Cost-effectiveness of trifluridine/tipiracil against nivolumab for heavily pretreated metastatic gastric cancer in Japan.

OBJECTIVE: Nivolumab and trifluridine/tipiracil have significantly improved the overall survival of patients with heavily pretreated metastatic gastric cancer in different placebo-controlled phase III trials. Accordingly, nivolumab and trifluridine/tipiracil have been approved and recommended for patients with heavily pretreated metastatic gastric cancer in Japan. The aim of this study was to assess the cost-effectiveness of trifluridine/tipiracil against nivolumab. METHODS: A partitioned survival model, which consisted of three health states, namely, 'pre-progression,' 'post-progression,' and 'death,' was constructed. Efficacy and safety data were derived from the TAGS and ATTRACTION-2 trials. Costs were estimated based on the standard clinical pathway and national insurance fee schedules. One-way and probabilistic sensitivity analyses were performed. The threshold value was set to JPY 7 500 000 (USD 68 182) for each quality-adjusted life-year. RESULTS: The expected median overall survival and progression-free survival were 5.59 and 1.99 months for trifluridine/tipiracil and 5.26 and 1.55 months for nivolumab, respectively. The quality-adjusted life-year and expected costs per patient were 0.4379 and JPY 2 054 625 (USD 18 678) for trifluridine/tipiracil and 0.5295 and JPY 5 018 148 (USD 45 620) for nivolumab, respectively. The expected median progression-free survival and overall survival were equivalent with trifluridine/tipiracil and nivolumab, whereas the expected quality-adjusted life-year with trifluridine/tipiracil was slightly lower than that with nivolumab. However, trifluridine/tipiracil reduced the total treatment cost by JPY 2 963 523 (USD 26 996) compared with that of nivolumab. The incremental cost-effectiveness ratio of nivolumab versus trifluridine/tipiracil was JPY 32 352 489 (USD 294 113) per quality-adjusted life-year gained. CONCLUSIONS: Trifluridine/tipiracil was more cost-effective than nivolumab for patients with heavily pretreated metastatic gastric cancer.

Effects of Testing Methods and Sample Configuration on the Flexural Properties of Extruded Polystyrene.

Extruded polystyrene (XPS) is frequently used in the construction of many different structures. Therefore, it is necessary to appropriately characterize its mechanical properties to ensure the safety of said structures. Among the available characterization tests, static bending tests are simple and easy to perform; owing to these characteristics, they should be performed more frequently than other tests. In static bending tests on XPS, there are several challenges owing to the high flexibility of XPS, and the chosen testing method and sample configuration affect the accuracy of characterization. For cellular plastics, including XPS, three-point bending (TPB) test methods are standardized by the International Organization for Standardization (ISO) and Japanese Industrial Standards (JIS) as in ISO 1209-2:2007 and JIS K 7221-2:2006, respectively, where the sample configurations are determined. Therefore, TPB tests of cellular plastics have been conventionally performed based on these standardized methods to characterize the bending properties. In contrast, investigations on the effects of testing methods and sample configurations have often been neglected due to the existence of these standardized methods. However, to characterize the bending properties of XPS accurately, the effects of the testing method and sample configuration must be examined in detail. In this study, three bending properties (Young's modulus, proportional limit stress, and bending strength) of samples cut from an XPS panel were determined using three-point bending (TPB), four-point bending (FPB), and compression bending (CB) tests with varying sample span/depth ratios from 5 to 50 at intervals of 5, and statistical analyses were performed to determine the relevance of the tests. The effect of sample configuration on Young's modulus could be reduced when the span/depth ratio range was 25-50, 25-50, and 15-50 in the TPB, FPB, and CB tests, respectively, whereas that on the proportional limit stress was reduced in the span/depth ratio range of 5-50, 20-50, and 15-50 in the TPB, FPB, and CB tests, respectively. Additionally, the effect on the bending strength was reduced when the span/depth ratio range was 5-50, 20-50, and 5-50 in the TPB, FPB, and CB tests, respectively. Therefore, these results suggest that the TPB and CB tests were more feasible than the FPB test when the span/depth ratio was determined as being 25-50 and 15-50, respectively. However, clear differences were observed in the sample bending properties determined in these tests. In light of these findings, further studies should be conducted to elucidate these differences.

Identifying sex from pharyngeal images using deep learning algorithm.

The pharynx is one of the few areas in the body where blood vessels and immune tissues can readily be observed from outside the body non-invasively. Although prior studies have found that sex could be identified from retinal images using artificial intelligence, it remains unknown as to whether individuals' sex could also be identified using pharyngeal images. Demographic information and pharyngeal images were collected from patients who visited 64 primary care clinics in Japan for influenza-like symptoms. We trained a deep learning-based classification model to predict reported sex, which incorporated a multiple instance convolutional neural network, on 20,319 images from 51 clinics. Validation was performed using 4869 images from the remaining 13 clinics not used for the training. The performance of the classification model was assessed using the area under the receiver operating characteristic curve. To interpret the model, we proposed a framework that combines a saliency map and organ segmentation map to quantitatively evaluate salient regions. The model achieved the area under the receiver operating characteristic curve of 0.883 (95% CI 0.866-0.900). In subgroup analyses, a substantial improvement in classification performance was observed for individuals aged 20 and older, indicating that sex-specific patterns between women and men may manifest as humans age (e.g., may manifest after puberty). The saliency map suggested the model primarily focused on the posterior pharyngeal wall and the uvula. Our study revealed the potential utility of pharyngeal images by accurately identifying individuals' reported sex using deep learning algorithm.

Impact of Initial Treatment Policies on Long-term Complications and Costs in Japanese Patients with Type 2 Diabetes: A Real-World Database Study.

INTRODUCTION: Type 2 diabetes (T2D) represents a remarkable disease burden in Japan, and the cost-effectiveness of pharmacotherapy is an important consideration. In this study, we compared the long-term effects of the type of initial medication, as well as the initial frequency of clinic visits, on the occurrence of T2D-related complications. Additionally, we compared the medical costs associated with each treatment pattern. METHODS: We analyzed electronic health record data collected from multiple primary care clinics in Japan. Patients were selected based on being primarily prescribed either biguanides (BG) or DPP-4 inhibitors (DPP-4i) during a 3-month baseline period, both of which are commonly used as first-choice medications in Japan. We then followed the onset of T2D-related complications and conducted survival analyses. Additionally, we calculated the accumulated medical costs up to the onset of an event or loss to follow-up, and summarized the annual costs per patient for each treatment pattern. RESULTS: A total of 416 Japanese patients with T2D who initiated treatment between January 2015 and September 2021 were included. The median follow-up period was 2.69 years. The survival analysis showed that the use of DPP-4is and frequent visits from the beginning of treatment did not offer a benefit in suppressing the onset of complications later on. On the other hand, it was found that the annual medical costs for the group using DPP-4i with frequent visits were about 1.9 times higher than for the group using BGs with less frequent visits. CONCLUSIONS: The results suggest that for Japanese patients with T2D, the use of BGs along with relatively long follow-up intervals in the beginning of treatment can remarkably reduce medical costs while providing a level of complication suppression equivalent to that of the use of DPP-4is or frequent visits.

Torsional Vibration Tests of Extruded Polystyrene with Improved Accuracy in Determining the Shear Modulus.

Recently, extruded polystyrene (XPS) foam has been used as a component of construction materials; therefore, it is important to characterize its mechanical properties, including shear modulus. Despite the importance, it is often difficult to determine the shear modulus accurately by using many of the conventional methods; therefore, it is desirable to establish another method to measure the shear modulus with a high accuracy. Among various methods, torsional vibration test is advantageous because it can be performed easily under the pure shear stress condition in the test sample and both the in-plane and out-of-plane shear moduli can be obtained. However, it is difficult to find any examples performing the torsional vibration tests. In this study, the in-plane and out-of-plane shear moduli of XPS were determined through torsional vibration tests using samples of various widths. In addition, the shear moduli were also determined through flexural vibration tests and compared with those obtained from the torsional vibration tests. In the torsional vibration tests, the anisotropy in these shear moduli became an obstacle, and the in-plane shear modulus determined using a single sample was often dependent on the width/thickness ratio of the sample. In this condition, the coefficient of variation of the in-plane shear modulus value was often close to 10%. However, when using data obtained from the samples with various width/thickness ratios, both the in-plane and out-of-plane shear moduli could be obtained while reducing the abovementioned dependence. Additionally, the coefficients of variation were restricted to those below 2% and 7% for the in-plane and out-of-plane shear moduli, respectively, and these values were obviously lower than those obtained from the flexural vibration tests (approximately 20%). In the proposed method, both the in-plane and out-of-plane shear moduli can be obtained accurately without using any numerical analyses, which are often required in the standardized methods to improve the accuracy. Thus, for accurate measurement of both types of shear moduli of XPS, we recommend performing torsional vibration tests using a range of samples of various width/thickness ratios.

Measurement of the Shear Properties of Extruded Polystyrene Foam by In-Plane Shear and Asymmetric Four-Point Bending Tests.

The shear modulus and shear strength of extruded polystyrene foam were obtained by the in-plane shear and asymmetric four-point bending tests. In addition, the test data were numerically analysed, and the effectiveness of these tests was examined. The numerical and experimental results suggest that the shear modulus and shear strength obtained from the in-plane shear test are significantly smaller than those obtained from the asymmetric four-point bending test because the influence of the stress concentration was less significant. Although the in-plane shear test is standardised in ASTM C273/C273M-11, it is considerable to adopt the asymmetric four-point bending test as another candidate for obtaining the shear properties of extruded polystyrene foam.