Cost-consequence analysis of continuous denosumab therapy for osteoporosis treatment in South Korea.

BACKGROUND: Insurance reimbursement provisions in South Korea limit osteoporosis medication availability for patients with T-scores exceeding - 2.5. This study aimed to evaluate the financial impact and fracture prevention of continuous denosumab therapy until a T-score>-2.0 (Dmab-C strategy), versus discontinuation of denosumab after reaching T-score>-2.5 (Dmab-D strategy) in osteoporosis patients. METHODS: A cost-consequence analysis from a Korean healthcare system perspective was performed using a newly developed Markov model. The incidence of vertebral and non-vertebral fracture, fracture-related deaths, drug costs, and fracture-treatment costs were estimated and compared between Dmab-C and Dmab-D strategy over a lifetime in eligible patients aged 55 years. RESULTS: Base-case analysis revealed that Dmab-C prevented 32.21 vertebral fracture (VF) and 12.43 non-VF events per 100 patients over a lifetime, while reducing 1.29 fracture-related deaths. Lifetime direct healthcare cost saving per patient was KRW 1,354,655 if Dmab-C replaces Dmab-D. When productivity losses were considered, Dmab-C saved KRW 29,025,949 per patient compared to Dmab-D. The additional treatment costs of Dmab-C could be offset by the higher subsequent treatment costs and fracture treatment costs of Dmab-D. The sensitivity analysis showed consistent patterns with results of the base-case analysis. CONCLUSION: Continuous treatment using denosumab until osteoporosis patients achieve and maintain a T-score of -2.0 would provide greater clinical and economic benefits in terms of fracture prevention and reduced mortality risks compared to outcomes from discontinuing treatment at a T-score of -2.5 or above. This new treatment strategy would effectively lower the risk of fractures and fracture-related mortality, ultimately leading to lower medical expenses.

Fast, facile and thermal damage free nanowelding of Ag nanowire for flexible transparent conductive film by pressure-assisted microwave irradiation.

A fast and straightforward fabrication process for producing a robust, flexible, and transparent conductive film was demonstrated using nanowelding of Ag nanowires through pressure-assisted microwave irradiation. This innovative process effectively reduces the sheet resistance of the Ag nanowire transparent conductive film without causing any thermal distortion to the PET substrate. The microwave irradiation induces nanowelding between Ag nanowires, leading to a decrease in sheet resistance by forming nanowelding junctions. This selective heating of Ag nanowires further enhances the reduction in sheet resistance. Additionally, the application of pressure-assisted microwave irradiation allows the Ag nanowires to be embedded into the PET substrate, resulting in the formation of a robust film capable of withstanding cycling bending stress. The pressure-assisted microwave irradiation process proves to be a strong fabrication method for creating Ag nanowire transparent conductive films, especially when dealing with thermally weak substrate materials.

Collateral impact of the COVID-19 pandemic on the use of healthcare resources among people with disabilities.

Objective: We assessed the collateral impact of the COVID-19 pandemic on healthcare service use among people with disabilities. Methods: We utilized the COVID-19 database from the Korean National Health Insurance Service claims from 2015 until June 2020. We included 5,850 people with disabilities and matched 5,850 without disabilities among those who were neither tested nor diagnosed with COVID-19. We used a quasi-experimental setting with a COVID-19 outbreak as an external event in a difference-difference estimation with matching controls. Results: Participants with disabilities recorded a larger decrease in the number of claims for total services (2.1 claims per 5 months) upon the COVID-19 pandemic's onset compared to those without disabilities (1.6 claims), and the difference-in-difference estimates were statistically significant (0.46 claims). The decline was driven by outpatient and emergency visits. The extent of the decline was large for the severe disability group overall. By disability type, those with a physical disability showed a statistically significant decline in the number of claims. Conclusion: The COVID-19 pandemic has had a collateral impact on people with disabilities' use of healthcare services. Continued assessment is needed regarding whether the collateral impact has been sustained or is following a different path.

An effective chemical pretreatment method for lignocellulosic biomass with substituted imidazoles.

Lignocellulosic biomass is the most abundant naturally renewable organic resource for biofuel production. Because of its recalcitrance to enzymatic degradation, pretreatment is a crucial step before hydrolysis of the feedstock. A variety of pretreatment methods have been developed and intensively studied to achieve optimal yield without imposing significant adverse impact on the environment. Herein, we present a novel chemical pretreatment method using substituted heterocycles with low temperature and short residence time requirements. 1-Methylimidazole (MI) is a precursor to some imidazolium-based ionic liquids. In this study, its potential utilization as a biomass pretreatment agent is being investigated for the first time. At mild conditions, such as 25°C for 5 min at ambient pressure, a substantial increase in the hydrolysis rate throughout the entire course of conversion for cellulose substrate was obtained. Furthermore, the pretreatment effectiveness of MI on both untreated and steam-exploded lignocellulosic biomass including loblolly pine, switchgrass, and sugarcane bagasse has been studied and MI was found to be an efficient delignifier. Remarkable rate enhancement was also observed for the non-woody lignocellulosic substrates after a short period of MI pretreatment at ambient conditions. The mechanism of MI pretreatment is explored through analysis of cellulose physical properties including crystallinity index, degree of polymerization, accessibility, and lignin dissolution quantification.

Protein engineering of cellulases.

This review covers the topic of protein engineering of cellulases, mostly after 2009. Two major trends that are identified in this work are: first, the increased importance of results from computational protein engineering to drive ideas in the field, as experimental ideas and results often are still scarce, and, second, the further development of helper proteins for cellulose hydrolysis, such as lytic polysaccharide monooxygenase (LPO). The discussion in this work focuses both on improved attributes of cellulases and on the domains of cellulase that have been improved.