Lifetime Of Patient Research Articles

Primary Care Clinic Visit Efficiency

A study was done in 2013 regarding Veteran's Affairs primary care clinics in New Mexico. The primary care clinics provide care for a group of patients on regular basis. They also see additional patients as needed. The team consisting of the provider(s), nurse(s), technician(s), and schedulers providing continuous and coordinated care throughout patient's life-time is called Patient Aligned Care Team (PACT). The purpose of the PACT is to maximize patient care using this continuous and familiar care model for the patients. The performance of five out of ten primary care teams were provided using the traditional measures identified by their healthcare system in the Patient Aligned Care Teams Compass Data Definitions. The measurements that were specifically interesting were Ratio of PC Telephone Encounters to All PC Encounters, Ratio of Non-Traditional Encounters, Same Day Appts. w/PC Provider Ratio, Continuity PCP (ER Excluded), Team 2ndDay Post DC Contact Ratio. The data was collected in 2012 and the evaluations, interviews, and analysis was completed in 2013. The team scores was provided and access was obtained to only five out of ten teams which data was available for. The Veteran's Affairs provided data regarding the performance metrics of the PACT teams. The data was evaluated by using statistical correlations. The interview questions were designed to further dissect the performance of each team and their practices. Teams were interviewed and the responses were summarized and analyzed. Responses from each team were converted into team's scores and compared to their PACT performance metrics. The comparison between teams' scores and PACT performance metrics provided insight into each team's perception of its own performance and its PACT performance metrics. The purpose of this project is to identify the value adding and non-value adding activities of the each team. So the management can encourage the promotion of value adding activities, decreasing the variation in the performance of the teams and so maximizing the patient care.

Economic evaluation of ivabradine in the treatment of chronic heart failure in Greece.

BackgroundThe objective of our study was to assess the cost-effectiveness of ivabradine plus standard care (SoC) in chronic heart failure (CHF) patients with sinus rhythm and a baseline heart rate ≥ 75 b.p.m. in Greece, in comparison with current SoC alone.MethodsAn existing cost-effectiveness model consisting of two health states, was adapted to the Greek health care setting. All clinical inputs of the model (i.e. mortality rates, hospitalization rates, NYHA class distribution and utility values) were estimated from SHIFT trial data. All costing data used in the model reflects the year 2013 (in €). An incremental cost effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. The horizon of analysis was over patient life time and both cost and outcomes were discounted at 3.5% per year. The analysis was conducted from a Greek third party-payer perspective.ResultsThe Markov analysis revealed that the discounted quality-adjusted survival was 4.27 and 3.99 QALYs in the ivabradine plus SoC and SoC alone treatment arms, respectively. The cumulative lifetime total cost per patient was €8,665 and €5,873, for ivabradine plus SoC and SoC alone, respectively. The ICER for ivabradine plus SoC versus SoC alone was estimated as €9,986 per QALY gained. The PSA showed that the likelihood of ivabradine plus SoC being cost-effective at a threshold of €36,000/QALY was found to be 95%.ConclusionsIvabradine plus SoC may be regarded as a cost-effective option for the treatment in CHF patients in Greece.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0631-0) contains supplementary material, which is available to authorized users.

Abstract 32: Suppression of medical radiation DNA damage in cancer susceptible and normal humans using a new aminothiol radioprotector

Abstract CT scan usage has greatly increased in the last two decades, with an estimated 85 million U.S. CT scans done in 2011. These exams are valuable and greatly enhance patient care. Certain CT scan and radiology procedures deliver ionizing radiation doses of 10-70 mSv. 30% of CT scan patients require three or more CT scans, some as many as nine. Recent studies reported significant correlations between CT radiation doses and subsequent tumors in children and adults. A 2012 report showed a radiation dose-dependent relationship between chest irradiation (mean dose = 14 mSv) in BRCA1/2-carrying women under age 30 and subsequent breast cancer incidence. There is a concern that recurrent diagnostic doses of radiation increase a patient's lifetime cancer risk, particularly in people with genetic cancer susceptibility syndromes, e.g., Li-Fraumeni, Bloom's, ataxia-telangiectasia mutated (ATM) and BRCA1/2 mutation carriers. These patients, who could benefit from early and recurring cancer screening that includes diagnostic radiation may now avoid diagnostic radiology because of the cancer-associated risks. A new family of aminothiol radioprotectors was discovered in our laboratory; PrC-210 is the prototype. Initial PrC-210 efficacy in suppressing ionizing radiation-induced DNA damage was assessed with ex vivo irradiation of cells. Studies to date have demonstrated: i) using primary mouse splenocytes, a) phosphorylation of ATM (p-ATM) increased in a radiation dose-dependent manner and 20 mM PrC-210 pretreatment of cells minutes before 10 Gy irradiation suppressed ATM activation to background with 10 mM PrC-210 equal in effect to KU55933, an ATM kinase inhibitor and positive control, and b) γ-H2AX activation by 10 Gy irradiation was suppressed to background by prior addition of 5-10 mM PrC-210, ii) using human HEK-293 cells, the activation of NF-κB achieved with 10 Gy irradiation can be suppressed to background by 5 mM PrC-210 pretreatment minutes before irradiation. These results support the notion that PrC-210 can completely inhibit ionizing radiation-induced DNA damage response in primary lymphocytes and human HEK-293 cells at PrC-210 concentrations achievable in rodent blood at a non-toxic systemic dose (i.e., <0.5 MTD dose). Separate studies showed that PrC-210 was free of the nausea/vomiting and hypotension toxicities that were accurately recreated using amifostine controls in accepted ferret and rat models. PrC-210, administered orally or by IP injection, also conferred 100% survival against an otherwise 100% lethal dose (8,750 mGy) of whole-body radiation to mice or rats. A single oral dose of PrC-210 prior to a diagnostic radiation procedure such as CT may suppress, possibly to background, DNA damage and associated risks, even in patients with cancer susceptibility syndromes, thus changing their screening and standard of care paradigm. Citation Format: William E. Fahl, Shelly Wuerzberger-Davis, Shigeki Miyamoto. Suppression of medical radiation DNA damage in cancer susceptible and normal humans using a new aminothiol radioprotector. [abstract]. In: Proceedings of the AACR Special Conference: Cancer Susceptibility and Cancer Susceptibility Syndromes; Jan 29-Feb 1, 2014; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(23 Suppl):Abstract nr 32. doi:10.1158/1538-7445.CANSUSC14-32

Advances in ophthalmic drug delivery.

Various strategies for ocular drug delivery are considered; from basic formulation techniques for improving availability of drugs; viscosity enhancers and mucoadhesives aid drug retention and penetration enhancers promote drug transport into the eye. The use of drug-loaded contact lenses and ocular inserts allows drugs to be better placed where they are needed for more direct delivery. Developments in ocular implants gives a means to overcome the physical barriers that traditionally prevented effective treatment. Implant technologies are under development allowing long-term drug delivery from a single procedure, these devices allow posterior chamber diseases to be effectively treated. Future developments could bring artificial corneas to eliminate the need for donor tissue and one-off implantable drug depots lasting the patient's lifetime.

Commentary on 'Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening'.

Commentary on 'Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening'.

αvβ6 Expression in myoepithelial cells: a novel marker for predicting DCIS progression with therapeutic potential.

The tumor microenvironment dynamically regulates the progression of cancer. In the breast, a unique component of the microenvironment is the myoepithelial cell. Normal myoepithelial cells act as "natural tumor suppressors"; however, more recent evidence suggests that these cells develop phenotypic changes, which may contribute to loss of tumor suppressor activity. We have shown that myoepithelial cells in a subset of preinvasive ductal carcinoma in situ (DCIS) upregulate expression of the integrin αvβ6, switching on tumor promoter activity through activation of TGFβ and MMP9. This makes the tumor microenvironment more permissive to invasion, seen both in vitro and in vivo. In human tissue samples, increased myoepithelial αvβ6 expression correlated with increased risk of disease progression and recurrence. Current estimates suggest that as many as 50% of DCIS cases will never progress in the patient's lifetime, but there are no markers to predict the outcome of individual cases. The identification of αvβ6 in a subset of DCIS presents a unique way to stratify patients with DCIS into those who may or may not progress to more serious disease. As αvβ6 is not expressed on most normal adult tissues, this finding may also provide novel targets for therapy in this high-risk group.

Overdetection of recurrence after radical prostatectomy: estimates based on patient and tumor characteristics.

Prostate-specific antigen recurrence (PSA-R) after radical prostatectomy (RP) can occur years before metastasis. This study estimates the chance that an untreated PSA-R would not progress to clinical metastasis within the patient's lifetime, that is, that recurrence is overdetected. Times from PSA-R to metastasis were estimated from patients with RP treated at Johns Hopkins University (Baltimore, MD) who did not receive salvage treatment (n = 441) at PSA-R. Times to other-cause death were based on U.S. life tables adjusted to reflect other-cause survival among RP cases in the Surveillance, Epidemiology, and End Results (SEER) registry. We used competing risks simulation to estimate lower bounds on the chance that other-cause death would precede clinical metastasis for patients with disease characteristics at diagnosis based on the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database (n = 4,455). Cumulative incidence of PSA-R in CaPSURE was 13.6% at 5 years and 19.9% at 10 years. The risk of other-cause death among patients with RP in SEER was 60% lower than the age-matched U.S. population. At least 9.1% of patients with PSA-R <5 years after RP and at least 15.6% of patients with PSA-R 5 to 10 years after RP were overdetected. At least 31.4% of patients over the age of 70 years at diagnosis, who recurred <10 years of diagnosis, were overdetected. This analysis indicates that PSA-R after RP may be overdetected, with risk depending on patient age and tumor characteristics. The potential for overdetection of recurrence confirms the need for approaches to determine whether and when to initiate salvage therapies.

Prevention, Early Detection, and Overdiagnosis of Colorectal Cancer Within 10 Years of Screening Colonoscopy in Germany

Screening colonoscopy was introduced in Germany in October 2002. We aimed to quantify its effects on prevention, early detection, and overdiagnosis of colorectal cancer (CRC) in the 10 years since its introduction. We analyzed data from more than 4.4 million screening colonoscopies (conducted on individuals 55-79 years old from 2003 through 2012) available through the national screening colonoscopy registry. CRCs prevented, detected earlier than they would have been without screening, and overdiagnosed (cancers detected at screening colonoscopy that would not have become clinically manifest during the patient's lifetime) were estimated by Markov models. Model parameters included sex-specific and age-specific findings at screening colonoscopy; mortality; rates of transition from nonadvanced to advanced adenoma, advanced adenoma to preclinical cancer, or preclinical cancer to clinically manifest cancer; and protection from screening colonoscopy. Overall, approximately 180,000 CRCs (1/28 screening colonoscopies) were estimated to have been prevented, and more than 40,000 CRCs (1/121 screening colonoscopies) were detected earlier than they would have been without screening, compared with approximately 4500 overdiagnoses (1/1089 screening colonoscopies). Almost all CRCs prevented or detected earlier than they would have been without screening resulted from screening colonoscopies performed on individuals up to 75 years old (97% and 89%, respectively), whereas 28% of overdiagnoses occurred from screening colonoscopies of individuals older than 75 years old. On the basis of a 10-year analysis of data from a national registry in Germany, screening colonoscopies have large potential for prevention and early detection of CRC, with low risk of overdiagnosis.

Laronidase-functionalized multiple-wall lipid-core nanocapsules: promising formulation for a more effective treatment of mucopolysaccharidosis type I.

Mucopolysaccharidosis I is a genetic disorder caused by alpha-L-iduronidase deficiency. Its primary treatment is enzyme replacement therapy (ERT), which has limitations such as a high cost and a need for repeated infusions over the patient's lifetime. Considering that nanotechnological approaches may enhance enzyme delivery to organs and can reduce the dosage thereby enhancing ERT efficiency and/or reducing its cost, we synthesized laronidase surface-functionalized lipid-core nanocapsules (L-MLNC). L-MLNCs were synthesized by using a metal complex. Size distributions were evaluated by laser diffraction and dynamic light scattering. The kinetic properties, cytotoxicity, cell uptake mechanisms, clearance profile and biodistribution were evaluated. Size distributions showed a D[4,3] of 134 nm and a z-average diameter of 71 nm. L-MLNC enhanced the Vmax and Kcat in comparison with laronidase. L-MLNC is not cytotoxic, and nanocapsule uptake by active transport is not only mediated by mannose-6-phosphate receptors. The clearance profile is better for L-MLNC than for laronidase. A biodistribution analysis showed enhanced enzyme activity in different organs within 4 h and 24 h for L-MLNC. The use of lipid-core nanocapsules as building blocks to synthesize surface-functionalized nanocapsules represents a new platform for producing decorated soft nanoparticles that are able to modify drug biodistribution.

Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting

Introduction and AimsTo project the long-term cost-effectiveness of treating non-valvular atrial fibrillation (AF) patients for stroke prevention with rivaroxaban compared to warfarin in Portugal. MethodsA Markov model was used that included health and treatment states describing the management and consequences of AF and its treatment. The model's time horizon was set at a patient's lifetime and each cycle at three months. The analysis was conducted from a societal perspective and a 5% discount rate was applied to both costs and outcomes. Treatment effect data were obtained from the pivotal phase III ROCKET AF trial. The model was also populated with utility values obtained from the literature and with cost data derived from official Portuguese sources. The outcomes of the model included life-years, quality-adjusted life-years (QALYs), incremental costs, and associated incremental cost-effectiveness ratios (ICERs). Extensive sensitivity analyses were undertaken to further assess the findings of the model. As there is evidence indicating underuse and underprescription of warfarin in Portugal, an additional analysis was performed using a mixed comparator composed of no treatment, aspirin, and warfarin, which better reflects real-world prescribing in Portugal. ResultsThis cost-effectiveness analysis produced an ICER of €3895/QALY for the base-case analysis (vs. warfarin) and of €6697/QALY for the real-world prescribing analysis (vs. mixed comparator). The findings were robust when tested in sensitivity analyses. ConclusionThe results showed that rivaroxaban may be a cost-effective alternative compared with warfarin or real-world prescribing in Portugal.

Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting

Introduction and AimsTo project the long-term cost-effectiveness of treating non-valvular atrial fibrillation (AF) patients for stroke prevention with rivaroxaban compared to warfarin in Portugal. MethodsA Markov model was used that included health and treatment states describing the management and consequences of AF and its treatment. The model's time horizon was set at a patient's lifetime and each cycle at three months. The analysis was conducted from a societal perspective and a 5% discount rate was applied to both costs and outcomes. Treatment effect data were obtained from the pivotal phase III ROCKET AF trial. The model was also populated with utility values obtained from the literature and with cost data derived from official Portuguese sources. The outcomes of the model included life-years, quality-adjusted life-years (QALYs), incremental costs, and associated incremental cost-effectiveness ratios (ICERs). Extensive sensitivity analyses were undertaken to further assess the findings of the model. As there is evidence indicating underuse and underprescription of warfarin in Portugal, an additional analysis was performed using a mixed comparator composed of no treatment, aspirin, and warfarin, which better reflects real-world prescribing in Portugal. ResultsThis cost-effectiveness analysis produced an ICER of €3895/QALY for the base-case analysis (vs. warfarin) and of €6697/QALY for the real-world prescribing analysis (vs. mixed comparator). The findings were robust when tested in sensitivity analyses. ConclusionThe results showed that rivaroxaban may be a cost-effective alternative compared with warfarin or real-world prescribing in Portugal.

Cost effectiveness of renal denervation therapy for the treatment of resistant hypertension in the UK.

Patients with resistant hypertension are at a high risk for developing serious cardiovascular events and renal complications. Catheter-based renal denervation (RDN) is a procedure with the potential to normalize systolic blood pressure (SBP). The overall objective of the study was to estimate the cost effectiveness of RDN in the UK for patients with diagnosed resistant hypertension, expressed as a standard cost per quality-adjusted life-year (QALY) ratio. A patient lifetime, economic, Markov heath-state model was developed, linking expected changes in SBP to reductions in risks for cardiovascular events and renal complications, using the Framingham, PROCAM, and other published risk equations. The model was developed from the perspective of the healthcare payer in the UK using relevant cost data from 2012. Clinical effectiveness for RDN (a mean reduction of 32 mmHg in SBP) was taken from the phase III Symplicity HTN-2 trial, in patients with a mean baseline SBP of 178 mmHg. HTN-2 was the largest, multicenter randomized controlled trial on the effectiveness of RDN therapy at the time of the model development. A systematic review identified UK-specific sources for utility, mortality, and cost parameter values, and included recently published UK guidelines for the clinical management of hypertension. RDN therapy resulted in an increase in health benefit over a patient's lifetime compared with anti-hypertensive pharmacological treatment alone (12.77 vs. 12.16 QALYs; discounted). Additional lifetime costs per patient were modeled at £2,961; equivalent to an incremental cost per additional QALY of £4,805. This result was robust to full probabilistic sensitivity and scenario analyses. RDN is an effective clinical procedure that offers patients a meaningful and cost-effective alternative for achieving SBP control, where traditional combination, anti-hypertensive pharmacologic strategies have been proven to be ineffective.

Two decades of using the combination of tetracycline derivatives and niacinamide as steroid-sparing agents in the management of pemphigus: Defining a niche for these low toxicity agents

The twin goals of long-term disease control and minimizing toxicities related to immunosuppression necessitate efforts to find effective steroid-sparing agents in the management of patients with autoimmune bullous diseases. Pemphigus especially requires a long view, because the disease can persist throughout a patient's lifetime, yet few clinical trial reports exist to guide the practitioner. We review the response of pemphigus patients to tetracycline, doxycycline, or minocycline plus niacinamide (TCN/NAM) as steroid-sparing therapy and to determine the effects of TCN/NAM on autoantibody levels during the long-term treatment of pemphigus. This was a retrospective chart review in a private medical dermatology practice setting of all pemphigus patients treated between 1993 and 2013. Clinical responses to TCN/NAM therapy after initial high-dose steroid induction therapy and pemphigus antibody levels were recorded over the course of disease flares and treatment cycles along with any related side effects. Anti-desmoglein 1 and 3 titers were compared in a subset of patients over time, and a statistical analysis was performed to correlate the clinical response with antibody levels. Fifty-one pemphigus patients (43 with pemphigus vulgaris, 7 with pemphigus foliaceous, and 1 with pemphigus erythematosus) received at least 3 months of TCN/NAM, and 16 patients with pemphigus vulgaris had 1 set of pemphigus antibody titers correlating to a baseline/flare and clinical remission. TCN/NAM was associated with disease control in 43 of 51 patients, with a duration of response ranging from 1 to 13 years (mean, 3.14 ± 2.97 years). Thirteen of 51 patients needed no additional treatment for complete disease control, while 33 of 51 needed intermittent topical clobetasol or short courses of oral steroids for long-term management. There were 5 nonresponders. Antidesmoglein titers trended lower in TCN/NAM responders, but only desmoglein 3 approached statistical significance (anti-desmoglein 1, P= .21; anti-desmoglein 3, P= .02). This is a retrospective analysis from a single practice. A lack of serial autoantibody titers limited statistical analyses. TCN/NAM may be useful as a steroid-sparing therapy for pemphigus.

SU‐E‐T‐304: Study of Secondary Neutrons From Uniform Scanning Proton Beams

Purpose:Secondary neutrons are unwanted byproducts from proton therapy and exposure from secondary radiation during treatment could increase risk of developing a secondary cancer later in a patient's lifetime. The purpose of this study is to investigate secondary neutrons from uniform scanning proton beams under various beam conditions using both measurements and Monte Carlo simulations.Methods:CR‐39 Plastic Track Nuclear Detectors (PNTD) were used for the measurement. CR‐39 PNTD has tissue like sensitivity to the secondary neutrons but insensitive to the therapeutic protons. In this study, we devised two experimental conditions: a) hollow‐phantom; phantom is bored with a hollow cylinder along the direction of the beam so that the primary proton passes through the phantom without interacting with the phantom material, b) cylindrical‐phantom; a solid cylinder of diameter close to the beam diameter is placed along the beam path. CR‐39 PNTDs were placed laterally inside a 60×20×35 cm3 phantom (hollow‐phantom) and in air (cylindrical‐phantom) at various angles with respect to the primary beam axis. We studied for three different proton energies (78 MeV, 162 MeV and 226 MeV), using a 4 cm modulation width and 5cm diameter brass aperture for the entire experiment and simulation. A comparison of the experiment was performed using the Monte Carlo code FLUKA.Results:The measured secondary neutron dose equivalent per therapeutic primary proton dose (H/D) ranges from 2.1 ± 0.2 to 25.42 ± 2.3 mSv/Gy for the hollow phantom study, and 2.7 ± 0.3 to 46.4 ± 3.4 mSv/Gy for the cylindrical phantom study. Monte Carlo simulations predicated neutron dose equivalent from measurements within a factor of 5.Conclusion:The study suggests that the production of external neutrons is significantly higher than the production of internal neutrons.

A Nonparametric Test for Comparing Cumulative Incidence Functions of Current Status Competing Risks Data

In survival or reliability studies, current status censoring is common where the exact life time of patients (objects) is unobservable, but one can only observe a monitoring time and whether the event of interest has happened or not before the monitoring time. In addition, when patients (objects) are exposed to the risk of failure due to two or more causes, we also observe the cause of failure for relapsed patients. Competing risks data with current status censoring arise frequently from cross-sectional studies in demography, epidemiology, and reliability studies. In this article, we propose a nonparametric test for comparing cumulative incidence functions of current status competing risks data. Asymptotic distribution of the test statistic is derived. A simulation study is conducted to assess the finite sample behavior of the test statistic. The practical utility of the procedure is well demonstrated using a real-life data set on menopausal history of 2423 women given in Jewell et al. (2003).

Cost-effectiveness of dapagliflozin (Forxiga®) added to metformin compared with sulfonylurea added to metformin in type 2 diabetes in the Nordic countries

AimsThe aim of this study was to assess the long-term cost-effectiveness of dapagliflozin (Forxiga®) added to metformin, compared with sulfonylurea (SU) added to metformin, in Nordic Type 2 diabetes mellitus (T2DM) patients inadequately controlled on metformin. MethodsData from a 52-week clinical trial comparing dapagliflozin and SU in combination with metformin was used in a Cardiff simulation model to estimate long term diabetes-related complications in a cohort of T2DM patients. Costs and QALYs were calculated from a healthcare provider perspective and estimated over a patient's lifetime. ResultsCompared with metformin+SU, the cost per QALY gained with dapagliflozin+metformin was €7944 in Denmark, €5424 in Finland, €4769 in Norway, and €6093 in Sweden. Metformin+dapagliflozin was associated with QALY gains ranging from 0.236 in Norway to 0.278 in Sweden and incremental cost ranging from €1125 in Norway to €1962 in Denmark. Results were robust across both one-way and probabilistic sensitivity analyses. Results were driven by weight changes associated with each treatment. ConclusionsResults indicate that metformin+dapagliflozin is associated with gains in QALY compared with metformin+SU in Nordic T2DM patients inadequately controlled on metformin. Dapagliflozin treatment is a cost-effective treatment alternative for Type 2 diabetes in all four Nordic countries.

Personalized Oxycodone Dosing: Using Pharmacogenetic Testing and Clinical Pharmacokinetics to Reduce Toxicity Risk and Increase Effectiveness

Pharmacogenomics is an emerging field that brings clinical relevance to genetic markers by individualizing drug selection and/or dose [1,2]. At the heart of this field is the concept that specific genes may hold the key to success or failure for critical therapies. Treatments for some cancer types are already guided by individuals' expression of specific genes [3–5]. For human immunodeficiency virus (HIV), pharmacogenetic studies, specifically “genotyping” studies, are utilized to select more effective therapy combinations or avoid potentially life-threatening adverse reactions and maximize efficacy [6–8]. Likewise, pharmacogenomic testing for crucial metabolic pathways should enable prediction of clinical drug response, especially when targeted binding sites or tissues are being considered [9,10]. One of the most appealing aspects of pharmacogenomic testing for metabolic pathways is practical utilization of this information clinically and physiologically for ultimate application and targeted patient-specific treatment. Identification of affected pathways could aid in clinical decision-making, drug selection, appropriate individualized calculated dosing, and weighing of wide-ranging treatment risks vs overall clinical outcomes, all of which could become essential portions of a patient's lifetime genetic profile within his or her medical record. Linares and colleagues provide an excellent overview of the application of clinical pharmacokinetics and its usefulness in …

Economic implications of using bendamustine, alemtuzumab, or chlorambucil as a first-line therapy for chronic lymphocytic leukemia in the US: a cost-effectiveness analysis.

BackgroundThe objective of this analysis was to evaluate the cost-effectiveness of using bendamustine versus alemtuzumab or bendamustine versus chlorambucil as a first-line therapy in patients with Binet stage B or C chronic lymphocytic leukemia (CLL) in the US.MethodsA discrete event simulation of the disease course of CLL was developed to evaluate the economic implications of single-agent treatment with bendamustine, alemtuzumab, or chlorambucil, which are indicated for a treatment-naïve patient population with Binet stage B or C CLL. Data from clinical trials were used to create a simulated patient population, risk equations for progression-free survival and survival post disease progression, response rates, and rates of adverse events. Costs from a US health care payer perspective in 2012 US dollars, survival (life years), and quality-adjusted life years (QALYs) were estimated over a patient’s lifetime; all were discounted at 3% per year.ResultsCompared with alemtuzumab, bendamustine was considered to be a dominant treatment providing greater benefit (6.10 versus 5.37 life years and 4.02 versus 3.45 QALYs) at lower cost ($78,776 versus $121,441). Compared with chlorambucil, bendamustine was associated with higher costs ($78,776 versus $42,337) but with improved health outcomes (6.10 versus 5.21 life years and 4.02 versus 3.30 QALYs), resulting in incremental cost-effectiveness ratios of $40,971 per life year gained and $50,619 per QALY gained.ConclusionBendamustine is expected to provide cost savings and greater health benefit than alemtuzumab in treatment-naïve patients with CLL. Furthermore, it can be considered as a cost-effective treatment providing health benefits at an acceptable cost versus chlorambucil in the US.

Commentary on the United Kingdom Prospective Diabetes Study outcomes model 2: Need for long-term follow up and quality of life data in Asian patients.

Commentary on the United Kingdom Prospective Diabetes Study outcomes model 2: Need for long-term follow up and quality of life data in Asian patients.

Ciclosporin in canine dermatology: a decade of comfort

I OFTEN begin a lecture on atopic dermatitis by reflecting what on our very limited (perhaps even naive) view of the pathogenesis of this challenging condition was 20 years ago,...