspectives, the increase in this excise tax on tobacco to the Taiwan government will have significant effect in reducing cigarette consumption; it will also generate additional tax revenues.

Two-year results from the asthma self-management program: long-term impact on health care services, costs, functional status, and productivity.

Participants in a variety of health plans, clinics and employer groups were invited to participate in the Asthma Self-Management Program (ASMP), an education program designed to improve self-management skills and daily functioning in individuals with asthma. The ASMP is an 8-week classroom program that provides information on the respiratory system, trigger avoidance, use of monitoring techniques and asthma medications. After program completion, graduates were contacted at scheduled intervals to reinforce performance of behaviors that are important to asthma self-management and to collect outcomes data. This paper reports the results of 2 years of follow-up with these individuals.

Barriers to progress in urinary incontinence: achieving quality assessments.

Urinary incontinence is a major care problem in nursing homes. Despite legislation aimed at decreasing its incidence, minimal progress has been made to achieve this goal. Obtaining an accurate assessment about the level and pattern of incontinence will assist caregivers in developing plans to reduce it. This article identifies barriers the authors have encountered in obtaining accurate records in a research project and strategies implemented to overcome these barriers.

Side-chain prediction by neural networks and simulated annealing optimization.

The prediction of the side-chain positions of proteins of known tertiary backbone structure was accomplished by a combination of neural networks and a simulated annealing method. Neural networks were used to generate distributions of side-chain dihedral angles. By eliminating network outputs with low activities, we were able to generate a reduced conformational space in which Monte Carlo-simulated annealing was carried out to optimize side-chain positions. In this study of 12 proteins, the average fractions of correct chi 1, chi 2 and combined chi 1 and chi 2 (to within 40 degrees of actual structure) were 82, 72 and 68% respectively.

Rapid, low-cost cleanup procedure for determination of semivolatile organic compounds in human and bovine adipose tissues.

A gas chromatographic/mass spectrometric (GC/MS) method is described for determination of organic environmental pollutants in human and bovine adipose tissues. Compounds such as organochlorine pesticides, polychlorinated biphenyls, polynuclear aromatic hydrocarbons, polychlorinated aromatics, and brominated aromatics are extracted with organic solvents and separated from coextracted lipids on a Florisil column. The eluate is concentrated and compounds are identified and quantitated by GC/MS analysis. The method was evaluated in a single laboratory for ability to recover compounds of environmental and regulatory importance. Except for a few more polar compounds, such as phthalates and phosphates, recoveries averaged about 85%. The elution system maximized recovery and allowed minimal coelution of lipid materials. Detection limits for most compounds studied were in the range of 5-50 ng/g (ppb).

A comparative study of two estrogen dosages in combined oral contraceptives among Sudanese women.

A prospective study of two combined oral contraceptives was conducted in the Sudan. No pregnancies occurred. Overall incidence of side effects was low. Headache was most frequently reported. Elevations were observed for weight, systolic and diastolic blood pressures, and SGOT and SGPT values while a decrease was seen for hemoglobin levels. Menstrual irregularities were not a problem for the users. Total 6-month use discontinuation rates were low for both pill groups.

Factors affecting physician participation in a state Medicaid program.

Critical to policy planning for a program of national health insurance or a National Health Service is an understanding of the strengths and weaknesses of current federally-supported health programs. One program which has been subjected to criticism is Medicaid. A major problem facing Medicaid is the high proportion of physicians who refuse to participate in the program, thus preventing the target population from obtaining access to medical care. A telephone survey was conducted to assess the attitudes and behavior of a stratified random sample of physicians regarding their participation in a Medicaid program. Physicians were asked to identify major advantages and disadvantages of the program to individual patients, to society and to their medical practice. Non-participants were asked to identify the major reasons why they did not participate in the program. Medical specialty was the only significant demographic determinant of participation. Inadequate reimbursement, excessive paperwork, patient abuses of the program and bureaucratic complexity were among the most prominent factors contributing to nonparticipation. Implications of these findings are discussed with respect to the role of primary care providers' perceptions in the planning of future national health programs.