Are Turkish pharmaceutical pricing strategies an access barrier to oncology medicines for Türkiye?

Objectives: Cancer diagnosis is increasing day by day all over the world. Deaths due to cancer are among the most common causes of death. Access to cancer drugs is a priority of health policies. The aim of this study is to evaluate access to cancer drugs through drug box sales data by modeling population growth, cancer incidence, and Fixed Euro Exchange (FEE) rate parameters used in drug pricing in Türkiye. Methods: Access to cancer drugs was evaluated by drug box sales figures obtained from IQVIA. Box sales data were classified according to diagnosis codes (ICD-10), reference, or generic status. Consumption of cancer drugs was examined over time with panel regression analysis, taking into account variables of population growth, cancer incidence, and the FEE rate in drug pricing in Türkiye. Results: The incidence of cancer in Türkiye was 215.1 in 2010 and 223.1 (per hundred thousand) in 2017. Whereas there was a 127.02% increase in the real euro exchange rate, there was an 89.6% increase in the FEE rate. With the regression approach, there is a negative relationship between the real and fixed exchange rate difference (RFED) and reference and generic drug consumption data. Medicine access is affected depending on diagnosis codes at different levels. Colorectal cancer medicine sales had negative correlations for each variable, namely, exchange rate, population growth, and cancer incidence. On the contrary, there was a positive correlation between non-small-cell lung cancer and relevant variables. Innovative medicine groups such as monoclonal antibodies and protein kinase inhibitor consumption showed a negative correlation. Conclusion: According to our results, pricing strategy may be an access barrier for oncology medicines in Türkiye. It should be reviewing the pricing policy that is beneficial for oncology medicine access in Türkiye.

Differentiation of memory processing stages and effect of demographic variables with alternative scoring approaches to the Rey auditory verbal learning test.

BACKGROUND: The Rey Auditory Verbal Learning Test (RAVLT) is the third most popular verbal memory test and the tenth most frequently used neuropsychological test. The original scoring system of RAVLT does not differentiate stages of memory processing, but a recently developed composite scoring system has this potential. The objectives were to compare the two systems in terms of their capacity to differentiate the stages of memory processing and to study the effect of demographic variables on the learning trials (T) of the Turkish form of RAVLT (T-RAVLT). METHOD: The sample consisted of 600 Caucasian Turkic adults, who were categorized into three levels of age, three levels of education, and two levels of gender. Individual administration of T-RAVLT was performed using the standard procedures of RAVLT. RESULTS: The components in the exploratory factor analysis (EFA) and latent variables in the confirmatory factor analysis (CFA) of the original scores were consistent with sequentially ordered T-RAVLT stages. Demographic variables (age, education, and gender) affected performances in all of the learning trials. The composite scores revealed retrieval and retention as separate components, but these scores could not be predicted from the relevant T-RAVLT scores. CONCLUSIONS: Findings recommend a combined utilization of the two scoring systems: The original system to provide scores on the performance at each stage of T-RAVLT and the combined system to provide separate scores on learning, retention, and retrieval, the three stages of memory processing. A selective effect of demographic variables on T1 was not observed, indicating a need for cross-cultural studies that are meticulously controlled for age and education.

Tooth crown discoloration induced by endodontic sealers: a 3-year ex vivo evaluation.

OBJECTIVES: The aim of this study was to evaluate the tooth crown discoloration induced by commonly used and new-generation endodontic sealers after 1 month and 1 and 3 years. MATERIALS AND METHODS: The crowns of 60 extracted incisors were cut and the pulp chambers were cleaned. The specimens were divided randomly into four groups (n = 15 each). Pulp chambers were filled with Pulpispad in group 1, AH26 in group 2, MTA Fillapex in group 3, and EndoREZ in group 4. Specimen color was measured with a spectrophotometer before and after sealer placement. Commission International de L'Eclairage's (CIE's) lighteness (L*), red-green (a*), yellow-blue (b*) color system values and color difference (ΔE) were recorded at 1 month and 1 and 3 years. Data were analyzed using repeated-measures analysis of variance and Tukey's honestly significant difference test (α = 0.05). RESULTS: All sealers caused discoloration. At 1 month, ΔE values were significantly higher in groups 1 and 2 than in groups 3 and 4 (p < 0.05). At 1 year, ΔE values were significantly lower in group 3 than in the other groups (p < 0.05). At 3 years, ΔE values were significantly higher in group 1 than in the other groups (p < 0.05). CONCLUSIONS: All tested sealers induced varying chromatic alterations. After root canal obturation, thorough debridement of sealers from the pulp chamber is essential for the prevention of sealer-induced discoloration. CLINICAL RELEVANCE: Tooth discoloration induced by endodontic materials is a problem for clinicians and patients and may impair the esthetic of endodontically treated teeth. Therefore, evaluation of long-term discoloration effects commonly used, and new-generation endodontic sealers were purposed in this study.

Sonoelastographic qualitative analysis for management of salivary gland masses.

OBJECTIVES: Our aim was to investigate whether the use of a qualitative elasticity scoring method by sonoelastography is beneficial for management of salivary gland masses. METHODS: Thirty-six patients with salivary gland masses (30 parotid and 6 sub-mandibular) were prospectively included in this study. For each lesion, B-mode sonographic and sonoelastographic images were obtained. Elasticity scores were determined by a 4-point scoring method. Differences among scores for benign and malignant masses were assessed by the Mann-Whitney U test. Qualitative variables were compared by the Pearson χ² test. The findings were compared with histopathologic diagnoses. RESULTS: The score values of 28 benign masses ranged from 1 to 4, whereas the values of 8 malignant masses ranged from 2 to 4. The mean scores ± SD were 2.25 ± 0.92 for benign lesions and 3.0 ± 0.75 for malignant lesions (P < .05). When we considered scores 1 and 2 as benign and scores 3 and 4 as malignant, 10 false-positive results were determined by the 4-point scoring method, and 64.2% of benign masses were diagnosed. CONCLUSIONS: Sonoelastography might be regarded as another sonographic parameter for management of salivary gland masses in terms of detecting benign masses.

Qualitative and semiquantitative evaluations of solid breast lesions by sonoelastography.

OBJECTIVES: Our purpose was to determine whether the combination of a qualitative elasticity scoring method and a semiquantitative strain index method by sonoelastography is useful for differentiating between benign and malignant breast masses. METHODS: Seventy-eight lesions in 71 consecutive patients with solid breast masses (62 benign and 16 malignant) were prospectively included in this study. For each lesion, B-mode sonographic and sonoelastographic images were obtained. After elasticity scores had been determined with a 5-point scoring method, strain indices of the lesions were calculated using a same-level and normal-appearing breast region as an internal reference by means of strain ratio measurement. The findings were compared with histopathologic findings. With the use of receiver operating characteristic curves, the diagnostic performances of the elasticity scoring and strain index methods were determined. RESULTS: The mean scores ± SD on sonoelastography were 2.69 ± 0.59 for benign lesions and 3.75 ± 0.68 for malignant lesions. The mean stiffness index values were 2.03 ± 2.67 for benign lesions and 5.97 ± 4.45 for malignant lesions. The areas under the curves were 0.864 for 5-point scoring and 0.840 for the strain index. Sensitivity and specificity were 80% and 95%, respectively, for 5-point scoring, 87.5% and 72.6% for B-mode sonography, and 80% and 93% for the strain index when a cutoff point of 3.52 was used. A semiquantitative evaluation using the strain index did not contribute to the qualitative scoring evaluation. CONCLUSIONS: After 5-point scoring with sonoelastography, additional measurement with the strain index is not mandatory for differentiating between benign and malignant breast masses.

Dynamic multislice computed tomography findings for parotid gland tumors.

OBJECTIVE: Our aim was to research the enhancement features of parotid gland masses in detail and characterize if the masses were Warthin tumors, adenomas, or malignant tumors. METHODS: The prospective study included 25 parotid tumors in 21 patients. Neck computed tomography (CT) was performed using a multislice CT unit. A full-neck CT examination was done at 30 seconds after completion of contrast injection, and then tumor-level images were obtained at 90 seconds and at 5 and 25 minutes. Computed tomography number (lesion density in Hounsfield units) was determined at each phase, and differences within and among tumor groups were statistically analyzed. Diagnoses were confirmed by histopathology. RESULTS: There were 11 Warthin tumors, 8 pleomorphic adenomas, 5 malignant tumors, and 1 basal cell adenoma. Ten Warthin tumors showed rapid contrast enhancement at 30 seconds and rapid reduction of enhancement from the first to the fourth phase. The basal cell adenoma showed also a peak enhancement at 30 seconds. Seven pleomorphic adenomas showed increased enhancement through the first 3 phases. Four malignant tumors showed peak enhancement at 90 seconds. Statistically significant differences within and among tumor groups were determined. CONCLUSIONS: The data suggest that peak tumor enhancement at 30 and 90 seconds, respectively, might identify Warthin and malignant tumors. Increased enhancement through all phases might be an indicator for diagnosing pleomorphic adenomas.