RESUMO
Background: The number of obese people continues to increase worldwide, and obesity-related complications add to every country's health burden. Consequently, new weight-loss medications, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), are attracting increasing attention. This study sought to assess the cost effectiveness for weight loss of 4 GLP-1RAs in adult patients with obesity in the United States. Methods: Four GLP-1RA groups that received Liraglutide (1.8 mg QD), Semaglutide (1.0 mg QW), Dulaglutide (1.5 mg QW), or Exenatide (10 µg BID), and one no-treatment group were compared using a decision-tree model. All the estimated parameters were derived from published articles. Quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) were adopted as the study endpoints. We analyzed the results with the willingness-to-pay (WTP) threshold, and conducted deterministic and probabilistic sensitivity analyses. Results: The GLP-1RAs produced effective weight-loss results; however, not all the GLP-1RAs were cost effective compared to no treatment based on a WTP threshold of $195000/QALY. Among the 4 GLP-1RAs, Semaglutide provided a cost-effective strategy with an ICER of $135467/QALY. The sensitivity analyses showed that these results are reliable. Conclusions: Among the 4 GLP-1RAs, Semaglutide was the most cost-effective obesity medication.
RESUMO
Purpose: With no existing gold standard for comparison, challenges arise for establishing the validity of a new standardized Mandarin language assessment normed in mainland China. Method: A new assessment, Diagnostic Receptive and Expressive Assessment of Mandarin (DREAM), was normed with a stratified sample of 969 children ages 2;6 (years;months) to 7;11 in multiple urban and nonurban regions in northern and southern China. In this study of 230 children, the sensitivity and specificity of DREAM were examined against an a priori judgment of disorders. External validity was assessed using 2 indices of language production for different age groups. Results: External validity was assessed against spontaneous language indices (correlation range: r = .6-.7; all ps < .01) and narrative indices (overall: r = .45, p < .01). Sensitivity (.73) and specificity (.82) of DREAM are moderate to good using a priori judgment as the standard. The values improved to .95 and .82 when spontaneous language and narratives were added to a priori judgment to define typicality. Divergent validity was moderate with nonlinguistic indices. Conclusion: DREAM holds promise as a diagnostic test of Mandarin language impairment for children aged 2;6 to 7;11.
