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1.
Food Chem ; 398: 133907, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35973298

RESUMO

A multi-channel colorimetric device was developed for the low-cost and simultaneous determination of three important parameters in wine safety and quality- total iron (Fe), methanol (MeOH), and total phenols. The detection was performed by assembling light-dependent resistors and light-emitting diodes in a 3D printed chamber, which measured colorimetric signals horizontally transmitting through the microwells of an 8-well strip. This device demonstrated linear relationships (R2 greater than 0.99) for all analytes with detection limits of 0.04 mg/L, 2.26 mg/L, and 3.40 mg/L for Fe, MeOH, and total phenols, respectively. Wine sample measurements showed that the multi-channel device was as accurate as the professional spectrophotometer and could simultaneously provide the three target concentrations to facilitate the analysis. With the merits of low fabrication cost and ease of use, this device could be used as a general platform for multiple-target detection, demonstrating great potential for application in food analysis.


Assuntos
Vinho , Colorimetria , Análise de Alimentos , Metanol/análise , Fenóis/análise , Vinho/análise
3.
Ann Lab Med ; 43(1): 73-81, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36045059

RESUMO

Background: BRCA testing is necessary for establishing a management strategy for ovarian cancer. Several BRCA testing strategies, including germline and somatic testing, are implemented in clinical practice in Korea. We aimed to comparatively evaluate their cost-effectiveness from patients' perspective. Methods: We developed a decision model comprising five BRCA testing strategies implemented in Korea: (1) germline testing first, followed by somatic tumor testing for patients without a germline variant; (2) somatic testing first, followed by germline testing for patients with a variant detected by somatic testing; (3) both germline and somatic testing; (4) germline testing alone; and (5) somatic testing alone, with no testing as the comparator. One-way sensitivity analysis was conducted to test the uncertainty of key parameters. Results: Assuming a willingness-to-pay of $20,000 per progression-free life-year gain (PF-LYG), all five strategies were considered cost-effective. Strategy 4 was the most cost-effective option, with an incremental cost-effectiveness ratio (ICER) of $2,547.7 per PF-LYG, followed by strategy 1, with an ICER of $3,978.4 per PF-LYG. Even when the parameter values were varied within the possible range, the ICERs of all strategies did not exceed the willingness-to-pay threshold. Conclusions: Considering the importance of knowing a patient's BRCA gene status, germline testing first, followed by somatic testing, may be a reasonable option.


Assuntos
Neoplasias Ovarianas , Análise Custo-Benefício , Feminino , Células Germinativas/patologia , Humanos , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , República da Coreia
4.
Biotechnol Bioeng ; 119(3): 994-1003, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34953069

RESUMO

Transition of rapid, ready-to-use, and low-cost nucleic acid-based detection technologies from laboratories to points of sample collection has drastically accelerated. However, most of these approaches are still incapable of diagnosis starting from sampling through nucleic acid isolation and detection in the field. Here we developed a simple, portable, low-cost, colorimetric, and remotely controllable platform for reliable, high-throughput, and rapid diagnosis using loop-mediated isothermal amplification (LAMP) assays. It consists of a thermally isolated cup, low-cost electronic components, a polydimethylsiloxane sample well, and a fast prototyped case that covers electronic components. The steady-state temperature error of the system is <1%. We performed LAMP, Colony-LAMP, and Colony polymerase chain reactions (PCRs) using the yaiO2 primer set for Escherichia coli and Pseudomonas aeruginosa samples at 65°C and 30 min. We detected the end-point colorimetric readouts by the naked eye under day light. We confirmed the specificity and sensitivity of our approach using pure genomic DNA and crude bacterial colonies. We benchmarked our Colony-LAMP detection against Colony PCR. The number of samples tested can easily be modified for higher throughput in our system. We strongly believe that our platform can greatly contribute rapid and reliable diagnosis in versatile operational environments.


Assuntos
Colorimetria , Técnicas de Amplificação de Ácido Nucleico , Escherichia coli/genética , Reação em Cadeia da Polimerase , Pseudomonas aeruginosa/genética , Sensibilidade e Especificidade
5.
Mol Pharm ; 19(2): 508-519, 2022 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-34939811

RESUMO

Using light scattering (LS), small-angle X-ray scattering (SAXS), and coarse-grained Monte Carlo (MC) simulations, we studied the self-interactions of two monoclonal antibodies (mAbs), PPI03 and PPI13. With LS measurements, we obtained the osmotic second virial coefficient, B22, and the molecular weight, Mw, of the two mAbs, while with SAXS measurements, we studied the mAbs' self-interaction behavior in the high protein concentration regime up to 125 g/L. Through SAXS-derived coarse-grained representations of the mAbs, we performed MC simulations with either a one-protein or a two-protein model to predict B22. By comparing simulation and experimental results, we validated our models and obtained insights into the mAbs' self-interaction properties, highlighting the role of both ion binding and charged patches on the mAb surfaces. Our models provide useful information about mAbs' self-interaction properties and can assist the screening of conditions driving to colloidal stability.


Assuntos
Anticorpos Monoclonais , Anticorpos Monoclonais/química , Método de Monte Carlo , Espalhamento a Baixo Ângulo , Difração de Raios X , Raios X
6.
Ann R Coll Surg Engl ; 104(4): 295-301, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34928713

RESUMO

INTRODUCTION: Bilateral neck exploration (BNE) has been the gold standard for the treatment of primary hyperparathyroidism (PHPT). Minimally invasive parathyroidectomy (MIP) has emerged as an alternative procedure for localised solitary adenomas. The most popular MIP techniques are the open MIP (OMIP) and the minimally invasive video-assisted parathyroidectomy (MIVAP). This study aims to assess whether we achieved a smooth transition from OMIP to MIVAP without compromising the results or increasing the cost. METHODS: A parathyroid adenoma was successfully localised preoperatively in 77/86 patients with PHPT. MIP was contraindicated in 27/86 cases. For MIVAP, a 5mm, 30 degree camera was employed, along with special instruments. RESULTS: Median preoperative parathyroid hormone (PTH) level was 145.9pg/dl (59-2,151) and median calcium (Ca) was 10.8mg/dl (9.3-19). Comparing MIVAP (N=31) with OMIP (N=28), there was no significant difference in the age, sex, location of the adenoma, preoperative PTH and Ca levels as well as in all the other factors compared, apart from the size of adenomas, which were bigger in the OMIP group (1.85cm vs 1.4cm, p=0.032). Moreover, cure rates, operating time, hospital stay and rates of postoperative normocalcaemia were similar between the two groups. CONCLUSIONS: Despite the learning curve, MIVAP was not found to be inferior to OMIP for localised adenomas. The final cost was no higher for MIVAP than OMIP with the use of common reusable instruments. This, along with surgeons' experience in parathyroid and endoscopic surgery facilitates a smooth and cost-effective transition from OMIP to MIVAP.


Assuntos
Neoplasias das Paratireoides , Paratireoidectomia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Hormônio Paratireóideo , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Cirurgia Vídeoassistida/métodos
7.
J. Health Biol. Sci. (Online) ; 10(1): 1-12, 01/jan./2022.
Artigo em Português | LILACS | ID: biblio-1367660

RESUMO

Objetivos: contribuir para a geração de dados de avaliação econômica de estratégias de empoderamento farmacoterapêutico para pacientes com Diabetes Mellitus tipo 2 (DM tipo 2). Métodos: este estudo farmacoeconômico é aninhado a um ensaio clínico com controle não randomizado que incluiu pacientes ≥18 anos de idade, cadastrados no HIPERDIA. Os pacientes foram alocados em um modelo de Markov conforme valores de hemoglobina glicada do acompanhamento. As probabilidades do surgimento de complicações relativas ao DM, incluindo-se óbito, foram estimadas por dez anos. Cada complicação do DM tipo 2 teve seu custo estabelecido para determinação do custo anual. Resultados: entre os participantes da intervenção, não ocorrem óbitos ocasionados por DM tipo 2, e a progressão de complicações mantém-se estável durante os anos simulados, enquanto, no grupo controle, 60% dos pacientes podem evoluir para óbito nos dez anos, e a probabilidade de serem acometidos por complicações relacionadas ao DM tipo 2 é crescente. Com relação aos custos, ao final de dez anos, os pacientes que participaram da Estratégia Individual de Empoderamento Farmacoterapêutico (EIEF) tiveram um custo médio de UU$134,45 poupando a vida de 100% dos pacientes, e os pacientes do atendimento convencional um custo médio de UU$237,12 e 40% dos pacientes acompanhados chegariam ao final do ciclo com vida. Conclusão: a EIEF parece ser uma alternativa economicamente viável em longo prazo, bem como para a promoção do controle glicêmico.


Objectives: contribute to the data generation for the economic evaluation of pharmacotherapeutic empowerment strategies for type 2 diabetes mellitus patients (type 2 DM). Method: This pharmacoeconomic study is nested in a clinical trial with non-randomized control that included patients ≥18 years old, registered in HIPERDIA. The patients were allocated to a Markov model according to the follow-up glycated hemoglobin values. The probabilities of the appearance of complications related to DM, including death, have been estimated for ten years. Each complication of type 2 DM had its cost established to determine the annual cost. Results: Among the participants in the intervention, there are no deaths caused by type 2 DM, and the progression of complications remains stable during the simulated years, whereas in the control group, 60% of the patients can progress to death in ten years and the probability of being affected by complications related to type 2 DM is increasing. Regarding costs, at the end of ten years, patients who participated in Individual Pharmacotherapeutic Empowerment Strategy (IPES) had an average cost of US$ 134.45, saving 100% of patient's lives, and conventional care patients cost an average of US$ 237.12 and 40% of the patients followed would reach the end of the life cycle. Conclusion: The IPES seems like an economically viable and long-term economic alternative and promotes glycemic control.


Assuntos
Diabetes Mellitus , Análise Custo-Benefício , Custos e Análise de Custo , Empoderamento , Controle Glicêmico
8.
Rev. biol. trop ; 70(1)dic. 2022.
Artigo em Inglês | LILACS-Express | LILACS, SaludCR | ID: biblio-1387718

RESUMO

Abstract Introduction: Most successful cases of COVID-19 pandemic mitigation and handling have relied on extensive reverse-transcription quantitative polymerase chain reaction (RT-qPCR). However, many emerging economies have struggled with current molecular testing demands due to economic, technical and technological constraints. Objective: To define a potential diagnostic protocol to increase testing capacity in current and post-pandemic conditions. Methods: We reviewed the literature, patents and commercial applications, for alternatives. Results: We found a good potential in saliva samples, viral inactivation and quick RNA extraction by heating; the use of an isothermal technology such as loop mediated isothermal amplification (LAMP) and naked eye test-result visualization by in-tube colorimetry or turbidity. Conclusions: Saliva samples with quick RNA extraction by heating and colorimetric LAMP are promising options for countries with economic and infrastructure limitations.


Resumen Introducción: La mayoría de los casos exitosos de mitigación y manejo de la pandemia de COVID-19 se han dado mediante pruebas basadas en la reacción en cadena de la polimerasa cuantitativa (RT-qPCR por sus siglas en inglés). Sin embargo, muchas economías emergentes han tenido problemas con las demandas actuales de pruebas moleculares debido a limitaciones económicas, técnicas y tecnológicas. Objetivo: Definir un protocolo de diagnóstico potencial para aumentar la capacidad de prueba en las condiciones actuales y posteriores a la pandemia. Métodos: Revisamos la literatura, las patentes y las aplicaciones comerciales, en busca de alternativas. Resultados: Encontramos un buen potencial en muestras de saliva, inactivación viral y extracción rápida de ARN por calentamiento; el uso de una tecnología isotérmica como la amplificación isotérmica mediada por horquillas (LAMP, por sus siglas en inglés) y la visualización del resultado de la prueba a simple vista mediante colorimetría o turbidez en el tubo. Conclusiones: Las muestras de saliva con extracción rápida de ARN por calentamiento y LAMP colorimétrico son opciones prometedoras para países con limitaciones económicas y de infraestructura.


Assuntos
Humanos , Técnicas de Diagnóstico Molecular/métodos , Teste Sorológico para COVID-19 , COVID-19
9.
Can Respir J ; 2022: 2878648, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36060827

RESUMO

Background: Both long-acting muscarinic antagonists (LAMAs) and long-acting ß2-agonists (LABAs) are widely used in the treatment of chronic obstructive pulmonary disease (COPD). A novel LAMA/LABA combination of umeclidinium/vilanterol (UMEC/VI; 62.5 µg/25 µg) is approved for chronic obstructive pulmonary disease (COPD) treatment. Objective: This study aimed to assess the efficacy and cost-effectiveness of UMEC/VI versus tiotropium (TIO) 18 µg in symptomatic patients with COPD from the perspective of the Chinese National Healthcare System. Methods: A simple analysis included three studies in the meta-analysis that compared UMEC/VI with TIO. A Markov model was developed to estimate the cost-effectiveness of UMEC/VI compared with TIO treatment in symptomatic patients with COPD. First, utilities, clinical efficacy, and adverse events obtained from the literature were utilized as model inputs. Costs were from Chinese average data, including local data. Costs were expressed in dollars based on 2020 prices. Then, the model outputs including drug costs, other medical costs, and total costs, and quality-adjusted life years (QALYs) were estimated. Costs and outcomes were discounted at a 5% annual rate. Furthermore, incremental cost-effective ratios (ICERs) were analyzed. Finally, the influences of changing parameters on the uncertainty of the results were assessed by means of one-way and probabilistic sensitivity analyses. Results: This study revealed that UMEC/VI treatment had a higher rate of clinical efficacy in comparison with TIO, and the differences in the rate of adverse events between the two treatments were not significant. The results indicated that UMEC/VI was superior to TIO, which provided an increase in QALYs (0.002) and a total cost savings of $765.67 per patient over 3 years. In the base case, the ICER of UMEC/VI is -$397468.04/QALY compared with TIO, suggesting that UMEC/VI may be considered a dominant option over TIO. According to the Chinese medical system, the probability of UMEC/VI being cost-effective was 61.6% at a willingness-to-pay (WTP) of $31554/QALY. Sensitivity analyses confirmed that the results were robust. Conclusion: UMEC/VI could be considered a cost-effective treatment compared with TIO in symptomatic COPD patients from the Chinese National Healthcare System perspective. These results may help decision-makers in China when making judgements on which treatments to administer.


Assuntos
Broncodilatadores , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Álcoois Benzílicos , Broncodilatadores/uso terapêutico , Clorobenzenos , Análise Custo-Benefício , Método Duplo-Cego , Combinação de Medicamentos , Humanos , Quinuclidinas , Brometo de Tiotrópio/uso terapêutico , Resultado do Tratamento
10.
Mar Policy ; 145: 105263, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36061141

RESUMO

During the shipping market boom in the 2000s, China adopted initiatives to expand its maritime education and training (MET) capacity, which significantly increased the supply of seafarer officers in the next few years. Drawing on multiple types of statistical information, including MET enrolments, seafarer numbers, seafarer wages, and labour market analyses, this paper examines the outcomes of the initiatives in the aftermath of the 2008 financial crisis and the COVID-19 outbreak. It shows that the financial crisis together with the expanded training capacity led to a serious oversupply problem, characterised by a lack of job opportunities, depressed wages, and slow career progression for junior officers. When the situation improved in 2017, however, a shortage of junior officers ensued, and their number plummeted quickly. The recent COVID-19 pandemic increased the demand for Chinese officers. Nevertheless, the decline in the number of 3rd officers continued. This paper discusses the causes and policy implications of the quick reverse from an oversupply to an acute shortage.

11.
Nanotechnology ; 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36075187

RESUMO

In this work we demonstrated the process of co-deposition of copper-tin sulfide species by the Atomic Layer Deposition (ALD) technique using all-low-cost precursors. For the deposition of tin species, the tin(IV) chloride SnCl4 was used successfully for the first time in the ALD process. Moreover, we showed that the successful deposition of the tin sulfide component was conditioned by the pre-deposition of CuSx layer. The co-deposition of copper and tin sulfides components at 150C resulted in the in-process formation of the film containing Cu2SnS3, Cu3SnS4 and π-SnS phases. The process involving only tin precursor and H2S did not produce the SnSx species. The spectroscopic characteristic of the obtained materials were confronted with the literature survey, allowing us to discuss the methodology of the determination of ternary and quaternary sulfides purity by Raman spectroscopy. Moreover, the material characterisation with respect to the morphology (SEM), phase composition (XRD), surface chemical states (XPS), optical properties (UV-vis-NIR spectroscopy) and electric (Hall measurements) properties were provided. Finally, the obtained material was used for the formation of the p-n junction revealing the rectifying I-V characteristics.

13.
Am J Prev Med ; 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36075816

RESUMO

INTRODUCTION: Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury. METHODS: A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests. RESULTS: Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury. CONCLUSIONS: Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.

14.
Support Care Cancer ; 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36076105

RESUMO

PURPOSE: We assessed the occurrence of neutropenia and febrile neutropenia (FN) and the associated healthcare resource in cancer patients receiving myelosuppressive chemotherapy in combination with pegfilgrastim versus lipegfilgrastim. METHODS: This is a retrospective analysis using a German health insurance claims database. Adults receiving chemotherapy with a prescription code for pegfilgrastim (n = 734) or lipegfilgrastim (n = 346) were observed over a 1-year follow-up period. Patient subgroups were analyzed according to cancer type and FN risk. FN risk was based on the chemotherapy regimen and any additional neutropenia risk factors. Outcomes were adjusted via regression analysis. RESULTS: Most patients were classified as high FN risk (70.0% pegfilgrastim; 65.6% lipegfilgrastim cohort). The mean age was 58.2 years in the pegfilgrastim cohort and 58.0 years in the lipegfilgrastim cohort, with more female patients than male patients (77.3% vs 79.8%, respectively), and the majority had breast cancer (64.9% and 68.8%, respectively). Overall, 10.0% and 10.4% of patients receiving pegfilgrastim or lipegfilgrastim experienced a neutropenia event (p = 0.82), with 4.4% and 3.5% of patients experiencing a FN event (p = 0.49). The mean neutropenia event-related healthcare costs were €604 and €441 for the pegfilgrastim and lipegfilgrastim cohorts; among patients with lymphoma, these costs were significantly greater (p = 0.03) with pegfilgrastim (€1,612) versus lipegfilgrastim (€382). The mean all-cause hospitalizations were significantly (p < 0.01) higher for lymphoma patients receiving pegfilgrastim (2.76) versus lipegfilgrastim (1.60). CONCLUSION: Overall, patients treated with pegfilgrastim and lipegfilgrastim were comparable in terms of neutropenia occurrences in the 1-year follow-up. In patients with lymphoma, neutropenia event-related healthcare costs and all-cause hospitalizations were significantly higher with pegfilgrastim compared with lipegfilgrastim in this study; however, this should be interpreted with caution in light of the limited sample size and the absence of clinical information.

15.
HardwareX ; 12: e00352, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36082148

RESUMO

A wind tunnel is an essential device for aerodynamic modeling and measurement. High cost and relatively huge size with no open market design hinder the wind tunnel from being widely available in laboratory design for universities and small R&D companies, particularly in a developed country with limited research funding. Thus, most aerodynamic modeling and measurement are done by simulating through computer software which leads to high deviation as the nature of wind is unpredictable. This project aims to provide an open design for a relatively low-cost wind tunnel that universities and R&D companies can quickly adapt. An open design for an open-loop wind tunnel is presented in this article. The proposed wind tunnel design is specifically intended to help the researcher with the aerodynamic measurement with minimum cost for building, customizable design, and reliable measurement. The components, parts, and equipment use the widely available part, which can be obtained across the globe. Validation and characterization are done using software simulation and actual measurement through the device. The proposed design can meet the criteria for aerodynamic measurement and can help the researcher provide a better analysis by combining the actual measurement and software simulation.

16.
J Med Econ ; : 1-11, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36082506

RESUMO

AIMS: To our knowledge, literature describing the place of care and associated costs during acute bipolar I disorder (BP-I) episodes is limited. We conducted a claims-based retrospective study to address this gap. MATERIALS AND METHODS: Adults with BP-I were identified via IBM MarketScan Commercial and Medicare Supplemental databases. The acute episode index date was defined by ≥1 inpatient BP-I claim(s) or ≥1 outpatient or ≥3 outpatient BP-I claims (depending on visit type) in a 2-week (manic/mixed) or 4-week (depressive) period. Likely acute episodes were defined as 3- and 6-week periods for manic/mixed and depressive episodes, respectively; total mental health-related medical costs (health plan + patient) were collected during these intervals and stratified by setting (inpatient versus outpatient). Initial and subsequent episodes were captured; data were reported in subgroups without and with clozapine use, a proxy for disease severity. The remission index date was the earliest outpatient claim with a bipolar remission diagnosis with no acute episode or treatment. Remission costs were collected over a 3-month period. All results were analyzed descriptively. RESULTS: A total of 41,516 patients with 130,221 acute manic/mixed episodes and 47,763 patients with 149,207 acute depressive episodes met study criteria. Over 84% of acute episodes were treated in outpatient settings. Mental health-related medical costs for manic/mixed episodes were $15,444 for inpatient and $1,577 for outpatient settings; inpatient and outpatient costs for depressive episodes were $17,376 and $2,154, respectively. Health plans covered approximately 78% of medical costs for both episode types with and without prior clozapine use. A total of 8,143 patients met remission criteria; total 3-month outpatient costs were $1,225. CONCLUSIONS: Most BP-I acute manic/mixed or depressive episodes were treated in the outpatient setting. Episodes with inpatient care were 8-10 times more costly than outpatient-only episodes. Health plans covered most medical costs, but additional patient-incurred out-of-pocket costs remained.

17.
Epilepsia ; 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36082520

RESUMO

OBJECTIVE: Existing gene panels were developed to understand the aetiology of epilepsy and while important, further benefits will arise from an effective pharmacogenomics panel for personalising therapy and achieving seizure control. Our study assessed the cost-effectiveness of a pharmacogenomics panel for patients with drug-resistant epilepsy, compared with usual care. METHODS: A cost-utility analysis was employed using a discrete event simulation model. The microsimulation model aggregated the costs and benefits of genetically-guided treatment versus usual care for 5000 simulated patients. The 10-year model combined data from various sources including; genomic databases on prevalence of variants, population-level pharmaceutical claims on antiseizure medications, published long-term therapy retention rates, patient-level cost data, and systematic reviews. Incremental cost per quality-adjusted life years (QALYs) gained were computed. Deterministic and probabilistic sensitivity analyses were undertaken to address uncertainty in model parameters. RESULTS: The mean cost of the genetically-guided treatment option was AU$98,199 compared with AU$95,386 for usual care. Corresponding mean QALYs were 4.67 compared with 4.28 for genetically-guided and usual care strategies, respectively. The incremental cost per QALY gained was AU$7,381. In probabilistic sensitivity analyses, the incremental cost per QALY gained was AU$6,321 (95% Uncertainty interval: AU$3,604, AU$9,621) with a 100% likelihood of being cost-effective in the Australian healthcare system. The most influential drivers of the findings were the monthly healthcare costs associated with reduced seizures, costs when seizures continued, and the quality of life estimates under genetically-guided and usual care strategies. SIGNIFICANCE: This early economic evaluation of a pharmacogenomics panel to guide treatment for drug-resistant epilepsy could potentially be cost-effective in the Australian healthcare system. Clinical trial evidence is necessary to confirm these findings.

18.
Aust Dent J ; 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36082536

RESUMO

BACKGROUND: The aim is to perform a model-based cost-effectiveness analysis of a silver diamine fluoride (SDF) protocol intervention to divert dental general anaesthesia (DGA) among Victorian children aged 2- 10 years. METHODS: Data inputs was based on an Australian single-cohort 2017/18 study. Intervention costs for standard care were derived from two subgroups of children: 1) children who received standard care without DGA, and 2) children who received standard care with DGA. Two scenarios were modelled due to limited post-follow-up data: 1) children receiving SDF had standard care without DGA (base-case scenario), and 2) children receiving SDF did not receive standard care without DGA (alternative scenario). A simple decision-tree model with probabilistic sensitivity analysis (PSA) estimated the incremental costs per diverted DGA. RESULTS: The probability of children requiring specialist referral and offered SDF, but the primary carer opted for DGA is 0.124 (SD 0.034), and the probability of children requiring DGA in standard care is 0.346 (SD 0.036). For both the base-case and alternative scenario, the incremental cost-effectiveness ratio outcome is dominant and their cost-effectiveness being either 74.8% or 100%, respectively. CONCLUSIONS: The SDF protocol intervention is cost-effective dental caries management option for young children where referral for DGA is considered. © 2022 Australian Dental Association.

19.
J Neurosurg Sci ; 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36082837

RESUMO

BACKGROUND: Acute hydrocephalus is a frequent complication of aneurysmal subarachnoid hemorrhage, and it is generally treated by external ventricular drainage. In the last decades, antibiotic-impregnated ventricular catheters have been introduced in the neurosurgical practice in order to reduce secondary cerebrospinal fluid infections which increase morbidity, mortality, and health care costs. METHODS: Data of 100 patients treated at Fondazione Policlinico Universitario Agostino Gemelli IRCCS between January 2012 and December 2019 were retrospectively reviewed in order to determine the cost-effectiveness and budget impact of antibiotic impregnated versus non-impregnated catheters in the management of patients with aneurysmal subarachnoid hemorrhage related hydrocephalus. A budget impact model was built depending on the use of antibiotic impregnated versus non-impregnated catheters. The model was populated with data extrapolated from existing literature concerning the Italian healthcare setting and national tariffs. RESULTS: A 25% reduction in the number of cerebrospinal fluid infections was achieved by using antibiotic impregnated catheters, resulting in an overall saving equal to €5.730,52/patient. Expanding results to a 100-patient sample, the possible savings would amount to €573.052,40 for the National Health Service. CONCLUSIONS: Antibiotic impregnated catheters use was associated to a reduction in cerebrospinal fluid infections rate as well as in costs related to hospital care when compared to non impregnated catheters. Thus these catheters represent, besides lifesaving, cost-saving devices that reduce the economic burden and ensure a safe clinical outcome in patients with aneurysmal subarachnoid hemorrhage related hydrocephalus. The present study provides concrete evidence of the benefit of Antibiotic impregnated catheters to decision-makers responsible of defining health policies.

20.
Artigo em Inglês | MEDLINE | ID: mdl-36083300

RESUMO

PURPOSE: Fluoropyrimidines, the major chemotherapeutic agents in various malignancies treatment, are metabolized by dihydropyrimidine dehydrogenase (DPD). DPD deficiency can lead to severe and sometimes fatal toxicity. In the present study, we developed a simple protocol to detect the DPYD*2A variant. Common side effects in patients treated with these drugs were also evaluated in a Kurdish population. METHOD: We established a reverse-transcriptase polymerase chain reaction (RT-PCR) technique for detection of DPYD*2A. Sanger sequencing was used to confirm the results. 121 Kurdish patients receiving fluoropyrimidine derivatives were enrolled, and clinical information regarding the dosage and toxicity was analyzed. RESULTS: Our RT-PCR method was able to detect one patient with heterozygous state for DPYD*2A (0.8%). The most observed adverse drug reactions were tingling, nausea, and hair loss. The frequency of patients with the toxicity of grade 3 or worse was 6.6%. CONCLUSION: This was the first study that detect DPYD*2A polymorphism in the Kurdish population. Our method was successfully able to detect the DPYD*2A variant and, due to its simplicity and cost-effectiveness, it may be considered as an alternative to the current methods, especially in developing countries. Our detected polymorphism rate at 0.8% is comparable with other studies. Despite the low rate of DPYD*2A polymorphism, pharmacogenetics assessment before beginning the treatment process is highly recommended due to its association with a high risk of severe toxicity.

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