Clinical assessment of prophylactic chemotherapy in treating with hydatidiform mole: A protocol for systematic review and meta-analysis.

BACKGROUND: Hydatidiform mole (HM) is more common as molar pregnancy. It is a disease classified under the category of gestational trophoblastic diseases, which could metastasize after originating in the placenta. A majority of females suffering from molar pregnancies are curable by evacuating retained products of conception and the patient's fertility is preserved. In some cases, the growth perseveres and leads to gestational trophoblastic neoplasia, which is an extremely malicious condition that needs chemo-based treatment. There is a possibility to lessen the risk of gestational trophoblastic disease in females with HM through the administration of prophylactic chemo. Yet, there is controversy regarding prophylactic chemotherapy administered pre-or-post removal of HM to curtail the malignant sequelae. Therefore, we will conduct this research to assess both the efficacy as well as security of using prophylactic chemotherapy to treat HM. METHODS: In the preliminary review, the authors will search for randomized controlled trials involving prophylactic chemotherapy to treat HM. The literature search is carried out in the following electronic databases from their inception to May 2021: Chinese National Knowledge Infrastructure, Chinese BioMedical Literature, and WanFang database are the three Chinese language databases. Web of Science, PubMed, Cochrane Library, and EMBASE are the four English language databases. The authors will also perform a manual search through the bibliographies in related literature to find extra articles and ongoing studies. Two independent authors will assess the literature according to an inclusion criteria, use a specialized data collection table to extract data, and use the Cochrane 'Risk of bias' tool for evaluating any possible bias risk in the selected articles. Data synthesis and statistical operations are completed with the RevMan software (v. 5.3). RESULTS: The present systematic analysis provides a rationalized synthesis of existing evidence related to the use of prophylactic chemotherapy in the treatment of HM. CONCLUSION: Our findings will summarize the current evidences for prophylactic chemotherapy in the treatment of HM. ETHICS AND DISSEMINATION: An ethics approval is nonrequired because pre published results will be used. REGISTRATION NUMBER: DOI 10.17605/OSF.IO/6QV52 (https://osf.io/6qv52/).

Herpes zoster vaccine: A health economic evaluation for Switzerland.

Herpes zoster (HZ) or "shingles" results from a reactivation of the varicella zoster virus (VZV) acquired during primary infection (chickenpox) and surviving in the dorsal root ganglia. In about 20% of cases, a complication occurs, known as post-herpetic neuralgia (PHN). A live attenuated vaccine against VZV is available for the prevention of HZ and subsequent PHN. The present study aims to update an earlier evaluation estimating the cost-effectiveness of the HZ vaccine from a Swiss third party payer perspective. It takes into account updated vaccine prices, a different age cohort, latest clinical data and burden of illness data. A Markov model was developed to simulate the lifetime consequences of vaccinating 15% of the Swiss population aged 65-79 y. Information from sentinel data, official statistics and published literature were used. Endpoints assessed were number of HZ and PHN cases, quality-adjusted life years (QALYs), costs of hospitalizations, consultations and prescriptions. Based on a vaccine price of CHF 162, the vaccination strategy accrued additional costs of CHF 17,720,087 and gained 594 QALYs. The incremental cost-effectiveness ratio (ICER) was CHF 29,814 per QALY gained. Sensitivity analyses showed that the results were most sensitive to epidemiological inputs, utility values, discount rates, duration of vaccine efficacy, and vaccine price. Probabilistic sensitivity analyses indicated a more than 99% chance that the ICER was below 40,000 CHF per QALY. Findings were in line with existing cost-effectiveness analyses of HZ vaccination. This updated study supports the value of an HZ vaccination strategy targeting the Swiss population aged 65-79 y.

Health outcomes of bedaquiline in the treatment of multidrug-resistant tuberculosis in selected high burden countries.

BACKGROUND: Less than one-third of patients who are estimated to be infected with multidrug-resistant tuberculosis (MDR-TB) receive MDR-TB treatment regimens, and only 48% of those who received treatment have successful outcomes. Despite current regimens, newer, more effective and cost-effective approaches to treatment are needed. The aim of the study was to project health outcomes and impact on healthcare resources of adding bedaquiline to the treatment regimen of MDR-TB in selected high burden countries: Estonia, Russia, South Africa, Peru, China, the Philippines, and India. METHODS: This study adapted an existing Markov model to estimate the health outcomes and impact on total healthcare costs of adding bedaquiline to current MDR-TB treatment regimens. A price threshold analysis was conducted to determine the price range at which bedaquiline would be cost-effective. RESULTS: Adding bedaquiline to the background regimen (BR) resulted in increased disability-adjusted life years (DALYs) averted, and reduced total healthcare costs (excluding treatment acquisition costs) compared with BR alone in all countries analyzed. Addition of bedaquiline to BR resulted in savings to healthcare costs compared with BR alone in all countries analyzed, with the highest impact expected in Russia (US$194 million) and South Africa (US$43 million). The price per regimen at which bedaquiline would be cost-effective ranged between US$23,904-US$203,492 in Estonia, Russia, Peru, South Africa, and China (high and upper middle-income countries) and between US$6,996-US$20,323 in the Philippines and India (lower middle-income countries); however, these cost-effective prices do not necessarily address concerns about affordability. CONCLUSIONS: Adding bedaquiline to BR provides improvements in health outcomes and reductions in healthcare costs in high MDR-TB burden countries. The range of prices per regimen for which bedaquiline would be cost-effective varied between countries.

Network-based Assessment on Chemical-induced Cholestatic Liver Injury.

The assessment of drug toxicity, especially hepatotoxicity, is a critical task in drug development process. To assist with early detection, various in silico approaches have been demonstrated to identify drugs with high hepatotoxicity potential. In this study, based on detailed review on previous reports on drug-induced cholestatic liver injury, we developed a network-based approach to predict cholestatic potential of chemicals using toxicogenomic data. First, the cholestasis network was constructed with 57 relevant genes and 78 connections between genes. Taking only genes in the disease network into account, the evaluation model was trained by genomic data of 17 typical chemicals associated with cholestasis and yielded the prediction accuracy at 88%. The performance of this model was further challenged by an X-permutation test and an external set of 98 chemicals. Among them, 14 chemicals were marked with high risk of inducing cholestasis by our approach. A survey of published literatures confirmed that 71.43% of our predicted chemicals have been shown to induce cholestatic liver injury experimentally and approximately 93% of them have been implicated to promote liver injury to various extents. Together, we concluded that network-based approaches greatly facilitate further understanding of molecular mechanisms for cholestatic liver injury and this concept could be easily generalized to other biological-relevant side-effect assessments.

[Research progress on the application of IPAT model and its variants].

IPAT model and its variants could describe the quantitative relationships between human driving force and the environmental pressure, benefit fundamental understanding of the dynamics of coupled human and natural systems, and are regarded as effective tools in solving the environmental problems caused by the social and economic development. In this paper, the fundamental concepts of IPAT model and its variants were discussed including definitions, historical developments and the hot issues in their applications. The future research trends were put forward aiming to further expand the use of IPAT models in the sustainable development of environment and social decision-making.

Cost-effectiveness of adding bedaquiline to drug regimens for the treatment of multidrug-resistant tuberculosis in the UK.

OBJECTIVE: To evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for multidrug-resistant tuberculosis (MDR-TB) in the United Kingdom (UK). METHODS: A cohort-based Markov model was developed to estimate the incremental cost-effectiveness ratio of bedaquiline plus BR (BBR) versus BR alone (BR) in the treatment of MDR-TB, over a 10-year time horizon. A National Health Service (NHS) and personal social services perspective was considered. Cost-effectiveness was evaluated in terms of Quality-Adjusted Life Years (QALYs) and Disability-Adjusted Life Years (DALYs). Data were sourced from a phase II, placebo-controlled trial, NHS reference costs, and the literature; the US list price of bedaquiline was used and converted to pounds (£18,800). Costs and effectiveness were discounted at a rate of 3.5% per annum. Probabilistic and deterministic sensitivity analysis was conducted. RESULTS: The total discounted cost per patient (pp) on BBR was £106,487, compared with £117,922 for BR. The total discounted QALYs pp were 5.16 for BBR and 4.01 for BR. The addition of bedaquiline to a BR resulted in a cost-saving of £11,434 and an additional 1.14 QALYs pp over a 10-year period, and is therefore considered to be the dominant (less costly and more effective) strategy over BR. BBR remained dominant in the majority of sensitivity analyses, with a 81% probability of being dominant versus BR in the probabilistic analysis. CONCLUSIONS: In the UK, bedaquiline is likely to be cost-effective and cost-saving, compared with the current MDR-TB standard of care under a range of scenarios. Cost-savings over a 10-year period were realized from reductions in length of hospitalization, which offset the bedaquiline drug costs. The cost-benefit conclusions held after several sensitivity analyses, thus validating assumptions made, and suggesting that the results would hold even if the actual price of bedaquiline in the UK were higher than in the US.

[Investigation of subjective well-being and influence factors among residents living in old districts in Wuhan, China].

OBJECTIVE: To investigate the subjective well-being and its influence factors among residents living in old districts in Wuhan. METHODS: In June, 2011, a total of 500 residents living in Shanghai Street in Wuhan were recruited as subjects for this study by two-stage stratified random sampling method. The information of demographic features, health status, spare time, family status, interpersonal relationship and social environment were collected by self-made questionnaires naming "survey of satisfaction of residents living in old districts". The results were analyzed by single-factor and multi-factors analysis method. RESULTS: In this study, 448 samples of questionnaire were answered qualified (89.6%, 448/500). The subjects aged (51.3 ± 16.1) years old. The single-factor analysis showed that male and female influence the subjective happiness got 5.43 ± 1.66, 5.77 ± 1.65 (U = -2.32, P < 0.05);the age of 0 - 45, 46 - 59, 60 and above group got 5.12 ± 1.68, 5.47 ± 1.81, 6.29 ± 1.23, respectively (H = 43.07, P < 0.01); the unmarried, married, divorced, loss of spouse and remarriage groups got 5.18 ± 1.94, 5.74 ± 1.54, 4.00 ± 2.04, 5.68 ± 1.91, 6.63 ± 0.92, respectively (H = 17.41, P < 0.01); education background were primary school and blow, junior middle school, senior high school, bachelor degree, master degree and above got 6.30 ± 1.42, 5.55 ± 1.82, 5.90 ± 1.46, 5.07 ± 1.74, 4.75 ± 2.22 (H = 26.99, P < 0.01); monthly household income was ¥0 - 2000, ¥2001 - 4000, ¥4001 - 8000, ¥8001 - 10 000, ¥10 000 and above got 5.34 ± 1.87, 5.68 ± 1.53, 6.20 ± 1.07, 7.33 ± 0.58, 6.00 ± 0.00, respectively (H = 13.85, P < 0.01). The subjective satisfaction of social environment ranked from high to low were: city public security (56.0%, 248/448), traffic environment (44.9%, 199/448), community environment (14.9%, 66/448), housing conditions (13.8%, 61/448) and medical environment (8.2%, 36/448). Multiple regression model suggested that the determinant coefficient was 0.53(P < 0.01), with a good degree of fitting. The model showed that the factors influencing the residents' happiness were ranked: social environment (ß' = 0.34), family status (ß' = 0.32), health status (ß' = 0.21), education background (ß'(0-6) school year = 0.00, ß'(7-9) school year = -0.12, ß'(9-12) school year = 0.04, ß'(>12) school year = -0.14), monthly household income (ß' = 0.07) and marital status (ß'(unmarried) = 0.00, ß'(married) = 0.03, ß'(divorced) = -0.03, ß'(widowed) = 0.01, ß'(remarried) = 0.02). CONCLUSION: The factors that social environment, family status, health status, education background, monthly household income and marital status could influence the subjective happiness of residents living in old districts in Wuhan. A perfect social security system could improve the subjective happiness of residents in old districts in Wuhan.