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1.
Value Health ; 27(7): 907-917, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38548182

RESUMEN

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of anti-vascular endothelial growth factor drugs (anti-VEGFs) compared with panretinal photocoagulation (PRP) for treating proliferative diabetic retinopathy (PDR) in the United Kingdom. METHODS: A discrete event simulation model was developed, informed by individual participant data meta-analysis. The model captures treatment effects on best corrected visual acuity in both eyes, and the occurrence of diabetic macular edema and vitreous hemorrhage. The model also estimates the value of undertaking further research to resolve decision uncertainty. RESULTS: Anti-VEGFs are unlikely to generate clinically meaningful benefits over PRP. The model predicted anti-VEGFs be more costly and similarly effective as PRP, generating 0.029 fewer quality-adjusted life-years at an additional cost of £3688, with a net health benefit of -0.214 at a £20 000 willingness-to-pay threshold. Scenario analysis results suggest that only under very select conditions may anti-VEGFs offer potential for cost-effective treatment of PDR. The consequences of loss to follow-up were an important driver of model outcomes. CONCLUSIONS: Anti-VEGFs are unlikely to be a cost-effective treatment for early PDR compared with PRP. Anti-VEGFs are generally associated with higher costs and similar health outcomes across various scenarios. Although anti-VEGFs were associated with lower diabetic macular edema rates, the number of cases avoided is insufficient to offset the additional treatment costs. Key uncertainties relate to the long-term comparative effectiveness of anti-VEGFs, particularly considering the real-world rates and consequences of treatment nonadherence. Further research on long-term visual acuity and rates of vision-threatening complications may be beneficial in resolving uncertainties.


Asunto(s)
Inhibidores de la Angiogénesis , Análisis Costo-Beneficio , Retinopatía Diabética , Años de Vida Ajustados por Calidad de Vida , Factor A de Crecimiento Endotelial Vascular , Humanos , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/economía , Retinopatía Diabética/terapia , Retinopatía Diabética/cirugía , Inhibidores de la Angiogénesis/economía , Inhibidores de la Angiogénesis/uso terapéutico , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Reino Unido , Agudeza Visual , Fotocoagulación/economía , Fotocoagulación/métodos , Modelos Económicos , Persona de Mediana Edad , Resultado del Tratamiento , Coagulación con Láser/economía , Coagulación con Láser/métodos , Masculino , Femenino , Edema Macular/tratamiento farmacológico , Edema Macular/economía , Edema Macular/terapia , Análisis de Costo-Efectividad
2.
J Chem Inf Model ; 60(4): 1955-1968, 2020 04 27.
Artículo en Inglés | MEDLINE | ID: mdl-32243153

RESUMEN

One of the key requirements for incorporating machine learning (ML) into the drug discovery process is complete traceability and reproducibility of the model building and evaluation process. With this in mind, we have developed an end-to-end modular and extensible software pipeline for building and sharing ML models that predict key pharma-relevant parameters. The ATOM Modeling PipeLine, or AMPL, extends the functionality of the open source library DeepChem and supports an array of ML and molecular featurization tools. We have benchmarked AMPL on a large collection of pharmaceutical data sets covering a wide range of parameters. Our key findings indicate that traditional molecular fingerprints underperform other feature representation methods. We also find that data set size correlates directly with prediction performance, which points to the need to expand public data sets. Uncertainty quantification can help predict model error, but correlation with error varies considerably between data sets and model types. Our findings point to the need for an extensible pipeline that can be shared to make model building more widely accessible and reproducible. This software is open source and available at: https://github.com/ATOMconsortium/AMPL.


Asunto(s)
Descubrimiento de Drogas , Programas Informáticos , Aprendizaje Automático , Reproducibilidad de los Resultados
3.
Surg Clin North Am ; 98(1): 73-85, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29191279

RESUMEN

Cancer of the pancreas (CaP) is a dismal, uncommon, systemic malignancy. This article updates an earlier experience of actual long-term survival of CaP in patients treated between 1991 to 2000, and reviews the literature. Survival is expressed as actual, not projected, survival.


Asunto(s)
Predicción , Neoplasias Pancreáticas/mortalidad , Estudios de Seguimiento , Salud Global , Humanos , Tasa de Supervivencia/tendencias
4.
Nurs Stand ; 28(39): 72-3, 2014 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-24866684

RESUMEN

A study of HCAs' skills shows in-house training may be inadequate, and should be a priority for employers.


Asunto(s)
Competencia Clínica , Capacitación en Servicio/normas , Evaluación de Necesidades , Irlanda del Norte , Sociedades de Enfermería
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