Japanese value set for the EORTC QLU-C10D: A multi-attribute utility instrument based on the EORTC QLQ-C30 cancer-specific quality-of-life questionnaire.

PURPOSE: This study aimed to develop a Japanese value set for the EORTC QLU-C10D, a multi-attribute utility measure derived from the cancer-specific health-related quality-of-life (HRQL) questionnaire, the EORTC QLQ-C30. The QLU-C10D contains ten HRQL dimensions: physical, role, social and emotional functioning, pain, fatigue, sleep, appetite, nausea, and bowel problems. METHODS: Quota sampling of a Japanese online panel was used to achieve representativeness of the Japanese general population by sex and age (≥ 18 years). The valuation method was an online discrete choice experiment. Each participant considered 16 choice pairs, randomly assigned from 960 choice pairs. Each pair included two QLU-C10D health states and life expectancy. Data were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life-year framework. Preference weights were calculated as the ratio of each dimension-level coefficient to the coefficient for life expectancy. RESULTS: A total of 2809 eligible panel members consented, 2662/2809 (95%) completed at least one choice pair, and 2435/2662 (91%) completed all choice pairs. Within dimensions, preference weights were generally monotonic. Physical functioning, role functioning, and pain were associated with the largest utility weights. Intermediate utility weights were associated with social functioning and nausea; the remaining symptoms and emotional functioning were associated with smaller utility decrements. The value of the worst health state was - 0.221, lower than that seen in most other existing QLU-C10D country-specific value sets. CONCLUSIONS: The Japan-specific QLU-C10D value set is suitable for evaluating the cost and utility of oncology treatments for Japanese health technology assessment and decision-making.

Economic evaluation of a preemptive treatment strategy for invasive fungal infection in neutropenic patients with hematological diseases.

We compared the expected medical costs of empirical and preemptive treatment strategies for invasive fungal infection in neutropenic patients with hematological diseases. Based on the results of two clinical trials with different backgrounds reported by Oshima et al. [J Antimicrob Chemother 60(2):350-355; Oshima study] and Cordonnier et al. [Clin Infect Dis 48(8):1042-1051; PREVERT study], we developed a decision tree model that represented the outcomes of empirical and preemptive treatment strategies, and estimated the expected medical costs of medications and examinations in the two strategies. We assumed that micafungin was started in the empirical group at 5 days after fever had developed, while voriconazole was started in the preemptive group only when certain criteria, such as positive test results of imaging studies and/or serum markers, were fulfilled. When we used an incidence of positive test results of 6.7 % based on the Oshima study, the expected medical costs of the empirical and preemptive groups were 288,198 and 150,280 yen, respectively. Even in the case of the PREVERT study, in which the incidence of positive test results was 32.9 %, the expected medical costs in the empirical and preemptive groups were 291,871 and 284,944 yen, respectively. A sensitivity analysis indicated that the expected medical costs in the preemptive group would exceed those in the empirical group when the incidence of positive test results in the former was over 34.4 %. These results suggest that a preemptive treatment strategy can be expected to reduce medical costs compared with empirical therapy in most clinical settings.

In vivo-in vitro replicative DNA synthesis (RDS) test using perfused rat livers as an early prediction assay for nongenotoxic hepatocarcinogens: II. Assessment of judgement criteria.

To better establish in vivo-in vitro hepatocyte replicative DNA synthesis (RDS) test using male F344 rats as a screening assay for nongenotoxic (the Ames-negative) hepatocarcinogens, judgement criteria were assessed after single-gavage treatment with seven model compounds. The profiles of RDS induction by the compounds were analysed in terms of both time-course and dose-dependence. Our data reveal that a value of 2% or more for RDS incidence should be judged as positive and that of less than 1% RDS incidence as negative using maximum tolerance dose (MTD) concentrations in time-course experiments at 15, 24, 39, 48 and 63 h. In the case of an incidence value between 1 and 2%, the finding of a clear dose-dependence was considered to justify the conclusion of a positive effect for 1/4 MTD, 1/2 MTD, MTD and 2 x MTD at a fixed time. The established judgement criteria are planned for introduction in detection of nongenotoxic hepatocarcinogens (the Ames-negative carcinogens) using the RDS test.

Assessment of the ischemia of the femoral head in idiopathic avascular necrosis. A preliminary report.

Hemodynamic (CATELIX/DF32P system) assessment of circulatory disturbances in idiopathic avascular necrosis (12 femoral heads of 10 patients), demonstrate that vascularity in the necrotic portion was less than 15 per cent (mean, 9%) of normal levels. In 2 cases reassessed after surgery, the recovery of vascularity was to 98 per cent. The vascularity in the translucent portion was fairly well maintained at 50 to 139 per cent. From a histological point of view, vascularity of less than 15 per cent is indicative of ischemia and necrosis of the bone. Hemodynamic methods demonstrate the presence of focal necrosis, long before there are obvious roentgenological abnormalities. The CATELIX/DF32P system is better than the G-M probe/32P system in some respects and is now readily available.