Cost-effectiveness of one-year adjuvant trastuzumab therapy in treatment for early-stage breast cancer patients with HER2+ in Vietnam.

BACKGROUND: In Vietnam, trastuzumab is included in social health insurance's benefits package with a reimbursement rate of 60%, but policymakers have been concerned about its cost-effectiveness. The research aims to evaluate the cost-effectiveness of one-year adjuvant trastuzumab therapy for early-stage breast cancer patients with human epidermal growth receptor 2 (HER2+) from a societal perspective. METHOD: A Markov model was developed and validated to estimate the lifetime cost and effectiveness (using life year and quality-adjusted life year) of one-year adjuvant trastuzumab therapy compared to chemotherapy (using paclitaxel) alone. Treatment efficacy and transition probabilities were estimated based on published trials (i.e., N9831, NSABP B-31, HERA, and BCIRG 006). Local cost and utility data were employed to capture the Vietnam context. One-way sensitivity analysis, probabilistic sensitivity analysis, threshold, and scenario analysis were also performed. RESULTS: One-year adjuvant trastuzumab therapy combined with chemotherapy compared to chemotherapy alone yielded an additional cost of 888,453,971VND (39,062 US$) with an additional 3.09 LYs and 1.61 QALYs, resulting in an ICER of 287,390,682 VND (12,635 US$) per LY gained, or 519,616,972 VND (22,845 US$) per QALY gained. The ICER exceeds the cost-effective threshold of 1- and 3-time GDP per capita by 6.3 and 2.1 times. The probabilistic sensitivity analysis shows similar results. According to one-way sensitivity analysis, ICERs were driven mainly by transition probabilities and trastuzumab price. One-year adjuvant trastuzumab therapy would be cost-effective at the 3-time GDP per capita threshold if the cost of Herceptin 150mg and 450mg vials were reduced by 56% and 54%, correspondingly. CONCLUSION: In Vietnam, one-year adjuvant trastuzumab therapy for early-stage breast cancer with HER2+ is not cost-effective. The research provided reliable and updated evidence to support policymakers in revising the health insurance benefit package. The policymakers should consider the options to reduce the cost of trastuzumab (e.g., regarding the use of trastuzumab biosimilars, price negotiation options, and options of optimizing the use of Herceptin vials among concurrent hospitalized breast cancer patients).

Willingness to Pay for Colorectal Cancer Screening in Vietnam: Policy Implications From a Contingent Valuation Survey.

OBJECTIVES: To determine the willingness to pay (WTP) for the fecal occult blood test (FOBT) and colonoscopy among the general population to provide evidence for policymakers in deciding whether to include them in the social health insurance benefit package and facilitate the pricing practice. METHODS: The conventional double-bounded dichotomous choice contingent valuation survey was used to determine the WTP. We recruited 402 people aged 50 to 75 who came to 3 primary healthcare clinics in Hanoi from February 2019 to April 2019. The questionnaire was built based on the pilot research with a 5-bid design, that is, the starting bids of US $4.05, 6.75, 13.51, 21.01, and 36.47 for FOBT and US $21.01, 40.52, 54.03, 81.04, and 182.34 for colonoscopy. The data analysis was performed using the DCchoice package version 3.5.1. Cost in Vietnam dong is converted to 2022 US $using purchasing power parity method. RESULTS: A total of 7.2% of participants refused to pay for FOBT and colonoscopy. Analysis of the univariate model showed that the mean and median WTP for FOBT were US $62.08 and 45.28. The mean and median WTP for colonoscopy were US $101.61 and 78.61. When adjusting the WTP value by related factors, the mean and median WTP estimates for FOBT were almost the same. The choice of WTP for FOBT and colonoscopy was statistically associated with several variables. CONCLUSIONS: This study supports the inclusion of FOBT and colonoscopy into the social health insurance benefits package. This study also supports policymakers in pricing practice to optimize the uptake rate of colorectal cancer screening tests.

Outcomes in Pregnant Adolescent Patients Infected With SARS-CoV-2.

BACKGROUND: Pregnant patients with coronavirus disease 2019 (COVID-19) are at risk for adverse pregnancy outcomes. Although clinical outcomes for pregnant adults have been reported, the impact of COVID-19 on adolescents is lacking. We sought to evaluate obstetric outcomes of pregnant adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and compare them with uninfected adolescent controls. METHODS: Retrospective cohort study of pregnant adolescents (14-19 years) who had a positive polymerase chain reaction test for SARS-CoV-2 from April 2020 to December 2020 at Inova Health System Hospitals. Controls included pregnant adolescents who tested negative. The primary outcome was a composite of preeclampsia, preterm delivery, cesarean delivery, fetal growth restriction and stillbirth. Secondary outcomes included maternal and neonatal morbidity. RESULTS: Forty-eight pregnant adolescents who tested positive for SARS-CoV-2 were compared with 394 controls. Infected adolescents were more likely to be Hispanic (91.67% vs. 12.18%; risk ratio [RR] 41.85 [95% CI: 15.43-113.5]) and uninsured (50% vs. 7.87%; RR 7.04 [95% CI: 4.31-11.49]. Nearly 80% of infected adolescents remained asymptomatic, whereas one-third of symptomatic adolescents progressed to severe or critical COVID-19. The primary composite outcome was more prevalent in infected adolescents compared with noninfected controls (41.67% vs. 25.38%; adjusted RR 2.65 [95% CI: 1.19-5.93]). Maternal morbidity was more prevalent in infected adolescents (6.25% vs. 0.76%; adjusted RR 9.53 [95% CI: 3.83-23.71]). Primary and secondary maternal outcomes were more prevalent in younger adolescents and those with higher severity of COVID-19. Maternal SARS-CoV-2 infection was not associated with neonatal morbidity. CONCLUSIONS: Pregnant adolescents infected with SARS-CoV-2 are more likely to have adverse obstetric outcomes and maternal morbidity compared with noninfected pregnant adolescents.

E-Cigarette Use among University Students from One University in Hanoi, Vietnam, and Associated Factors.

OBJECTIVE: Describe the use of e-cigarettes and factors associated with e-cigarette use among university students from one university in Vietnam in 2021. METHODS: This cross-sectional study was conducted with a total of 554 full-time undergraduate students recruiting for the study. Data was collected using a structured self-administered questionnaire. A logistic regression analysis was performed to identify factors with significant association with students' use of e-cigarettes. RESULTS: The study revealed that 13.2% of students were current users. Students who had e-cigarette smokers in the family (aOR=6.1, 95% CI: 2.5-15.4; p<0.001), used traditional cigarettes (aOR=23.6, 95% CI: 10.5-53.4; p<0.001), consumed alcohol (aOR=5, 95%CI: 1.6 - 15.9; p<0.01), were exposed to e-cigarette advertising (aOR=2.6; 95%CI: 1.1-5.9; p<0.01), and  had inadequate knowledge about e-cigarettes (aOR=2.2; 95%CI: 1-4.7; p<0.01) were more likely to use e-cigarettes. CONCLUSION: This study updates the status of e-cigarette use among students in one university in Vietnam, thereby suggesting strategies to reduce the use of e-cigarettes among university students.

Physical activity among HIV-positive patients receiving antiretroviral therapy in Hanoi and Nam Dinh, Vietnam: a cross-sectional study.

OBJECTIVES: Antiretroviral therapy (ART) has facilitated the transition of HIV infection into a chronic disease, where adherence to medications is required along with keeping a healthy lifestyle. Therefore, an increase in physical activity has been recommended for patients with HIV in order to maintain their health status. This study looked to determine the physical activity level and its associated factors among patients with HIV receiving ART treatment. SETTINGS: Eight outpatient clinic sites across different levels of the health systems in both rural and urban settings in Hanoi and Nam Dinh, Vietnam. STUDY DESIGN AND PARTICIPANTS: A cross-sectional study was performed among 1133 patients with HIV receiving ART treatment from January to August 2013. PRIMARY AND SECONDARY OUTCOME MEASURES: Physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). Socioeconomic, health-related quality of life, ART adherence and ART-related characteristics were self-reported. RESULTS: 16% of participants were inactive, and 68% were reported active via health-enhancing physical activity. Rural participants reported a higher level of physical activity compared with urban participants. Participants having a longer duration of ART were less likely to be physically active. Participants who were female and self-employed, who had higher CD4 cell count, higherEuroQol - 5 dimensions - 5levels (EQ-5D-5L) index/EQ-Visual Analogue Scale, and shared their health status with their peers were more likely to have a higher IPAQ score or be physically active. A lower IPAQ score was associated with participants living in urban areas and being at the symptomatic stage. Participants having poor adherence and longer duration of ART were more likely to be physically inactive. CONCLUSION: The majority of participants who received ART were physically active. There is a need for interventions to promote physical activity among patients with HIV in urban areas and in the later ART treatment phases. Other potential interventions to increase the level of physical activity include peer support and job guidance.

Child Desire Among Men and Women Living with HIV/AIDS in the Traditional Culture of Vietnam.

In various settings, heterogeneity in fertility rates among HIV-affected couples highlights the importance of understanding contextual factors to inform program planning and implementation. We interviewed 1016 patients with HIV/AIDS at seven clinics in Vietnam to assess their desire to have a(nother) child and willingness to pay (WTP) for prevention of mother to child transmission (PMTCT) services. One-fifth of participants reported their desire for a(another) child and this was slightly higher among men than women. Factors associated with the desire to have a(nother) child of HIV/AIDS patients included (1) not yet have a child or a son, (2) provincial and district-level service, (3) income per capita, (4) marital status and (5) history of drug injection. The average WTP for PMTCT service was US $179 (95% CI 161-197). The study highlights the need for interventions on social, cultural barriers, improved accessibility and outcomes of counseling, and better care and treatment services for couples and child affected by HIV/AIDS.

A ReaxFF force field for sodium intrusion in graphitic cathodes.

Sodium intercalation and adsorption on graphitic carbon plays an important role in cathode wear during aluminium electrolysis and is relevant for sodium ion battery (NIB) applications. We present a parameter set for the ReaxFF formalism trained to describe sodium interactions with graphitic carbon. The force field developed reproduce the training data with reasonable accuracy and displays qualitatively adequate predictive power. The force field is applied in hybrid grand canonical Monte Carlo-molecular dynamics (GC-MC/MD) simulations of model systems representative of sodium intrusion in graphitic carbon cathodes used in aluminium electrolysis.