Cost-effective Research Articles

Cost-effectiveness analysis of three surgical approaches for parathyroidectomy in secondary hyperparathyroidism patients

BackgroundThere are three main surgical treatment options for secondary hyperparathyroidism (SHPT): subtotal parathyroidectomy (sPTX), total parathyroidectomy with auto-transplantation (tPTX+AT), and total parathyroidectomy (tPTX). However, a debate regarding which of these surgical methods is optimal has been ongoing. Aim of this study is to compare medical costs and final outcomes associated with the three surgical approaches for the entire treatment duration, aiming to identify the most cost-effective surgical method.MethodsBased on previous research data from domestic and international studies, as well as data from on-site surveys, TreeAge Pro 2022 software was used to construct a Markov model for the surgical treatment of SHPT patients. The model was run using data from the 2022 registered population of end-stage renal disease dialysis patients in China (1 million) as baseline cohort. Main indicators for this analysis are total cost, quality-adjusted life years, and incremental cost-effectiveness ratio (ICER). The study period is 10 years post-surgery, with a discount rate of 5% per year. Uncertainty in the model was assessed using one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).ResultsThe costs incurred by SHPT patients undergoing sPTX, tPTX, and tPTX+AT within 10 years post-surgery are $7042.54, $9983.00, and $11435.60, respectively, with total utilities generated being 13.23 QALYs, 18.76 QALYs, and 18.69 QALYs. Compared to sPTX, the incremental costs and incremental effects of tPTX and tPTX+AT are $2,924.71 and $4,456.66, with 5.53 QALYs and 5.46 QALYs, respectively. The ICER for tPTX and tPTX+AT groups are $532.13/QALY and $805.10/QALY, respectively, which are well below our set willingness-to-pay (WTP) threshold. Sensitivity analysis results indicate that varying any parameter within a certain range over the given time interval will not cause the ICER to exceed the WTP threshold and will not reverse the primary analysis results.ConclusionIn the Chinese healthcare system, tPTX is considered the most cost-effective treatment for refractory hyperparathyroidism, when compared to tPTX+AT and sPTX.

Factors influencing participation and engagement in post-stroke cardiac rehabilitation and exercise: an exploratory qualitative study.

The secondary prevention benefits of cardiac rehabilitation and similar exercise classes for stroke survivors are well established, however post-stroke exercise participation remains low. This research aimed to explore the factors affecting participation and engagement in UK-based post-stroke cardiac rehabilitation and exercise, from the perspective of the service user and service provider. An exploratory study, using semi-structured interviews, was conducted (n = 8, service user = 4), adopting a phenomenological approach. All interviews applied a topic guide informed by the Health Belief Model and the International Classification of Functioning, Disability and Health, and were analysed using inductive thematic analysis. Post-stroke cardiac rehabilitation and exercise participation was influenced by numerous factors, encompassed into three themes: Accessibility (describing the environmental pre-class limiting factors), Programme Structure (valuing in-class supervision, socialisation and adaptations) and Patient Characteristics (encompassing the influence of the service user's personality and experiences). Effective secondary prevention of stroke through cardiac rehabilitation and other exercise-based rehabilitation requires policy development and commissioning to ensure appropriate delivery. Further research should determine the feasibility of novel exercise class formats, in addition to larger trials investigating their clinical benefit and cost effectiveness.

Cost-Utility Analysis of LifeVest® in Post-Myocardial Infarction Patients at Risk of Sudden Cardiac Death in England.

Patients with a left ventricular ejection fraction ≤ 35% are at increased risk of sudden cardiac death (SCD) within the first months after a myocardial infarction (MI). The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution which can protect patients from SCD during the first months after an MI, when the risk of SCD is at its peak. This study aimed to evaluate the cost-effectiveness of WCD combined with guideline-directed medical therapy (GDMT) compared to GDMT alone, after MI in the English National Health Service (NHS). A multi-state Markov model, with a hypothetical cohort of 1000 patients, was developed to evaluate WCD + GDMT compared with GDMT alone, over a lifetime time horizon. Model input parameters were obtained from the pivotal randomised controlled trial and literature. The outcomes were costs and quality-adjusted life-years (QALYs), discounted at 3.5% annually, with overall results presented as an incremental cost-effectiveness ratio (ICER). The cost-effectiveness analysis demonstrated that WCD + GDMT is potentially a cost-effective option with an ICER of £23,024 per QALY gained, which is in the acceptable willingness to pay threshold (WTP) range of £20,000-£30,000 set by the National Institute for Health and Care Excellence (NICE) in England. Results of probabilistic sensitivity analysis (PSA) indicated that WCD + GDMT has 89.3% and 23% probability of being cost-effective at WTP thresholds of £30,000 and £20,000, respectively. Implementation of WCD in patients post-MI is potentially a cost-effective use of resources for the NHS and improves clinical outcomes amongst adherent patients and in circumstances where implantable cardioverter defibrillators are not indicated by the guidelines.

Commentary on "preoperative cardiology consultations for geriatric patients with hip fractures rarely provide additional recommendations and are associated with prolonged hospital stays and delayed surgery: a retrospective case control study".

This letter discusses the recent study by Vahabi et al., which examined the role of preoperative cardiology consultations in geriatric patients undergoing hip fracture surgery. While the study highlights the limited impact of these consultations on treatment modifications and the associated delays in surgical intervention, this letter suggests areas for further exploration. Specifically, it proposes extending outcome monitoring to include long-term cardiovascular events and incorporating cost-effectiveness analysis to better assess the value of preoperative consultations. Moreover, the letter advocates for the use of blinding in future studies to minimize selection bias and enhance the reliability of results.

Glucose Lowering through Weight management (GLoW): a randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme vs a diabetes education programme in adults with a recent diagnosis of type 2 diabetes.

UK standard care for type 2 diabetes is structured diabetes education, with no effects on HbA1c, small, short-term effects on weight and low uptake. We evaluated whether remotely delivered tailored diabetes education combined with commercial behavioural weight management is cost-effective compared with current standard care in helping people with type 2 diabetes to lower their blood glucose, lose weight, achieve remission and improve cardiovascular risk factors. We conducted a pragmatic, randomised, parallel two-group trial. Participants were adults (≥18 years) with overweight or obesity (BMI≥25 kg/m2) and recently diagnosed with type 2 diabetes (≤3 years), recruited from 159 primary care practices in England. We randomised participants to a tailored diabetes education and behavioural weight management programme (DEW; delivered by Weight Watchers) or to current standard care diabetes education (DE; Diabetes Education and Self Management for Ongoing and Newly Diagnosed [DESMOND] programme), using a computer-generated randomisation sequence in a 1:1 allocation stratified by gender and diabetes duration, unknown to those collecting and analysing the data. Participants could not be blinded due to the nature of the interventions. Participants completed assessments at 0, 6 and 12 months. The primary outcome was 12 month change from baseline in HbA1c. We also assessed bodyweight, blood pressure, cholesterol (total, HDL, LDL), glucose-lowering medication, behavioural measures (physical activity, food intake), psychosocial measures (eating behaviour, diabetes-related quality of life, wellbeing) and within-trial and modelled lifetime cost effectiveness. We randomised 577 participants (DEW: 289, DE: 288); 398 (69%) completed 12 month follow-up. We found no evidence for an intervention effect on change in HbA1c from baseline to 12 months (difference: -0.84 [95% CI -2.99, 1.31] mmol/mol, p=0.44) or 6 months (-1.83 [-4.05, 0.40] mmol/mol). We found an intervention effect on weight at 6 (-1.77 [-2.86, -0.67] kg) and 12 months (-1.38 [-2.56, -0.19] kg). Participants in DEW had a higher likelihood of achieving diabetes remission than participants in DE (6 months: RR 2.10 [95% CI 1.03, 4.47]; 12 months: RR 2.53 [1.30, 5.16]). DEW was cost-effective compared with DE in within-trial and lifetime analyses, in the latter generating an incremental cost effectiveness ratio of £2290 per quality-adjusted life year gained. A commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of type 2 diabetes did not improve HbA1c up to 12 months post intervention in this trial. The intervention could help people achieve weight loss and be cost-effective compared with current standard National Health Service care. ISRCTN 18399564 FUNDING: National Institute for Health and Care Research (NIHR; RP-PG-0216-20010), Medical Research Council (MC_UU_00006/6), NIHR Cambridge Biomedical Research Centre (NIHR203312).

Semaglutide 2.4 mg versus Liraglutide 3 mg for the Treatment of Obesity in Greece: A Short-Term Cost-Effectiveness Analysis.

Obesity is a global health issue with significant economic implications for health systems. Pharmacotherapy, including semaglutide 2.4 mg and liraglutide 3 mg, offers a treatment option for weight management; however, its cost-effectiveness requires evaluation. This study assesses the short-term cost-effectiveness of semaglutide 2.4 mg versus liraglutide 3 mg in achieving clinically relevant weight loss targets at 68 weeks in Greece. A short-term cost-effectiveness analysis was conducted from the perspective of the Greek third-party payer [National Organization for the Provision of Health Services (EOPYY)], comparing costs and outcomes for semaglutide 2.4 mg and liraglutide 3 mg over a 68-week horizon. Effectiveness was measured by the proportion of patients achieving weight loss targets of ≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20%, using efficacy data from the STEP-8 head-to-head trial, a 68-week, randomized, double-blind study conducted in the USA, comparing semaglutide 2.4 mg versus liraglutide 3 mg in adults who were overweight or had obesity without diabetes. Only direct medical costs were included, reflecting the payer perspective, and no discounting was applied owing to the short time horizon. Deterministic and probabilistic sensitivity analyses assessed the results' robustness. Semaglutide 2.4 mg had higher treatment costs (€3285.55) compared with liraglutide 3 mg (€2742.47) but demonstrated greater efficacy and a lower cost of control across all weight loss targets. The cost per patient achieving ≥ 5% weight loss was €3768.72 for semaglutide and €4718.66 for liraglutide, corresponding to a difference of €949.95 per patient. The cost difference widened at higher weight loss targets, with semaglutide showing differences of €6064.20 for ≥ 10% weight loss, €17,005.23 for ≥ 15%, and €37,296.00 for ≥ 20%. These findings were consistent across sensitivity analyses. Semaglutide 2.4 mg is likely to be a short-term, cost-effective treatment option for adults who are overweight or have obesity without diabetes in Greece.

Towards routine high-throughput analysis of fecal bile acids: validation of an enzymatic cycling method for the quantification of total bile acids in human stool samples on fully automated clinical chemistry analyzers.

Bile acid diarrhea is a common but underdiagnosed condition. Because the gold standard test (75SeHCAT) is time-consuming and not widely available, fecal bile acid excretion is typically assessed by chromatography and mass spectrometry. Although enzymatic cycling assays are well established for the rapid and cost-effective analysis of total bile acids (TBA) in serum or plasma, their full potential has yet not been extended to stool samples in clinical routine. The performance of the 'Total bile acids 21 FS' reagent (DiaSys) was evaluated in fecal matrix according to CLSI guidelines and EU-IVD Regulations (2017/745), and compared to an established microplate-based kit (IDK®) by measuring patient stool samples (n=122). Method agreement was assessed by Passing-Bablok and Bland-Altman analysis. The quantification of eight individual BAs was assessed using HPLC-MS/MS as reference method. The DiaSys assay showed linearity between 3.5 and 130 μmol/L, good repeatability, total precision, and reproducibility with CVs of 1.7 %, 3.5 %, and 3.0 %. Limit of blank (LoB), detection (LoD), and quantitation (LoQ) were≤0.17,≤0.3, and 3.5 μmol/L, respectively. No significant interference from endogenous substances was observed. The methods showed good correlation up to 140 μmol/L (r=0.988), despite differences in the quantification of individual BAs, with mean deviations of 7 % (DiaSys) and 31 % (IDK®), respectively. The advantages of enzymatic TBA analysis on fully automated clinical chemistry platforms can be exploited for the routine analysis of stool samples. However, cycling assays may benefit from reference standards that take into account the composition of the fecal BA pool.

Cervical cancer screening by cotesting method for Vietnamese women 25–55 years old: a cost-effectiveness analysis

BackgroundCervical cancer (CC) is preventable through regular screening and vaccination against human papillomavirus (HPV). However, CC remains a significant public health issue in low-income and middle-income countries (LMICs) like Vietnam,...

N34 Could the targeted use of home faecal calprotectin testing increase uptake and help to address cost effectiveness concerns?

Abstract Background Home faecal calprotectin testing (HFC) has a role in the management of inflammatory bowel disease (IBD) with faster turnaround times, earlier clinical input, and potentially greater patient engagement. However, despite positive feedback from patients, a previous in-house audit demonstrated a low yield of completed tests (39%)1, raising concerns about cost effectiveness of HFC compared to standard testing. Variation in counselling and heterogeneity in reasons for requesting HFC may have contributed to our results. We wanted to explore if using HFC in a targeted way with standardised counselling could improve completion rates in our centre and identify where HFC might be cost effective. Methods 3 clinical indications were identified: young adult patients (YA), patients starting advanced therapies (AT) and patients on cancer surveillance (CS). All patients were counselled on the HFC process in a standard way by a limited number of clinicians to minimise variation, including viewing an instruction video online from CalproSmart2, and making patients aware of the cost of HFC in relation to hospital tests. Once counselled, patients were asked to confirm they were happy to do the HFC prior to the kit being sent. Outcomes including completion rates and where available, reasons for non-completion were recorded. Results Between July 2023 and August 2024 HFC kits were sent to 70 individual patients (Table 1). 35/70 HCF were completed (50%). Additionally, 6 patients advised that they did receive and perform their HFC but had issues with the kit or app (8%). Reminder texts were sent to non-completers, but this did not result in any further tests being completed. The highest completion rate of HFC, 22/32 (68%) was in the AT indication. 23/70 (33%) HFC results were >250 (range 274->1500). Of these, 15/23 (65%) patients had changes made to their treatment, ranging from initiation of topical therapy to a switch in AT, within 2 weeks of the result being available. Conclusion HFC completion rates improved (58% vs 39%) when patients were more aware of how to do the test, the reason for the investigation and where use was targeted to specific clinical scenarios as part of routine care. When HFC was elevated, clinical decision making was prompt with the potential to identify nonresponse or loss of response to AT in a timely manner, reducing flares and unscheduled admissions. While challenges demonstrating cost effectiveness remain, the benefits of HFC for patients who engage with the process seem evident and warrant ongoing investigation into how best to incorporate into clinical care, particularly as part of at home monitoring to support patient self-management and disease monitoring on advanced therapy.

Integrating circular economy policies in urban policy making: Strategies for green energy and environmental management to reinforce city image in China.

The implementation of circular economy (CE) policies in the management of urban policies have become essential for improving overall quality of life, development of green energy, and environmental management hence improving the image of cities. This research focuses on uncovering the core concepts of CE within urban environments, emphasizing actions that can improve green energy and environmental management. The CE aims to create a closed-loop system by prioritizing practices like remanufacturing, reusing, and recycling, which collectively help decrease resource usage and limit environmental damage. Therefore, in the study, the fuzzy Analytical Hierarchy Process (AHP) and fuzzy VIekriterijumsko KOmpromisno Rangiranje (VIKOR) are used to assess the identified several key factors and strategies for integrating CE activities for sustainable urban policy making and reinforce city image in China. The results of fuzzy AHP indicated that economic viability, policy and governance, and technological innovation are the key factors. While the cost effectiveness, policy flexibility and adaptability, and resource efficiency are identified as most crucial sub-factors. The fuzzy VIKOR presented that green building and sustainable development policies, green infrastructure development, and policy alignment and institutional support are the key strategies in handling and mitigating environmental issues as well as supporting economic growth, thus CE policies holds the key in creating a better perception of cities as innovative and sustainable. The contributions to this research are significant as it provides a structure for policymakers by offering a framework to integrate CE principles into urban policies. It also shows how CE can solve environmental challenges, promote growth in economy, and contribute to sustainable urban transformation. The implications of this study extend to policymakers, urban planners, and stakeholders dealing with greener and more adaptable cities consistent with global sustainability goals.

P0958 Curcumin-QingDai combination for active ulcerative colitis: A cost-effectiveness analysis

Abstract Background A combination of two herbal compounds, curcumin and QingDai (CurQD), was recently proposed as an effective treatment for patients with active ulcerative colitis (UC) based on randomized controlled and real-world evidence, but no cost-effectiveness analysis for this nutraceutical is currently available Methods A Markov model was generated to simulate the progression of patients with moderate-to-severe UC, by separate analysis for a cohort of advanced therapy-naïve and advanced therapy-experienced patients. Medications costs were derived from published average wholesale price (AWP) in the US. Efficacy data was modeled by synthesis of efficacy reports of randomized placebo-controlled trials and real-world cohort studies of all FDA-approved drugs for UC, and each compared with CurQD. The model used a time horizon of 54 weeks. The threshold of 50,000$/quality adjusted life-year (QALY) was chosen, and a one-way sensitivity analysis was performed for testing analysis robustness. Results The comparison of CurQD with the FDA approved advanced therapies for UC yielded an estimated incremental cost-effectiveness ratio (ICER) of over 200,000$/QALY for all comparisons. Differences ranged from -0.05 to a slight gain of 0.07 QALY in bio-experienced patients and from -0.1 to 0.04 QALY in bio-naïve patients. The one- way sensitivity analysis proved the robustness of the analysis. Conclusion The present analysis suggests that the markedly reduced cost and demonstrated efficacy of CurQD provides a significant cost-effectiveness benefit over advanced therapies for active UC, including over anti-TNF biosimilars.

Use of alternative payment models for substance use disorder prevention in the United States: development of a conceptual framework

BackgroundAlternative payment models (APMs) are methods through which insurers reimburse health care providers and are widely used to improve the quality and value of health care. While there is a growing movement to utilize APMs for substance use disorder (SUD) treatment services, they have rarely included SUD prevention strategies. Challenges to using APMs for SUD prevention include underdeveloped program outcome measures, inadequate SUD prevention funding, and lack of clarity regarding what prevention strategies might fit within the scope of APMs.MethodsIn November 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), through a contract with Westat, convened an expert panel to refine a preliminary conceptual framework developed for utilizing APMs for SUD prevention and to identify strategies to encourage their adoption.ResultsThe conceptual framework agreed upon by the panel provides expert consensus on how APMs could finance a variety of prevention programs across diverse populations and settings. Additional efforts are needed to accelerate the support for and adoption of APMs for SUD prevention, and the principles of health equity and community engagement should underpin these efforts. Opportunities to increase the use of APMs for SUD prevention include educating key groups, expanding and promoting the SUD prevention workforce, establishing funding for pilot studies, identifying evidence-based core components of SUD prevention, analyzing the cost effectiveness of APMs for SUD prevention, and aligning funding across federal agencies.ConclusionGiven that the use of APMs for SUD prevention is a new practice, additional research, education, and resources are needed. The conceptual framework and strategies generated by the expert panel offer a path for future research. SUD health care stakeholders should consider ways that SUD prevention can be effectively and equitably implemented within APMs.

Cost-effectiveness Analysis of Uterus Transplantation versus Gestational Carrier for Treatment of Absolute Uterine Factor Infertility.

Patients with uterine factor infertility (UFI) have few options for family building. Uterus transplant is a feasible treatment for some patients; however, cost remains a significant concern. To compare the cost effectiveness of treatment for patients with absolute uterine factor infertility to achieve 1-2 singleton births by gestational carrier or uterus transplant DESIGN: Decision analysis from the United States healthcare sector perspective, with time horizons to achieve one or two singleton births. Gestational carrier or uterus transplant MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios, comparing the costs (2020 U.S. Dollars) and effectiveness (quality-adjusted life years, QALYs, and live births) to achieve one or two births by gestational carrier and uterus transplant. In the base case of one singleton birth, the overall cost using a gestational carrier was $97,712.90 ($56,985.20-$153084.20) compared $116,137.20 ($67,142.88-$182,290.86) after uterus transplant. QALYs were higher in the gestational carrier arm (0.93) compared to uterus transplant (0.90) and overall rates of live birth were also higher in the gestational carrier arm (94%) compared to the uterus transplant arm (77%). Costs of the gestational carrier and uterus transplant recipient were the most significant cost variables in the model. Monte Carlo simulation showed that uterus transplant had a 37% chance of being the cost-effective strategy for a single live birth at a willingness to pay of $150,000/QALY. In the case of two singleton births, the cost using a gestational carrier was $186,278.56 ($103,597.81-$296,010.27) compared to $164,276.84 ($111,961.91-$229,394.43) after uterus transplant. QALYs were again higher in the gestational carrier arm (0.93) compared to uterus transplant (0.89). Overall rates of two live birth were also higher in the gestational carrier arm (86%) compared to the uterus transplant arm (66%). Monte Carlo simulation showed that uterine transplant has a 62% chance of being the cost-effective strategy for two live births at a willingness to pay of $150,000/QALY. Treatment of uterine factor infertility with a gestational carrier is likely the most cost-effective approach for patients delivering a single child. However, the absolute costs associated uterus transplant were 14% less than a gestational carrier for those having two live singleton births.

Incremental Cost-Effectiveness Ratios (ICERs) and Revised Metformin Cost-Effectiveness Conclusions in the Diabetes Prevention Program/ Diabetes Prevention Program Outcomes Study.

Introduction: Based on previously published US Diabetes Prevention Program (DPP) cost-effectiveness analyses (CEAs), metformin continues to be promoted as "cost-effective." We reviewed a 10-year CEA to assess this. Treatment alternatives included placebo, branded metformin and individual lifestyle modification. Following the original CEA, we added group lifestyle as a modeled alternative. Methods: Original published data were taken as given and re-analyzed according to accepted principles for calculating incremental cost-effectiveness ratios (ICERs). With more than 2 treatments, these require attention to the rankings of interventions according to cost or effect prior to stipulating appropriate ICERs to calculate. Results: With appropriate ICER calculations, metformin was not cost-effective. Net Loss calculations indicated substantial costs/health losses to using metformin instead of the optimal lifestyle alternative in response to metformin having been confusingly labeled "cost-saving" in the original CEA. Conclusions: The original DPP CEA, subsequent analyses and citations of such analyses continue to conclude that both metformin and lifestyle modification are cost-effective in diabetes prevention. However, using metformin implies substantial costs and health losses compared to the cost-effective lifestyle modification. It may be that metformin has a role in cost-effective diabetes prevention, but this has yet to be shown based on DPP data.

Comparing gestational carrier to uterine transplantation in uterine-factor infertility: a cost-effectiveness analysis.

To compare the cost-effectiveness of a gestational carrier to a uterine transplantation in the treatment of absolute uterine-factor infertility. We performed a cost-effectiveness analysis using a decision-tree mathematical model comparing a gestational carrier to a uterine transplantation. Published literature was used to derive costs for solid organ transplant, immunosuppression, gestational carrier obtainment, in vitro fertilization, preimplantation genetic testing, and frozen embryo transfer. Gestational modality: gestational carrier or uterine transplantation. We assumed graft failures occurred immediately and frozen embryo transfers at least six months after transplant. The primary outcomes were costs per live birth, number of children born, and quality adjusted life years (QALYs) for each gestational modality. Uterine transplantation was more expensive than a gestational carrier by $1.4 million U.S. Dollars with a lower utility by 23.74 QALYs using the same average number of children born per two FETS. After 10,000 simulated iterations, the gestational carrier arm had two children born 42% of the time, compared to only 17% of the time in the uterine transplantation arm. No children were born 56% of the time in the uterine transplantation arm versus 16% for the gestational carrier arm. Deterministic and probabilistic sensitivity variance of all cost parameters by +/- 75% ($39,292-$275,044 for gestational carrier versus $390,761-$2,735,329 for uterine transplantation) and other input parameters by +/- 20%, including graft failure (21-31%) and live birth per embryo transfer (29-78%), produced the same outcomes in >99% of scenarios simulated, as did variation in immunosuppression time (2-18 months) between delivery and subsequent FET. UTX was no longer absolutely dominated if the probability of a live birth per transfer using UTX increased beyond 85%, startup cost for UTX decreased to less than $13,646.28, or GC costs increased to greater than $359,200. Our model suggests gestational carrier use is currently more cost-effective than uterine transplantation for treating absolute uterine-factor infertility. However, the desire to carry one's own child is an intangible factor not captured in cost analyses, and improvements in uterine transplantation success rates or reduced costs may alter these results in the future.

Effects of noise and metabolic cost on cortical task representations.

Cognitive flexibility requires both the encoding of task-relevant and the ignoring of task-irrelevant stimuli. While the neural coding of task-relevant stimuli is increasingly well understood, the mechanisms for ignoring task-irrelevant stimuli remain poorly understood. Here, we study how task performance and biological constraints jointly determine the coding of relevant and irrelevant stimuli in neural circuits. Using mathematical analyses and task-optimized recurrent neural networks, we show that neural circuits can exhibit a range of representational geometries depending on the strength of neural noise and metabolic cost. By comparing these results with recordings from primate prefrontal cortex (PFC) over the course of learning, we show that neural activity in PFC changes in line with a minimal representational strategy. Specifically, our analyses reveal that the suppression of dynamically irrelevant stimuli is achieved by activity-silent, sub-threshold dynamics. Our results provide a normative explanation as to why PFC implements an adaptive, minimal representational strategy.

Social prescribing for adults with chronic pain in the U.K.: a rapid review.

Social prescribing links patients to community groups and services to meet health needs; however, it is uncertain what the benefits and impacts of social prescribing are for people with chronic pain. The National Institute for Health and Care Excellence (NICE) undertook a systematic review to investigate the clinical and cost effectiveness of social interventions aimed at improving the quality of life of people with chronic pain; no relevant clinical studies comparing social interventions with standard care for chronic pain were found, though the inclusion criteria for studies was narrow. To undertake a rapid review of all types of research and policy on social prescribing for adults with chronic pain in the U.K. (i) to describe the characteristics of relevant research and (ii) to synthesise data on impact. A two-stage rapid review was planned. Stage (i) scoped and categorised knowledge from a comprehensive representation of the literature. In stage (ii), we undertook a descriptive synthesis of quantitative data along with a thematic analysis of qualitative data identified by stage (i). Of 40 full-text records assessed for inclusion, three met the inclusion criteria from academic databases. An additional five records were found in grey literature. Six records reported quantitative findings suggesting that social prescribing reduced pain severity and discomfort, pain medication and clinical appointments; and improved quality of life and ability to manage health. Five records captured qualitative data from interviews, case studies and anecdotal quotes that suggested positive impact on health and wellbeing; and increased self-efficacy in social prescribers undertaking training on pain. There is tentative evidence that social prescribing improves health and wellbeing outcomes in adults with chronic pain and that there is a need to upskill social prescribers in contemporary pain science education. Research on the routes to referral, outcomes and impacts is needed. Social prescribing is valued and may be of benefit for people with chronic pain. There is a need to further develop and evaluate social prescribing services for people with chronic pain to enhance holistic patient centered care.

Is first-line treatment with polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) for previously untreated diffuse large B-cell lymphoma cost-effective in China? A cost-effectiveness analysis using a Markov model

ObjectiveTo evaluate the cost-effectiveness of polatuzumab vedotin–rituximab–cyclophosphamide, doxorubicin and prednisone (pola-R-CHP) in CD20-positive patients with previously untreated diffuse large B-cell lymphoma (DLBCL) in China.DesignA Markov model was constructed to analyse...

How do foreign and domestic institutional investors drive the market value? The influence of family ownership

PurposeThis paper aims to investigate and compare the impact of foreign and domestic institutional investors on the market value of family and non-family companies. Subsequently, it examines how different degrees of family ownership influence foreign and domestic institutional investors and their value impacts.Design/methodology/approachThe sample of this study includes 339 non-financial firms from NIFTY-500 for 11 years from 2011 to 2020, which contains 128 family and 211 non-family companies. Both static (fixed-effect model) and dynamic (two-step system generalized method of moments) models are employed to test the hypotheses.FindingsFindings suggest that foreign institutional investors outshine domestic institutions regarding value creation. Meanwhile, higher (>50%) family holdings are detrimental to foreign institutional investors, while moderate holdings (26–49%) improve domestic institutional investments. The favorable effect of foreign players gets diluted with the higher (>50%) family holdings, while the adverse impact of domestic players improves with the moderate (26–49%) family holdings. Overall, partial family control is beneficial, while low and absolute family control is detrimental to market value. These findings indicate that institutional investors are family control-dependent, where the family control effect is not static.Originality/valueThis paper offers a novel perspective by addressing the effect of costs and benefits realized at three distinctive levels of family holdings on foreign and domestic institutional investors and their value impacts to witness differences caused by varying family control, which is not done earlier as per the best of our knowledge.

Cost-effectiveness analysis of durvalumab with chemotherapy and maintenance durvalumab with or without olaparib for advanced endometrial cancer

This study evaluates the cost-effectiveness of adding durvalumab to chemotherapy, with subsequent maintenance either with olaparib (DOCT) or without olaparib (DCT), versus chemotherapy alone (CT) as a first-line treatment for advanced endometrial cancer (EC) in the United States, stratified by mismatch repair deficiency (dMMR) and proficiency (pMMR). A Markov model based on DUO-E Phase III trial data simulated disease progression and outcomes. Total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER) were evaluated. Sensitivity analysis assessed model robustness. For dMMR EC, costs (QALYs) were $1,204,763.33 (5.49), $590,732.13 (4.61), and $1,495,528.15 (3.68) for DOCT, DCT, and CT, respectively, with ICER of $584,140.94/QALYs (DOCT vs. CT) and $476,946.43/QALYs (DCT vs. CT). For pMMR EC, costs (QALYs) were $421,126.70 (3.00), $400,470.92 (2.45), and $133,424.52 (1.69), with ICER of $219,601.20/QALYs (DOCT vs. CT) and $351,777.86/QALYs (DCT vs. CT). In the overall population, costs (QALYs) were $607,921.80 (3.89), $417,637.19 (2.82), and $141,594.38 (2.16), with ICER of $269,195.01/QALYs (DOCT vs. CT) and $416,098.68/QALYs (DCT vs. CT). From a U.S. payer perspective, DOCT and DCT regimens are not cost-effective compared to CT for advanced or recurrent EC, including dMMR and pMMR subgroups, at a $150,000/QALY threshold.