Cost-Effectiveness Analysis of Trastuzumab Deruxtecan Versus Trastuzumab Emtansine for Patients With Human Epidermal Growth Factor Receptor 2 Positive Metastatic Breast Cancer in the United States.

OBJECTIVES: To assess the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine as second-line therapy for patients with human epidermal growth factor receptor 2 positive metastatic breast cancer from a US healthcare sector perspective. METHODS: A 3-state partitioned survival model was developed to estimate the cost-effectiveness of trastuzumab deruxtecan compared with trastuzumab emtansine. For both treatments, modeled patients were administered treatment intravenously every 3 weeks indefinitely or until disease progression. Transition parameters were principally derived from the updated DESTINY-Breast03 phase III randomized clinical trial. Costs include drug costs extracted from Centers for Medicare and Medicaid Services average sales price and administrative, adverse event, and third-line therapy costs derived from published literature, measured in 2022 US dollars. Health utilities for health states and disutilities for adverse events were sourced from published literature. Effects were measured in quality-adjusted life years (QALYs). We conducted both probabilistic sensitivity analysis and comprehensive scenario analysis to test model assumptions and robustness, while utilizing a lifetime horizon. RESULTS: In our base-case analysis, total costs for trastuzumab deruxtecan were $1 266 945, compared with $820 082 for trastuzumab emtansine. Total QALYs for trastuzumab deruxtecan were 5.09, compared with 3.15 for trastuzumab emtansine. The base-case incremental cost-effectiveness ratio was $230 285/QALY. Probabilistic sensitivity analysis indicated that trastuzumab deruxtecan had an 11.1% probability of being cost-effective at a $100 000 per QALY willingness-to-pay threshold. CONCLUSIONS: Despite the higher efficacy of trastuzumab deruxtecan in patients with human epidermal growth factor receptor 2 positive metastatic breast cancer, our findings raise concern regarding its value at current prices.

Refluxed Esterification of Fullerene-Conjugated P25 TiO2 Promotes Free Radical Scavenging Capacity and Facilitates Antiaging Potentials in Human Cells.

Titanium dioxide nanomaterials have good capability to prevent human cells from damage under UV irradiation. However, some studies indicated that the nanoscale of titanium dioxide could potentially cause harmful effects such as free radical generation under UV irradiation and thereby accelerate the progress of cell aging. Fullerenes can scavenge large amounts of free radicals due to the fact that fullerenes contain enormous amount of π electrons with low lying lowest unoccupied molecular orbital, but its adverse properties, such as the poor solubility in water, restricted the applicability. In this study, we employed water-soluble carboxylic acid fullerenes (C60-COOH and C70-COOH) as the free radical scavenger and modify onto the surface of titanium dioxide by refluxed esterification (P25/C60-COOH or C70-COOH) technique. The conformation and properties of these nanomaterials were characterized by techniques and equipment such as X-ray diffraction, energy dispersive spectroscopy analysis, scanning electron microscopy, thermal gravimetric analysis, high-resolution transmission electron microscopy, and Fourier transform infrared spectroscopy. We also introduced methylene blue and rhodamine B as indicators to evaluate and demonstrate the scavenging capacity of these nanomaterials. Moreover, we examined the biocompatibility and UV protection capacity of our P25/fullerene composites in human 293T cells, and applied luciferase activity assay to investigate the possible underlying cell protection mechanisms exhibited by these nanomaterials. Our data indicate that both P25/C60-COOH and P25/C70-COOH could protect human cells against UV exposure. P25/C70-COOH exhibits great anti-inflammation capacity, whereas P25/C60-COOH exhibits great anti-oxidative stress and anti-DNA damage capacity. Our results suggest that most of our P25/fullerene composite materials have the ability to reduce free radicals and exhibit high biomedical potential in anti-inflammation, anti-oxidant, and anti-aging applications.

Implementation and outcomes of hospital-wide computerized antimicrobial approval system and on-the-spot education in a traumatic intensive care unit in Taiwan.

BACKGROUND/PURPOSE: Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan. METHODS: We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed. RESULTS: Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum ß-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy. CONCLUSION: Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality.

Incidence and lifetime risk of uterine corpus cancer in Taiwanese women from 1991 to 2010.

OBJECTIVE: Although uterine corpus cancer has been the most common malignancy of the female genital tract in many countries, the lifetime risk of this cancer has not yet been determined among Taiwanese women. The purpose of the study was to describe the change in incidence and the lifetime risk of uterine corpus cancer over a 20-year period from 1991 to 2010 in Taiwan. MATERIALS AND METHODS: We conducted a population-based registry study using the released database (available online) from the Taiwan Cancer Registry. RESULTS: A total of 15,542 women newly diagnosed with uterine corpus cancer were included in this study. The total number of this cancer increased by 5.7-fold from 1991 to 2010. The annual age-specific rate nearly doubled during the past decade (2001-2010) when compared with the previous decade (1991-2000). Incidence rates were highest in women aged 50-59 years, and increasing incidence rates were observed in each age strata starting from 40 years to 85 years and more, after the year 2000. The lifetime risk of being diagnosed with uterine corpus cancer was 0.39% in 1991-1995, 0.54% in 1996-2000, 0.73% in 2001-2005, and 1.12% in 2006-2010 among Taiwanese women. CONCLUSION: According to the observed changes in incidence rate, the burden of uterine corpus cancer in the general female population is expected to increase in the near future. From a public-health perspective, care providers should develop strategies for the prevention, early detection, and intervention to reduce the rapidly increasing incidence of uterine corpus cancer in Taiwan.