US Dollars Research Articles

Household Food Security Status and Diet Diversity Predictors of Mother Child-Dyads from Rural Smallholders in Three Agroecological Zones of Malawi

ABSTRACT Data from mother-child dyads (n = 375) living in rural smallholder farming households in Malawi was utilized. Households with an average income of >$4.2 US dollars per member had 60% lower odds (OR: 0.40, 95%CI: 0.19–0.82) of food insecurity. Household food insecurity was a predictor of Minimum Dietary Diversity for Women (MDD-W) (OR: 0.43, 95%CI: 0.21–0.89). Children whose female caregivers met MDD-W had 37 times higher odds (OR: 37.6, 95%CI: 13.9–117) of meeting the recommended dietary diversity score. To address food and nutrition security in this population, an approach that encompasses women’s empowerment and income diversification is required.

Comparing pulsed field ablation and thermal energy catheter ablation for paroxysmal atrial fibrillation: A cost-effectiveness analysis of the ADVENT trial

Background Pulsed field ablation (PFA) has emerged as an effective technology in the treatment of paroxysmal atrial fibrillation (AF). Objective To evaluate the cost-effectiveness of PFA vs. thermal ablation from a US healthcare payer perspective using data from a randomized trial. Methods A hybrid decision tree and Markov model was developed comparing patients receiving PFA to thermal ablation (either radiofrequency or cryoballoon ablation) from a US healthcare payer perspective at 5-, 10-, 20-, and 40-year time horizons. Direct medical costs (in 2024 US Dollars), quality-adjusted life years (QALYs), and the net monetary benefit were evaluated at a willingness-to-pay (WTP) threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed to test model uncertainty. The budget impact for a standard US healthcare payer with 1 million beneficiaries was also assessed. Results Over a 40-year time horizon, PFA resulted in an additional 0.044 QALYs at a lower cost of $2,871 compared to thermal ablation. PFA was cost-effective in 54.9% of simulations. Anticoagulation and ablation procedure costs had the largest impact on model uncertainty. The expected cost savings per member per month for a US healthcare payer adopting PFA were $0.00015, $0.0059, and $0.02343 in years 1, 4, and 6, respectively. Conclusions PFA was at least as cost-effective as conventional thermal ablation modalities for treatment of paroxysmal AF and potentially reduces US healthcare payer costs. Providers and payers should consider designating PFA among the preferred first-line therapies for eligible patients.

Estimated direct medical cost of orthopaedic trauma surgery in Saudi Arabia: a single-centre retrospective cost analysis

BackgroundPhysical trauma is a significant contributor to morbidity and mortality worldwide. In Saudi Arabia, RTAs are the leading cause of injuries, with fractures being a critical aspect of trauma care. To address this prevalent healthcare burden, a detailed analysis of the costs associated with surgical interventions to optimize resource allocation and improve healthcare planning is crucial.MethodThis retrospective cost analysis was conducted at King Saud University Medical City between January 2016 and March 2022. A total of 2689 orthopaedic trauma surgeries were analysed. The cost data were converted to US dollars (1 USD = 3.75 SR). Statistical analysis was conducted via SPSS, with comparisons of costs by sex, age group, procedure type, and other relevant factors.ResultsThe total cost of trauma surgeries over the study period was $8,548,749.90. The most common procedure was ORIF, which was performed 1415 times, accounting for $5,660,000.00 of the total cost. Males represented 65.7% of the patients, incurring $5,647,976.44 in expenses. Patients under the age of 21 had the highest number of cases by age (43.5%), and the total cost was $3,276,293.44. Scheduled surgeries had higher average costs than emergent procedures did, and lower extremity surgeries accounted for more cases but had lower average costs than upper extremity surgeries did.ConclusionThe cost of orthopaedic trauma care is significantly influenced by factors such as procedure type, age, and sex. When certain cost patterns are identified and analysed, an approach toward cost effectiveness while maintaining high-quality healthcare delivery can be achieved. Projected trends show an increase in the number of cases by 2030, indicating increased costs. Future studies should consider additional factors, such as rehabilitation costs, and explore cost-saving opportunities in surgical interventions.

Cost Analysis Related to Diagnosis, Treatment and Management of Cervical Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Study

Cervical cancer remains a significant public health issue globally. In Antigua and Barbuda, cervical cancer is ranked among the top five most common cancers in terms of incidence and mortality among females. There is no evidence that the costs of diagnosing, treating, and managing this cancer have been studied before in Antigua and Barbuda. From the providers’ perspective, this study aimed to estimate costs associated with cervical cancer in Antigua and Barbuda. The prevalence-based cost-of-illness methodology was used to assess patient data abstracted from four study sites for the period 2017–2021, and to derive the annual prevalence. Top-down and bottom-up costing approaches were used to estimate direct medical costs. Costs were computed using the 2021 price level and converted to United States Dollars (USD). Total annual direct medical costs of cervical cancer were estimated at USD 0.24 million (ranging between USD 0.19 million and USD 0.30 million). Major cost drivers were treatment (USD 112,863.76), post-treatment side-effects care (USD 67,406.57), and the diagnostic process (USD 26,238.58). The overall direct medical unit costs for managing a case were estimated at USD 115,822.09. Our study reflects the current estimates for managing cervical cancer and provides evidence to complement cervical cancer prevention and cost containment measures in Antigua and Barbuda.

Declining Blowout Fracture Cases and Rising Costs in South Korea (2010-2023).

Blowout fractures are a significant component of maxillofacial trauma care, but their incidence appears to be declining in South Korea. This study aims to investigate the trends in blowout fracture cases from 2010 to 2023 and assess the implications for plastic and reconstructive surgery, as well as the financial burden on patients. A retrospective observational study was conducted using data from the Health Insurance Review and Assessment Service in South Korea. Patients diagnosed with orbital fractures (International Classification of Diseases, 10th Revision code S02.3) between 2010 and 2023 were included. Variables such as patient demographics, National Health Insurance (NHI) payments, and patient out-of-pocket expenses in United States dollars were analyzed. Time-series forecasting was performed using the Auto-Regressive Integrated Moving Average (1,1,1) model to predict future trends. A total of 163,146 patients were diagnosed with blowout fractures from 2010 to 2023. The number of cases decreased by 48.0%, from 18,340 in 2010 to 9534 in 2023 (P < 0.001). Despite the decline in cases, the average NHI payment per patient increased by 135.5%, and patient out-of-pocket expenses rose by 127.5% (P < 0.01). Strong negative correlations were found between patient numbers and per-patient costs for both NHI payments (r = -0.933) and patient expenses (r = -0.929). The Auto-Regressive Integrated Moving Average model forecasts suggest that case numbers may stabilize, but health care costs will continue to rise through 2028. The declining trend in blowout fracture cases poses challenges to the sustainability of this subspecialty in plastic and reconstructive surgery. Concurrently, the increasing financial burden on patients highlights limitations in the current health care coverage. Plastic and reconstructive surgeons must adapt by diversifying skills and fostering interdisciplinary collaboration. Policy reforms are necessary to reduce the financial burden on patients and ensure equitable access to care.

Cost-Utility Analysis of Trastuzumab-Emtansine Versus Trastuzumab for the Treatment of Residual Invasive HER-2-Positive Breast Cancer in Iran

Background: Breast cancer is one of the most common types of cancer in women, and its incidence is increasing in Iran. HER-2-positive breast cancer is invasive and often associated with poorer outcomes. Patients with this type of breast cancer can develop resistance to medications like trastuzumab. Trastuzumab-emtansine (TDM1) is a medication developed to reduce cancer cell resistance to trastuzumab. The TDM1 has been shown to decrease the incidence of death and recurrence in breast cancer. Objectives: This study aimed to evaluate the cost-utility and calculate the budget impact of TDM1 versus trastuzumab for the treatment of residual invasive HER-2-positive breast cancer. Methods: A Markov model with a lifetime horizon was developed, incorporating four health states. Women aged 45 with residual invasive HER-2-positive breast cancer entered the model. The study adopted a healthcare system perspective, with costs reported in 2021 US dollars. Discount rates of 7% for costs and 3% for utility values were applied. Utility values and transition probabilities were derived from published literature. Costs were estimated based on guidelines, expert opinions, and Iranian tariffs. Iran’s pharmacoeconomic threshold of 1085$ was used for comparison. The incremental cost-effectiveness ratio (ICER) and budget impact of TDM1 were calculated, and sensitivity analyses were conducted to assess the robustness of the model. Results: The model indicated that treatment with TDM1 resulted in a 1.59 quality-adjusted life year (QALY) increase, with an additional cost of 1408$. This was deemed cost-effective, considering Iran’s pharmacoeconomic threshold of 1085$ (calculated ICER: 886$ per QALY gained). One-way sensitivity analysis revealed that the model was sensitive to the costs of TDM1 and trastuzumab, the discount rates for utility values and costs, and the probability of achieving invasive disease-free survival (IDFS). Probabilistic sensitivity analysis showed that 59.61% of simulations fell below Iran’s pharmacoeconomic threshold, supporting the model's robustness. The budget impact analysis revealed that the additional budget required for TDM1 treatment over a three-year period was 1,120,546$ compared to trastuzumab. Conclusions: Although TDM1 imposes higher costs, it is more cost-effective than trastuzumab for the treatment of residual invasive HER-2-positive breast cancer in Iran.

Mechanisms of Monetary Cooperation in BRICS: First Results and New Challenges

The issues of creating a more equitable global monetary and financial system have been constantly in the focus of the BRIC countries since 2006. Gradual introduction of unprecedented restrictive measures against one of the participants – Russia – forced member states to intensify the work on diminishing their dependence on actions of the United States, searching for alternative ways of payment for goods and services and reducing transactions in US dollars. The article analyses prerequisites for development of monetary cooperation within BRICS and implications of the measures already taken in this direction. The extent to which introduction of a common currency can contribute or, on the contrary, create barriers to deepening economic integration within BRICS is explored. The experience of introducing euro in the EU shows that the decision on joining a common currency is not just an economic, but also a political one. Ignoring the risks associated with a radical change in payment systems can lead to serious disruptions in the world economy and push exporters and importers away from implementation of agreements reached at the highest level. The authors come to the conclusion that speeding up currency cooperation without relying on comprehensive consideration of the interests of BRICS countries and assessment of potential costs and benefits can lead to deterioration of the terms of mutual trade against the backdrop of the US attempts to maintain the existing architecture of global monetary system with absolute domination of the US dollar.

Macroeconomics As A Determinant Of Demand For Oil And Gas Exports And Non-oil And Gas In East Nusa Tenggara Region By Timor Leste

International trade is a key component in enhancing welfare and economic growth, as well as generating foreign exchange needed for development. East Nusa Tenggara (NTT), with its significant potential in the oil and gas, as well as non-oil and gas sectors, has considerable export opportunities to Timor Leste. However, the effectiveness of NTT's exports is heavily influenced by various macroeconomic factors, such as exchange rates, per capita income, and government spending in both Indonesia and Timor Leste. The variation in resources and production capacity in NTT offers opportunities to meet Timor Leste's demand, but changes in macroeconomic conditions play a critical role in determining the competitiveness of NTT's export products. This study employs a quantitative approach with multiple linear regression analysis to examine the impact of macroeconomic variables on the demand for oil and gas, as well as non-oil and gas exports from NTT to Timor Leste. The sample used consists of annual time series data from 2021 to 2023, including the Rupiah exchange rate against the US Dollar, Timor Leste's per capita income, and government spending in Timor Leste. The results show that the exchange rate has a significant negative impact on export demand, while government spending has a positive effect. Timor Leste's per capita income does not significantly affect export demand. These findings are expected to contribute to policymakers in improving NTT's export competitiveness and volume, ultimately having a positive impact on the region's economic welfare.ipsum

The Application of Machine Learning Techniques to Predict Stock Market Crises in Africa

This study sought to ascertain a machine learning algorithm capable of predicting crises in the African stock market with the highest accuracy. Seven different machine-learning algorithms were employed on historical stock prices of the eight stock markets, three main sentiment indicators, and the exchange rate of the respective countries’ currencies against the US dollar, each spanning from 1 May 2007 to 1 April 2023. It was revealed that extreme gradient boosting (XGBoost) emerged as the most effective way of predicting crises. Historical stock prices and exchange rates were found to be the most important features, exerting strong influences on stock market crises. Regarding the sentiment front, investors’ perceptions of possible volatility on the S&amp;P 500 (Chicago Board Options Exchange (CBOE) VIX) and the Daily News Sentiment Index were identified as influential predictors. The study advances an understanding of market sentiment and emphasizes the importance of employing advanced computational techniques for risk management and market stability.

Economic Impact of Government Interventions during the COVID-19 Pandemic in Iran: A Systematic Review and Content Analysis

Background: Iran is one of the hardest hit countries by COVID-19 and has witnessed a high incidence and prevalence of mortality and morbidity cases. This study generally aims to highlight the main economic aspects of government responses to the COVID-19 outbreak in Iran. Methods: In order to benefit from a comprehensive tool to evaluate direct and indirect costs of approvals, a preliminary systematic review was conducted. Qualitative content analysis and simplified method of activity-based costing (ABC) were used in order to calculate the aggregate cost of a given set of activities. The direct and indirect costs of approvals based on the aggregated costs of categorized activities were analyzed. All costs were converted into US dollars using the monthly mean exchange rate. Results: Totally, 164 publications were included in the systematic review. Designed tool was approved by expert opinions (met CVI&gt;0.79 and CVR≥0.6) and seven aspects of economic consequences of COVID-19 interventions were assessed. The overall tangible and calculable costs were estimated about 25,755,700,000 US$. Direct support and compensation for losses of industries and companies accounted for the largest costs (41%) related to COVID-19 interventions (10,587,000,000 US$). Conclusion: Establishing economic security for industries, rapid and simultaneous measures of prevention, treatment and vaccination, and increasing household income can significantly reduce the costs of controlling similar diseases in the future.

An Economic Impact Analysis of the Covid-19 Pandemic in the Nepalese Tourism Sector

Background: A considerable number of studies in the Nepalese context have revealed that Nepal’s tourism sector has been adversely affected by the Covid-19 pandemic; however, none of these studies have quantified these consequences in monetary terms. This assessment is expected to offer valuable insight for enhancing the resilience of tourism sector to future global disruptions and developing tailored policies to bolster the Nepalese tourism sector against external shocks. Objectives: This study addresses a critical gap in understanding the full economic ramifications of the Covid-19 pandemic in the Nepalese tourism sector by quantifying the primary, secondary and tertiary revenue losses. By providing a comprehensive assessment of the pandemic’s impact, this study aims to inform policymakers and industry stakeholders in developing tailored strategies for recovery and resilience. Methods: Secondary data are used in this study. It employs Stynes et al.’s (2000) revised money generation framework and the Keynesian macroeconomic multiplier approach to assess the actual and expected economic impacts of tourism activities in Nepal during the pandemic periods of 2020 and 2021. The actual value is determined using the actual tourism statistics, while the expected value is based on the targeted tourism statistics reported by the Ministry of Culture, Tourism, and Civil Aviation, Nepal. The difference between the two estimates is attributed to the economic impact of the Covid-19 pandemic in those years. Results: This study reveals an expected revenue decrease of 1.038 billion US dollars in 2020 and 1.309 billion US dollars in 2021. In addition, the tourism multiplier values are declining in Nepal over the observed years. Conclusion: This study provides two key conclusions. First, the Nepalese tourism sector is susceptible to travel restrictions. Second, tourism revenue is being drained from the local economy due to the increasing importation of merchandise and services to satisfy the Nepalese tourism sector’s demand.

Examining the Impact of Merger and Acquisition Perception on Customer Loyalty in the Banking Sector: Evidence from Structural Equation Modeling

Background: A considerable number of studies in the Nepalese context have revealed that Nepal’s tourism sector has been adversely affected by the Covid-19 pandemic; however, none of these studies have quantified these consequences in monetary terms. This assessment is expected to offer valuable insight for enhancing the resilience of tourism sector to future global disruptions and developing tailored policies to bolster the Nepalese tourism sector against external shocks. Objectives: This study addresses a critical gap in understanding the full economic ramifications of the Covid-19 pandemic in the Nepalese tourism sector by quantifying the primary, secondary and tertiary revenue losses. By providing a comprehensive assessment of the pandemic’s impact, this study aims to inform policymakers and industry stakeholders in developing tailored strategies for recovery and resilience. Methods: Secondary data are used in this study. It employs Stynes et al.’s (2000) revised money generation framework and the Keynesian macroeconomic multiplier approach to assess the actual and expected economic impacts of tourism activities in Nepal during the pandemic periods of 2020 and 2021. The actual value is determined using the actual tourism statistics, while the expected value is based on the targeted tourism statistics reported by the Ministry of Culture, Tourism, and Civil Aviation, Nepal. The difference between the two estimates is attributed to the economic impact of the Covid-19 pandemic in those years. Results: This study reveals an expected revenue decrease of 1.038 billion US dollars in 2020 and 1.309 billion US dollars in 2021. In addition, the tourism multiplier values are declining in Nepal over the observed years. Conclusion: This study provides two key conclusions. First, the Nepalese tourism sector is susceptible to travel restrictions. Second, tourism revenue is being drained from the local economy due to the increasing importation of merchandise and services to satisfy the Nepalese tourism sector’s demand.

The Asymmetric Impact of Economic Policy Uncertainty on the Demand for Money in the GCC Countries

Heightened uncertainty in global economic policy has sparked a renewed interest in studying people’s demand for money, particularly to explore whether this demand exhibits asymmetry. In this study, we utilize a nonlinear ARDL approach to investigate the asymmetric effects of global economic policy uncertainty on money demand in each GCC country. Understanding the impact of global economic policy uncertainty on money demand in GCC countries is essential for crafting effective monetary policies, especially given that these countries maintain a pegged exchange rate to the US dollar, leaving them susceptible to economic slowdowns and global business cycles. The findings show varying sensitivity to changes in economic policy uncertainty across GCC countries, with most countries demonstrating asymmetric responses. Policymakers should consider incorporating a nonlinear ARDL model when analyzing money demand in these nations.

Use of individualized starting dose and niraparib hematologic adverse event management costs in ovarian cancer.

Aim: To understand the impact of the niraparib individualized starting dose (ISD), compared with fixed starting dose (FSD), on the cost of hematologic adverse event (AE) management from a US payer perspective. Methods: The frequencies of grade ≥3 hematologic AEs that occurred in >1% of patients treated with niraparib were obtained from the primary analysis results of the phase III PRIMA/ENGOT-OV26/GOG-3012 trial. US unit costs for each grade ≥3 AE in the base case were obtained from the 2017 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project database; unit costs were adjusted to 2020 US dollars. AE management costs per patient were calculated by multiplying AE unit cost by the frequency of each AE by niraparib starting dose. Because AEs were assumed to occur independently of one another, costs were added to derive the total cost. Results: For niraparib, the estimated AE management cost per patient was lower for the ISD than the FSD for all hematologic AEs (FSD vs ISD: thrombocytopenia, $4701.87 vs $1921.89; anemia, $2784.00 vs $1760.59; platelet count decreased, $2103.47 vs $922.51; neutropenia, $2112.50 vs $1369.56; neutrophil count decreased, $1285.87 vs $770.38). The total mean calculated AE management cost per patient was $12,987.71 with the FSD and $6744.93 with the ISD. Conclusion: For niraparib, the cost of managing hematologic AEs in the US was reduced by almost half with the ISD compared with the FSD. The cost reduction and improvements in safety associated with the niraparib ISD support its use in clinical practice.

A crypto way out: cryptocurrency, techno-economic imaginaries, and crisis in Russia

ABSTRACT Russia is a global forerunner in cryptocurrency adoption. This paper explores how cryptocurrency, as a techno-economic actant, informs the way Russians strategize their lives and imagine alternative futures. Based on in-depth interviews with Russian cryptocurrency owners and advocates (N = 21), we show how this new digital asset is tied to specific techno-economic imaginaries, allowing Russians to envision shortcuts out of prolonged crises. By mobilizing concepts from science and technology studies, sociology of crises, and the study of economic valuation, we unpack how cryptocurrency has a performative effect (i.e. acts and makes act) on the way Russians live during crises. The analysis reveals three shortcuts on different social levels. First, on a day-to-day level, cryptocurrency is imagined as a way to hedge against inflation, circumvent payment restrictions, and find alternative sources of income. Second, it acquires political value as it is seen as a means to circumvent state power through self-custody of value and anonymity. Finally, engagement with cryptocurrency fosters a belief in an alternative geofinancial configuration, envisioning the replacement of the US Dollar as the global currency and imagining a post-state tech utopia.

The 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach in Tanzania: a cost-effectiveness analysis

BackgroundReactive case detection (RACD) for malaria control has been found effective in low transmission settings, but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown. We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy (1,7-mRCTR) in three moderate-to-high malaria transmission districts in Tanzania.MethodsThe costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa, Kibiti, and Rufiji districts in Tanzania from 2019–2021. Empirical cost data were collected using household surveys. The incremental costs of the intervention were calculated from under a societal perspective. Costs are reported in 2022 US dollars.Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected. We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios (ICERs).Propagated uncertainty was assessed via second-order Monte Carlo simulation, including bootstrapping of empirical data distributions. Incremental costs per disability-adjusted life year (DALY) averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.ResultsThe programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars (USD) per 1000 population. The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone, yielding an incremental cost per additional case detected of 12.0 USD. Based on modelling results, for every percentage point decline in malaria prevalence, the intervention averted 95.2 cases and 0.04 deaths per 1000 population. On average, the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population. Compared to passive malaria detection, the ICERs for the 1,7-mRCTR intervention were 7.3 USD per case averted, 16,884 USD per death averted, and 163 USD per DALY averted.ConclusionsOur analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a willingness-to-pay threshold of 417 USD per DALY averted, showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.Graphical

Comparing ambulatory to inpatient percutaneous nephrolithotomy: systematic review and meta-analysis.

To investigate the differences in perioperative characteristics and postoperative outcomes between inpatient and ambulatory percutaneous nephrolithotomy (PCNL) with a subgroup analysis of same-day discharge (SDD) patients, summarise published ambulatory pathways and compare cost and satisfaction data. This study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered a priori with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023438692). Ambulatory PCNL was defined as patients who were discharged after an overnight stay (≤23 h) and SDD was considered a subgroup discharged on postoperative Day 0. A total of 25 studies were included in the systematic review, of which 12 comparative studies were utilised for meta-analysis. We had a pooled population of 2463 patients, of which 1956 (79%) ambulatory (747 [30%] SDD) and 507 (21%) inpatients. The ambulatory PCNL cohort had fewer overall complications (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.47-0.90; P = 0.010); however, there were no differences in major complications (i.e., Clavien-Dindo Grade ≥III; RR 0.46; 95% CI 0.17-1.21; P = 0.12), emergency department visits (RR 1.09, 95% CI 0.69-1.74; P = 0.71), 30-day readmission (RR 1.09, 95% CI 0.54-2.21; P = 0.81) or readmission at any point (RR 1.00, 95% CI 0.53-1.88; P = 0.99). The ambulatory PCNL cohort was more likely to be stone-free defined by imaging (RR 1.35, 95% CI 1.09-1.66; P = 0.005); however, when stone-free was inclusive of any definition there was no difference in stone-free rates (RR 1.10, 95% CI 0.98-1.23; P = 0.10). Subgroup analysis of SDD did not result in any significant differences. Cost savings ranged from $932.37 to a mean (standard deviation) $5327 (442) United States Dollars per case. No studies reported patient satisfaction data. Ambulatory PCNL seems to be a safe and efficacious model for select patients. Selection bias likely influenced ambulatory outcomes; however, this supports overall safety of current ambulatory inclusion criteria.

Cost-Effectiveness of Capivasertib as a Second-Line Therapy for Advanced Breast Cancer.

Capivasertib, a first-in-class AKT inhibitor, was recently approved as a second-line treatment for advanced breast cancer. However, capivasertib is expensive, raising questions over its economic value. This study provides the first evidence on the cost effectiveness of adding capivasertib to endocrine therapy (fulvestrant) for patients with PIK3CA/AKT1/PTEN-altered, hormone receptor-positive (HR+) human epidermal growth factor receptor2-negative (HER2-) advanced breast cancer. A Markov model was built to compare the costs and effectiveness of three treatment strategies. The first strategy involved adding capivasertib to fulvestrant for all patients, while the second strategy involved adding it for only postmenopausal women. The third strategy involved treatment with fulvestrant alone. Analyses were conducted from a US payer perspective over a lifetime horizon. Costs were measured in 2023 US dollars, and effectiveness was measured in life years (LYs) and quality adjusted life years (QALYs), discounted at 3% per year. One-way sensitivity analyses, probabilistic sensitivity analyses, and scenario analyses were conducted to assess the robustness of results. The addition of capivasertib to fulvestrant for all patients was associated with $410,765 higher costs and 1.46 additional quality adjusted life years (QALYs) compared with fulvestrant alone, resulting in an incremental cost effectiveness ratio of $280,854/QALY. The strategy of adding capivasertib for only patients who are postmenopausal was extended dominated, i.e., yielded fewer QALYs at a higher cost per QALY than if capivasertib was added for all patients. These results were found to be robust in sensitivity and scenario analyses. At its current price, our analysis suggests that theaddition of capivasertib to fulvestrant as a second line treatment is not cost effective versus fulvestrant alone at a willingness-to-pay threshold of $100,000/QALY. The price of capivasertib will need to be reduced by nearly 70% (to $7000 per cycle) for it to become cost effective.

Adult Work Ability Following Diagnosis of Bacterial Meningitis in Childhood

ImportanceA diagnosis of bacterial meningitis in childhood can lead to permanent neurological disabilities. Few studies have examined long-term consequences for work ability in adulthood.ObjectiveTo compare earnings, work loss, and educational attainment between adults diagnosed with bacterial meningitis in childhood and population comparators.Design, Setting, and ParticipantsThis nationwide registry-based matched cohort study included individuals in Sweden diagnosed with bacterial meningitis in childhood (aged &amp;amp;lt;18 years) from January 1, 1987, to December 31, 2019, and general population comparators matched 1:9 on age, sex, and place of residence. Follow-up was completed December 31, 2020. Data were analyzed from February 7 to September 12, 2023.ExposureA diagnosis of bacterial meningitis in childhood recorded in the National Patient Register.Main Outcomes and MeasuresAnnual taxable earnings (in 2020 US dollars), work loss (sum of sick leave and disability insurance), and educational attainment.ResultsThe cohort included 2534 individuals diagnosed with bacterial meningitis in childhood (mean [SD] age at diagnosis, 4.7 [5.3] years) and 22 806 comparators (13 510 [53.3%] male). Among those with childhood bacterial meningitis, 812 (32.0%) were diagnosed at younger than 1 year and 1351 (53.3%) were male. From 18 to 34 years of age, those with childhood meningitis had lower adjusted earnings relative to comparators and higher adjusted work loss. When pooling observations for individuals 28 years or older, the annual mean reduction in earnings was −$1295 (95% CI, −$2587 to −$4), representing a 4.0% (95% CI, 0%-8.0%) reduction relative to comparators, and the annual increase in work loss was 13.5 (95% CI, 8.6-18.5) days. There was a larger reduction in earnings for those with childhood meningitis relative to comparators with pneumococcal (Streptococcus pneumoniae) vs meningococcal (Neisseria meningitidis) meningitis. For work loss, there was a difference among all 3 major causes of meningitis, with the largest increase for pneumococcal meningitis. Individuals diagnosed at a younger age (below the median) had lower earnings relative to comparators and higher work loss than individuals diagnosed at an older age (above the median). Fewer individuals with childhood meningitis relative to comparators had obtained a high school degree at age 30 years (adjusted odds ratio, 0.68 [95% CI, 0.56-0.81]).Conclusions and RelevanceIn this cohort study of adults diagnosed with bacterial meningitis in childhood, findings suggest that work ability decreases relative to population comparators, with lower earnings and higher work loss, especially among adults diagnosed with pneumococcal meningitis or diagnosed at a young age, with long-lasting costs for the individual patient and society at large.

Impact of financial support on treatment outcomes of multidrug-resistant tuberculosis: A population-based, retrospective cohort study in Shanghai, China

BackgroundTo date, the prolonged treatment duration and expensive second-line anti-tuberculosis drugs (SLDs) for multidrug-resistant tuberculosis (MDR-TB) can impose a significant financial burden, which may negatively impact treatment outcomes. This study examines the effect of a subsidy policy on treatment outcomes of MDR-TB patient.. MethodsWe collected demographic and drug resistance data of all registered MDR-TB patients between April 2011 and December 2019 in Shanghai, China. Documentation of financial support received was routinely maintained until December 2021. We employed multivariate logistic regression to assess the association between financial support and treatment outcomes, estimating odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). ResultsOf the 865 patients, 70.6% (611/865) achieved treatment success. The median amount compensated under the subsidy policy was 2359 United States dollar (USD), with an interquartile range from 1116 to 5652 USD. A positive association was found between benefiting from the subsidy policy and higher rate of treatment success, with an adjusted OR of 2.95 (95% CI, 2.03–4.28). Among the 641 patients covered by the policy, the adjusted OR comparing those with higher versus lower reimbursement was 1.74 (95% CI, 1.16–2.61). ConclusionsFinancial support policies for MDR-TB patients demonstrate a positive influence on treatment outcomes.