Lowest Cost-effectiveness Ratio Research Articles

The public health impact and cost-effectiveness of the R21/Matrix-M malaria vaccine: a mathematical modelling study

The R21/Matrix-M vaccine has demonstrated high efficacy against Plasmodium falciparum clinical malaria in children in sub-Saharan Africa. Using trial data, we aimed to estimate the public health impact and cost-effectiveness of vaccine introduction across sub-Saharan Africa. We fitted a semi-mechanistic model of the relationship between anti-circumsporozoite protein antibody titres and vaccine efficacy to data from 3 years of follow-up in the phase 2b trial of R21/Matrix-M in Nanoro, Burkina Faso. We validated the model by comparing predicted vaccine efficacy to that observed over 12-18 months in the phase 3 trial. Integrating this framework within a mathematical transmission model, we estimated the cases, malaria deaths, and disability-adjusted life-years (DALYs) averted and cost-effectiveness over a 15-year time horizon across a range of transmission settings in sub-Saharan Africa. Cost-effectiveness was estimated incorporating the cost of vaccine introduction (dose, consumables, and delivery) relative to existing interventions at baseline. We report estimates at a median of 20% parasite prevalence in children aged 2-10 years (PfPR2-10) and ranges from 3% to 65% PfPR2-10. Anti-circumsporozoite protein antibody titres were found to satisfy the criteria for a surrogate of protection for vaccine efficacy against clinical malaria. Age-based implementation of a four-dose regimen of R21/Matrix-M vaccine was estimated to avert 181 825 (range 38 815-333 491) clinical cases per 100 000 fully vaccinated children in perennial settings and 202 017 (29 868-405 702) clinical cases per 100 000 fully vaccinated children in seasonal settings. Similar estimates were obtained for seasonal or hybrid implementation. Under an assumed vaccine dose price of US$3, the incremental cost per clinical case averted was $7 (range 4-48) in perennial settings and $6 (3-63) in seasonal settings and the incremental cost per DALY averted was $34 (29-139) in perennial settings and $30 (22-172) in seasonal settings, with lower cost-effectiveness ratios in settings with higher PfPR2-10. Introduction of the R21/Matrix-M malaria vaccine could have a substantial public health benefit across sub-Saharan Africa. The Wellcome Trust, the Bill & Melinda Gates Foundation, the UK Medical Research Council, the European and Developing Countries Clinical Trials Partnership 2 and 3, the NIHR Oxford Biomedical Research Centre, and the Serum Institute of India, Open Philanthropy.

Real-World Clinical Equivalence of Generic and Branded Tofacitinib: A Prospective Longitudinal Cohort Study in Patients With Rheumatoid Arthritis

ObjectivesTo explore the clinical efficacy and safety of generic tofacitinib vs brand name tofacitinib in patients with rheumatoid arthritis (RA) in a single-center comparative study based on a prospective real-world cohort. MethodsPatients with RA receiving tofacitinib, either generic (Kelejia) or branded (Xeljanz), from March 2017, to December 31, 2022, were enrolled. The primary outcome was the simplified disease activity index (SDAI)–defined remission rate at month 6. Secondary outcomes included the rates of remission and low disease activity defined by other composite scores; European Alliance of Associations for Rheumatology response rate, and ultrasonic synovitis scores at months 1, 3, 6, and 12. Cost-effectiveness was investigated. Propensity score–based inverse probability of treatment weighting was adopted to reduce selection bias. ResultsA total of 204 patients were enrolled: 59 in the generic group and 145 in the branded group. An SDAI-defined remission was achieved in 41.1% and 39.2% of patients in the generic and branded groups, respectively, at month 6 (P=.85). Rates of remission and low disease activity achievement, changes in clinical disease activity scores, and power Doppler and gray scale synovitis scores at months 1, 3, 6, and 12 were comparable between the 2 groups. Similar proportions of patients in the groups achieved moderate/good response at months 1, 3, 6, and 12. Rates of drug retention and adverse effects were also similar in the 2 groups. Both Kelejia and Xeljanz were cost-effective, but Kelejia had a lower average cost-effectiveness ratio. ConclusionGeneric tofacitinib (Keljia) had equivalent clinical efficacy and safety and better cost-effectiveness compared with its originator (Xeljanz).

Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands.

For postmenopausal Dutch women who have been referred to the FLS, direct access to CT2S may be cost-effective compared with DXA for age groups 70s and 80s, when considering the ICER threshold of the Netherlands. This study positions CT2S as a potential novel osteoporosis-screening tool for secondary fracture prevention in the clinical setting.A shorter screening interval of 2 y increases the effectiveness of both screening strategies, but the ICER of CT2S compared with DXA also increased substantially, which made CT2S no longer cost-effective for the 70s age group; however, it remains cost-effective for individuals in their 80s.Annual zoledronic acid treatment with better adherence may contribute to a lower cost-effectiveness ratio when comparing CT2S to DXA screening and the treat all strategies for all age groups.

Societal benefits of surrogate outcomes to support reimbursement decisions: The case of prostate cancer.

372 Background: Incorporating surrogate outcomes for survival into economic evaluations for localized prostate cancer (LPC) has the potential to reduce the time needed to subsidise new therapies but may increase uncertainty regarding true benefit. The ICECaP study demonstrated that metastasis-free survival (MFS) is a strong surrogate of overall survival (OS) in LPC. We sought to model the benefits to society of earlier funding decisions, and to understand the context of societal trade-offs between aspects of drug value and time to reimbursement decision-making in LPC. Methods: Societal benefits were modelled using a 4-health state (biochemical recurrence (BCR), BCR-free, metastasis and death) partitioned survival model to evaluate the cost-effectiveness of abiraterone plus prednisolone (AAP) plus standard of care (SoC) compared to SoC alone in LPC. Survival outcomes were dependent on the ICECaP surrogacy relationship. Treatment pathways and costs reflected Australian practice and quality of life was informed by the literature. The model evaluated the difference between deciding to reimburse AAP now, based on MFS, versus wait for OS 3 years. Societal trade-offs were captured using a population based discrete choice experiment exploring the influence on preference for drug reimbursement of cost-effectiveness, cost to Government, adverse events, proportions expected to benefit, nature of benefits, the completeness of data and the time of follow-up. Preferences were analysed using mixed logit analyses. Results: The analysis of societal benefits showed that using MFS as a surrogate for OS could prevent 117 patients from recurrence, 30 from metastases and save 63 lives in the short-term when AAP is compared with SoC for LPC patients in Australia. Delaying the reimbursement decision for 3 years results in a loss of 4.48 years, 0.47 quality adjusted life years, and increase the cost to $11,558 per patient over the lifetime. The analysis of societal trade-offs reflected results from 1,003 community members and showed an inclination to favour reimbursing interventions that benefit a high proportion of patients (OR=2.10 CI 95%=1.91, 2.32), have a lower cost-effectiveness ratio (OR=0.81 CI 95%= 0.78, 0.88) and an aversion for evidence from ongoing studies (OR= 0.83 CI 95%= 0.78, 0.88). Conclusions: Using MFS as surrogate for funding decision in LPC is likely to produce benefits to society in terms of improved short and long-term outcomes. This contrasts with societal preferences to delay reimbursement decisions to increase certainty. This suggests, improved cost-effectiveness could be used to compensate for the uncertainty arising from the use of surrogate outcomes in reimbursement decisions. The use of evidence-based surrogate outcomes in economic evaluations to support reimbursement decisions can reduce the time it takes new interventions to become available improving the benefits to society.

COMPARATIVE ANALYSIS OF THE USE OF MAINTENANCE THERAPY DRUGS IN WOMEN IN THE PROCESS OF RADIOTHERAPY AFTER SURGICAL TREATMENT OF ENDOMETRIAL CANCER

Aim. To carry out a comparative analysis of the cost of a "unit of effect" of emoxipin, ethoxidol and mexidol used to improve the quality of life of women receiving radiation therapy after surgical treatment of endometrial cancer. Materials and methods. The pharmacoeconomic analysis was carried out in accordance with the Guidelines for Calculating Costs in Conducting Clinical and Economic Studies of Medicinal Products and included determining the position of the study and the list of costs, the time period for cost accounting and cost calculation. The results of the use of the studied drugs were evaluated according to the previously published dynamics of integrative indicators of QL according to the generic questionnaire SF-36 and the cancer-specific questionnaire for patients with endometrial cancer FACT-En. In the course of the analysis, a comparison was made of the direct costs (Cost, in rubles) for the purchase of each of the studied drugs with the consequences (Ef) of their course use. The result of the pharmacoeconomical analysis was expressed in the form of a cost-effectiveness coefficient (CER = Cost / Ef) per patient. Results. As a result of the clinical and economic analysis, it was found that in most cases mexidol is characterized by the lowest cost-effectiveness ratio. This concerns the calculation of CER according to the dynamics of the integral indicator (TS) of the questionnaire for the functional assessment of endometrial cancer therapy (FACT-En) and the psychological component of health (MH) according to SF-36. The exception was the result of the calculation of "cost-effectiveness" according to the criterion of increasing PH – the physical component of health according to SF-36. In this situation, mexidol was inferior to ethoxidol in terms of pharmacoeconomic efficiency. In all cases, without exception, the most expensive was the use of emoxipin. Conclusion. According to the pharmacoeconomic criterion "costs - effectiveness", the most expensive is the use of emoxipin, and the least expensive is the use of mexidol. In all cases, the "cost per unit effect" of emoxipin was 3-6 times higher than the corresponding indicators of mexidol and ethoxidol.

Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure.

Nonbiological artificial liver (NBAL) is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio (CER) of comprehensive medical treatment, plasma exchange (PE), and double plasma molecular adsorption system (DPMAS) plus half-dose PE (DPMAS+PE) in patients with HBV-ACLF. A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment, PE, or DPMAS+PE and were prospectively evaluated. Patients were divided into four subgroups based on the pretreatment prothrombin activity (PTA): Group I (PTA>40%), group II (PTA 30-40%), group III (PTA 20-30%), and group IV (PTA<20%). The main outcome measures were 28 day effectiveness; 90 day liver transplantation-free survival; change of biochemical parameters; and CER. DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure. Clearance of serum total bilirubin (TBIL), AST, and creatinine (Cr) were significantly higher in the DPMAS+PE group than in the PE group. For subjects with group I liver failure, DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness. Compared with comprehensive medical treatment and PE alone, DPMAS with half-dose sequential PE treatment more effectively improved TBIL, AST, and Cr in HBV-ACLF patients, improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure, and was more cost effective. DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.

Plasma-assisted flame stabilization by AC dielectric barrier discharge in burst mode

Compared to the continuous mode of a high-frequency alternating current (HFAC) source, the burst mode is believed to be capable of controlling flow and combustion while saving discharge energy. Thus, the effect of burst mode on plasma-assisted flame stabilization, which is driven by an HFAC source, is investigated based on a plasma manipulation diffusion flame experiment system. A specially designed injector with a coaxial dielectric barrier discharge configuration is used to generate a methane-air diffusion flame and air plasma. The influence of the actuating parameters of the burst mode on plasma flame stabilization and the discharge power consumption are studied. The results show that the plasma injector has the typical volt–ampere characteristics of dielectric barrier discharge. The discharge clearly exhibits regular unsteady operation characteristics when the source is in burst mode. Two flame stability thresholds are found with increasing discharge voltage. According to the first and second flame stability threshold values and the flame pattern, raising the control frequency and the duty cycle is favorable for flame stabilization. However, for a fixed duty cycle of 50%, because the time scale of the actuator-off duration is longer than that of combustion, when the control frequency is too low, the flame cannot be stabilized even though the applied voltage is very high. For a fixed control frequency of 100 Hz, the flame is also difficult to stabilize when the duty cycle is too small. Mainly due to the unsteady gasdynamic effects of plasma in the burst mode, this approach can achieve the same flame stabilization effect as that of the continuous mode while reducing the energy consumption. The cost-effectiveness ratios of the two optimum actuation schemes are only 6.4% and 10.1%. In addition, the burst mode is better than the continuous mode in avoiding undesirable arc discharge. To better stabilize the flame while maintaining a relatively low cost-effectiveness ratio, actuator setting schemes with high frequency and a small duty cycle should be selected.

Peripherally inserted central catheter versus totally implanted venous port for delivering medium- to long-term chemotherapy: A cost-effectiveness analysis based on propensity score matching.

Peripherally inserted central catheters (PICCs) and totally implanted vascular access ports (PORTs) have been widely used for medium- to long-term chemotherapy. PICCs are associated with lower insertion cost, but higher complication rates than PORTs. However, there is a paucity of cost-effectiveness comparisons between the devices. We aimed to compare the cost-effectiveness of PICCs and PORTs for medium- to long-term chemotherapy from catheter insertion to removal. A cost-effectiveness analysis was conducted based on propensity score matching (PSM) from the hospital perspective. Data were collected from a retrospective cohort study. The total cost outcome comprised insertion, maintenance, removal and complication costs. The effectiveness outcome was the complication-free rate. The primary and supplemental outcomes were cost-effectiveness ratios (CERs) and incremental cost-effectiveness ratios (ICERs). A total of 1050 patients (after PSM for 417 patients) were included. The average total cost for 3-6 month ($603.55 ± 78.68 vs $1270.21 ± 128.84), 6-9 month ($731.40 ± 42.97 vs $1414.48 ± 155.43), and 9-12 month ($966.83 ± 53.78 vs $1587.76 ± 160.56) dwell times were all significantly lower for PICCs than for PORTs (p < 0.001). PICCs were associated with significantly lower complication-free rates than PORTs during the 3-6 month (65.22% vs 90.58%, p < 0.001), 6-9 month (53.33% vs 91.80%, p < 0.001), and 9-12 month (44.44% vs 88.46%, p = 0.015) dwell times. Ultimately, PICCs were associated with lower CERs than PORTs for the 3-6 month (928.54 vs 1395.84) and 6-9 month (1380.00 vs 1537.48) but higher CER for the 9-12 month (2197.34 vs 1804.27) dwell times. ICERs were 2564.08 and 1751.49 with dwell times of 3-6 months and 6-9 months, respectively. This study provided economic evidence that informs vascular access device choice for medium- to long-term chemotherapy. For 3-9 month dwell times, PICCs were more cost-effective than PORTs. Furthermore, ICERs were applied and the choice was determined by willingness-to-pay. For 9-12 month dwell times, PORTs might be more cost-effective than PICCs, and studies with larger sample size would be needed to verify this finding in the future.

Survival Rate and Cost-Effectiveness of Conventional and Atraumatic Restorative Treatment Restorations among Anganwadi Preschool Children in Bengaluru City: A Follow-up Study.

Background:Atraumatic restorative treatment (ART) approach helps reduce barriers to restorative care for the patients. This study was done to compare the survival rate and cost-effectiveness of conventional and ART restorations at time-intervals of 6, 12, and 18 months among anganwadi preschool children in Bengaluru city.Materials and Methods:133 children aged 3–5 years attending anganwadi centers in Bengaluru city based on inclusion and exclusion criteria were recruited for the present study. A split-mouth technique was used in which the participants received two types of carious cavity excavation techniques (conventional and ART) followed by restoration using glass ionomer cement. Comparison and evaluation were made at the end of 6 months, 12 months and 18 months intervals to check for the survival rate and cost-effectiveness.Results:The survival rates of ART when compared to conventional restorations were higher at 6 months and 12 months 97.7% and 93.07%, respectively, and at 18 months survival rate of conventional restorations were higher. The cost-effectiveness ratio (CER) of the ART restoration was lower when compared to conventional restorations.Conclusion:The carious cavities restored using ART techniques had a better survival rate at 12 months and lower CER when compared to the conventional technique.

Multi-Granularity Mission Negotiation for a Decentralized Remote Sensing Satellite Cluster

Satellite remote sensing is developing towards the micro-satellite cluster, which brings new challenges to mission assignment and planning for the cluster. A multi-agent system (MAS) is used, but the time delay caused by communication and computation is rarely considered. To solve the problem, a neural-network-based multi-granularity negotiation method under decentralized architecture is proposed. Firstly, we divided negotiation into three levels of granularity, and they work in different modes. Secondly, a neural network was trained to help the satellite select the best level in real-time. Through experiments, we compared the satellites working in three different levels of granularity, in which a multi-granularity decision was used. As a result of our experiments, a lower cost-effectiveness ratio was obtained, which proved that the multi-granularity negotiation method proposed in this paper is practical.

Which Nonsurgical Treatments Do Patients Believe Are Most Effective for Hip and Knee Arthritis?

Background:The purpose of this study was to determine which nonsurgical treatments patients believe are most effective for managing pain secondary to hip and knee arthritis.Methods:Five hundred sixty-five consecutive patients were administered an anonymous questionnaire developed in consultation with a center with expertise in survey design. Statistical analyses included Student t-test, Fisher Exact, Wilcoxon Rank-Sum test, and generalized cost-effectiveness analysis.Results:Four hundred thirty-six patients completed the questionnaire (response rate 77.2%). Opioids (52 of 118; 44.1%), prescription nonsteroidal anti-inflammatory drugs (NSAIDs) (67 of 200; 33.5%), and corticosteroid injections (87 of 260; 33.5%) were reported as most effective. Stem cell and platelet-rich plasma injections were selected by three of 12 (25.0%) and three of 15 patients (19.5%), respectively, and physical therapy (PT) by 50 of 257 patients (19.5%). Twenty-five percent of respondents received opioids, commonly prescribed by primary care providers (48.2%) and orthopaedic surgeons (39.5%). Opioid use correlated with lower patient-reported effectiveness of PT, NSAIDs, and corticosteroid injections (P < 0.05). The highest cost-effectiveness ratios were NSAIDs, opioids, and acetaminophen (2.2, 3.7, 4.0, and 5.4, respectively). The lowest cost-effectiveness ratios were stem cell injections, platelet-rich plasma injections, and PT (1966.7, 520.8, and 138.6, respectively).Conclusions:The nonsurgical treatments that are reported by patients to be most effective are oftentimes the least expensive.

How Are Incremental Cost-Effectiveness, Contextual Considerations, and Other Benefits Viewed in Health Technology Assessment Recommendations in the United States?

ObjectivesTo review assessments from the Institute for Clinical and Economic Review (ICER) and describe how cost-effectiveness, other benefits or disadvantages, and contextual considerations affect Council members’ assessments of value. MethodsAssessments published by the ICER between December 2014 and April 2019 were reviewed. Data on the assessment, intervention, results from cost-effectiveness analyses, and Council members’ votes were extracted. Voting data were examined using bar charts and radar plots. Spearman’s correlations between the number of votes for other benefits and contextual considerations were estimated. Two case studies (tisagenlecleucel and voretigene neparvovec) explored the relationship between different aspects of value and the vote. ResultsThirty-one ICER assessments were reviewed, which included 51 value votes and 17 votes on other benefits and contextual considerations. On average, interventions with lower cost-effectiveness ratios received a higher proportion of high and intermediate value votes; however, there was heterogeneity across assessments. Of other benefits or disadvantages, having a novel mechanism of action received the most votes (n = 138), and reducing health disparities received the fewest (n = 24). Of contextual considerations, treating a condition that has a severe impact on length and quality of life received the most votes (n = 164). There was a strong positive correlation between votes for reduced caregiver/family burden and improving return to work/productivity (ρ = 0.88, P < .05). Two case studies highlighted that factors beyond cost-effectiveness can lead to lower (tisagenlecleucel) or higher (voretigene neparvovec) assessments of value. ConclusionCouncil members’ judgments about the value of interventions are influenced by other benefits or disadvantages and contextual considerations but anchored by cost-effectiveness.

Sequencing Systemic Therapy Pathways for Advanced Hepatocellular Carcinoma: A Cost Effectiveness Analysis

Introduction: Hepatocellular carcinoma (HCC) is the most common form of liver cancer worldwide and carries a poor prognosis. Historically, sorafenib was the only available systemic treatment for advanced HCC. However, in recent years, 6 new treatments have been approved by the US Food and Drug Administration (FDA): regorafenib, lenvatinib, cabozantinib, pembrolizumab, ramucirumab, and nivolumab. Data are lacking regarding the most appropriate sequencing pathway for these agents. Our objective was to conduct a comprehensive cost effectiveness analysis (CEA) of different 1st- and 2nd-line treatment pathways for HCC reflecting all new drug approvals, and then use our data to provide guidance for clinicians on which pathway is the most cost-effective. Materials and Methods: Markov models were used to evaluate the cost effectiveness of 8 different 1st- and 2nd-line treatment sequences. The model allowed for 9 possible states. Cost effectiveness ratios (CER) and incremental CER (ICER) were calculated to compare costs between different pathways and against a willingness-to-pay (WTP) threshold. Efficacy and toxicity data were extracted from the landmark trials for each agent. All agents except ramucirumab were included. The cost of each agent was based on the wholesale acquisition cost (WAC) in USD as of June 2019. Monte-Carlo methods were used to simulate the experience of 1,000,000 patients per treatment sequence for a 12-month period. Results: The pathway with the lowest CER was sorafenib, followed by pembrolizumab (USD 227,741.03/quality-adjusted life year [QALY]). ICER analysis supported implementing 2nd-line pembrolizumab-based pathways at a higher WTP threshold of 300,000/quality-adjusted life year. Sensitivity analysis did not substantially change these results. Conclusions: The most cost-effective strategy was 1st-line tyrosine kinase inhibitor therapy followed by 2nd-line immunotherapy. All pathways exceeded a commonly accepted WTP of USD 100–150,000/QALY. Our preliminary results warrant further studies to best inform real-world practices.

Pharmacoeconomic studies of technologies for prevention of hpv-associated cervical pathologies

In Ukraine, cervical cancer (CC) is the second most frequent cancer among women of reproductive age and causes more than two thousand deaths per year. The results of clinical and laboratory studies indicate the high prevalence of human papillomaviruses (HPV) of high carcinogenic risk in Ukraine, being the cause of the development of CC. The concept of pharmaceutical prevention is becoming more and more relevant today as it includes a set of measures aimed at preserving and promoting health, improving the quality of life, preventing the occurrence of pathological conditions and diseases; and if they occur - the progression and worsening of a patient's condition, relapse and transition to chronic form, as well as prevention of possible negative or undesirable consequences.&#x0D; The aim of the work – рharmacoeconomic research using mathematical modeling of prevention technologies of HPV-associated cervical pathologies based on vaccination and diagnostic screening among women of different ages.&#x0D; Pharmacoeconomic analysis of prevention technologies for women aged 18 years and more proposed a developed mathematical model, the overall idea of which reflected the current scientific understanding of the causes and development of CC. The detection of severe dysplasia is the primary purpose of diagnostic screening, and the establishment of diagnostic status in the presence of HPV infection is additional information that allows refining the diagnostic screening scheme. Minimization of total costs implies the simultaneous achievement of the maximum possible socio-economic effect from the introduction of complex technology for the prevention of HPV-associated pathologies of the cervix. It may be seen in the reduction of the total number of undiagnosed persons with severe dysplasia, which will be affected by both HPV vaccination and diagnostic screening. This justification is the basis for formalizing the pharmacoeconomic evaluation of complex technology for the prevention of HPV-associated cervical pathologies in the form of a cost-effectiveness factor.&#x0D; The proposed method of pharmacoeconomic assessment was put into practice using retrospective data of 145 women with a prevalence of young ones aged 22 to 36 years. On the basis of the received frequency, clinical and epidemiological data, it was possible to determine the coefficient of influence of the persistence of HPV on the development of severe forms of dysplasia, as an additional criterion for pharmacoeconomic evaluation. Analytical studies have shown that at constant costs for the diagnosis or vaccination of one person, the cost-effectiveness ratio of complex prevention technology is significantly dependent on the impact of HPV persistence. A case study was examined, in which the cost of diagnostic screening was 10 times lower than the cost of vaccination per person, the HPV vaccination efficiency was 90%, the vaccination coverage rate was 10%, and the non-vaccinated diagnostic screening rate was 80%. In this example, it was shown that the use of HPV persistence as additional weight in the calculation of diagnostic screening coverage allows for more pharmacologically sound prevention regimens due to the lower cost-effectiveness ratio, all else being equal.&#x0D; A method of pharmacoeconomic evaluation based on determining the utility of the costs of diagnostic screening and vaccination for HPV infection as a complex technology for the prevention of HPV-associated cervical pathologies is proposed. An additional criterion for pharmacoeconomic evaluation is the coefficient of the impact of HPV persistence on the development of severe dysplasia, which is equal to the ratio of the proportion of women with severe dysplasia to the proportion of women with HPV at the previous time. Analytical studies have shown that the use of HPV persistence as additional weight in the calculation of diagnostic screening coverage allows for more pharmacologically sound prevention regimens due to the lower cost-effectiveness ratio, all things being equal.

Experimental Investigation of Inverse Diffusion Flame Stabilization by Nonequilibrium Plasma

A plasma injector is designed to improve the flame stabilization of a typical coaxial injector. Based on the plasma injector experimental system, the effects of an ac dielectric barrier discharge generated plasma on a inverse diffusion flame are investigated. The electrical characteristics, discharge images, plasma species, thermal effect, gas dynamic effect, flame shape, and heat release are analyzed in detail. The results show that species including C, , , and CH are generated in the methane discharge plasma. The concentration of CH radically increases linearly with increasing voltage, while its spatial distribution tends to be uniform. However, the CH radical concentration decreases with an increasing flow rate. For application to plasma-assisted combustion, the thermal effect of the ac dielectric barrier discharge plasma on the C jet can be neglected. The heating is limited to within the injector. The jet angle, which reflects the transverse movement degree of the methane flow, is expanded by the discharge. Because of the gas dynamic effect of the plasma, which changes the pattern of the original jet, the mixing between the fuel and the oxidizer is improved when the discharge is active. The original unstable flame with a single layer is transformed into a stable double-layer flame, and the heat release from the flame is enhanced. However, the stable flame might become unstable if the discharge voltage is too high. The plasma shows better performance with respect to flame stabilization under a high flow rate or a fuel-rich condition. The lowest cost-effectiveness ratio is only 0.7% in the experiment.

Highlights of the 16th St Gallen International Breast Cancer Conference, Vienna, Austria, 20-23 March 2019: personalised treatments for patients with early breast cancer.

The 16th St Gallen International Breast Cancer Conference took place in Vienna for the third time, from 20–23 March 2019. More than 3000 people from all over the world were invited to take part in this important bi-annual critical review of the ‘state of the art’ in the primary care of breast cancer (BC), independent of political and industrial pressure, with the aim to integrate the most recent research data and most important developments in BC therapies since St Gallen International Breast Cancer Conference 2017, with the ultimate goal of drawing up a consensus for the current optimal treatment and prevention of BC.This year, the St Gallen Breast Cancer Award was won by Monica Morrow (Memorial Sloan Kettering Cancer Center, USA) for her extraordinary contribution in research and practise development in the treatment of BC. She opened the session with the lecture ‘Will surgery be a part of BC treatment in the future?’ Improved systemic therapy has decreased BC mortality and increased pathologic complete response (pCR) rates after neoadjuvant chemotherapy (NACT). Improved imaging and increased screening uptake have led to detect smaller cancers. These factors have highlighted two possible scenarios to omit surgery: for patients with small low-grade ductal carcinoma in situ (DCIS) and for those who have received NACT and had a clinical and radiological complete response. However, considering that 7%–20% of `low-risk’ DCIS patients have co-existing invasive cancer at diagnosis, that surgery has become progressively less morbid and less toxic than some systemic therapies with a lower cost-effectiveness ratio, and that identification of pathologic complete response (pCR) without surgery requires more intensive imaging follow-up (more biopsies, higher cost and more anxiety for the patient), surgery still appears to be an essential treatment for BC.The Umberto Veronesi Memorial Award went to Lesley Fallowfield (Brighton and Sussex Medical School, UK) for her important research and activity in the field of the development of patient outcome, of better communication skills and quality of life for women. In her lecture, she remarked on the importance of improving BC personalised treatments, especially through co-operation between scientists, always considering the whole woman and not just her breast disease. This award was given by Paolo Veronesi, after a moving introduction which culminated with the following words of Professor Umberto Veronesi:‘It is not possible to take care of the people’s bodies without taking care of their mind. My duty, the duty of all doctors, is to listen and be part of the emotions of those we treat every day’.

Interest of Systematic Chest Radiography during Periodic Medical Visits in Workers

Background: Systematic chest X-ray is the most prescribed examination by occupational physicians during periodic medical check-ups in our context, unlike in most countries where this practice has been discontinued. Objective: The objective was to determine the diagnostic yield and cost-effectiveness of chest radiography during periodic medical check-ups of workers in Ngaoundere. Materials and Methods: A cross-sectional and descriptive study was carried out in Ngaoundere Regional Hospital from January to December 2018, concerning all persons coming to perform a systematic chest X-ray in the context of the periodic medical check-up having been consented to participate in the study. Posteroanterior (PA) chest radiographs were obtained from all workers during this periodic medical check-up. The variables studied were: age, sex, clinical manifestations, antecedents, job type, cost, and chest X-ray results. Statistical analysis was performed using the Sphinx Plus2-Lexica-V5 Edition software. Results: 753 workers were selected for this study, of whom 88.04% were men and 11.96% were women, a sex ratio H/F is of 7.4, the average age was 39 ± 7.89 years with extremes of 24 and 56 years, the most frequent job type was the administration (38.37%), the storekeepers (17.92) and the drivers (15.27%), most of them were asymptomatic (97.47%), some had cough (2.52%), chest pain (2.12%), dyspnea (0.26%) and fever (0.13%). History was dominated by lung infection (2.39%), pleurisy (1.06%) and tuberculosis (0.79%). 7.43% of workers occasionally smoked tobacco and consumed alcohol. 41 cases of pathologies (5.44%) were found on the chest X-ray, including 1 case (0.13%) of evolutionary pathology, 40 cases (5.31%) of sequelae pathologies. When the results of the chest X-ray are compared with the clinical signs and the pathological history of the workers, it is found that the only case with evolutionary abnormalities on the chest X-ray showed clinical signs and that the other cases with sequelae abnormalities had either clinical signs or antecedents related to these abnormalities. The cost of a chest X-ray at the time of our study was 5,000 FCFA ($8.59), for a total of 3,765,000 FCFA ($6473.74) for all the X-rays performed. Conclusion: In view of the low rate of abnormalities on the chest X-ray and the sequelae nature of the pathologies, it can be said that the routine X-ray of the chest during the periodic medical check-ups has a low diagnostic yield and a low cost-effectiveness ratio and is not profitable. It should be non-systematic and case-by-case based on the clinical context and background of workers.

Cost-effectiveness of using a rapid diagnostic test to screen for human African trypanosomiasis in the Democratic Republic of the Congo.

New rapid diagnostic tests (RDTs) for screening human African trypanosomiasis (HAT) have been introduced as alternatives to the card agglutination test for trypanosomiasis (CATT). One brand of RDT, the SD BIOLINE HAT RDT has been shown to have lower specificity but higher sensitivity than CATT, so to make a rational choice between screening strategies, a cost-effectiveness analysis is a key element. In this paper we estimate the relative cost-effectiveness of CATT and the RDT when implemented in the Democratic Republic of the Congo (DRC). Data on the epidemiological parameters and costs were collected as part of a larger study. These data were used to model three different diagnostic algorithms in mobile teams and fixed health facilities, and the relative cost-effectiveness was measured as the average cost per case diagnosed. In both fixed facilities and mobile teams, screening of participants using the SD BIOLINE HAT RDT followed by parasitological confirmation had a lower cost-effectiveness ratio than in algorithms using CATT. Algorithms using the RDT were cheaper by 112.54 (33.2%) and 88.54 (32.92%) US dollars per case diagnosed in mobile teams and fixed health facilities respectively, when compared with algorithms using CATT. Sensitivity analysis demonstrated that these conclusions were robust to a number of assumptions, and that the results can be scaled to smaller or larger facilities, and a range of prevalences. The RDT was the most cost-effective screening test in all realistic scenarios and detected more cases than CATT. Thus, on this basis, the SD BIOLINE HAT RDT could be considered as the most cost-effective option for use in routine screening for HAT in the DRC.

Pharmacoeconomics of three Therapeutic Schemes for Anti-tuberculosis Therapy Induced Liver Injury in China.

To evaluate the pharmacoeconomics of three therapeutic schemes in treating anti-tuberluosis therapy -induced liver injury (anti-TB DILI).MethodsIn the construction of a decision tree model, the efficacy and safety parameters came from the results of the randomized, controlled trial conducted here, the effect parameters were derived from expert advice, and the cost parameters, such as usage specification, number, and unit price, came from literature, expert advice, and so on.ResultsThe cost-effectiveness analysis (CEA) based on the effect degrees showed that bicyclol had the best effect (4.63562). The incremental cost-effectiveness ratio (ICER) (206.03270) of bicyclol was the lowest. The cost-effectiveness ratio of silibinin was the lowest (68.59987). The CEA based on the complete normalization rate showed that bicyclol had the highest complete normalization rate (83.562%), the lowest cost-effectiveness ratio (4.63627), and the smallest ICER (4.63504). Sensitivity analyses proved the robustness of the results.ConclusionsBicyclol is the most cost-effective therapy and the preferred choice for treating anti-TB DILI.

Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis

Background and objectivesLocoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. Materials and methodsWe performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. ResultsUse of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs €28,605.00). ConclusionsUltrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.