Cost-saving Treatment Research Articles

Effects of Clinical Pharmacist Intervention in a Saudi ICU: A Prospective, Cross-Sectional Study

Given their contributions to better patient outcomes, medication safety, and lower drug cost, critical care pharmacists are especially prepared to play a major role within the critical care interdisciplinary team in managing the therapeutic element. Consequently, this research set out to evaluate the ICU clinical pharmacist interventions' frequency, kind, and effect, as well as the acceptability of these interventions by the doctors who provide them. The research was prospective and cross-sectional in nature. Over the course of six months, from April 1, 2023, to October 1, 2023, data was collected daily from a minimum of 380 interventions. This research covered all patients hospitalized to the intensive care unit at Saudi Arabia throughout the specified time frame. Over the duration of the 6-month trial, 120 patients had a total of 500 interventions. Of these, 490 (98%) had physician approval for clinical pharmacist treatments. The majority of the recommendations (34.8%, or 174 out of 500) were related to safety concerns; among these, 48.27%, or 48 out of 174, were for medication cessation owing to extended duration, while 30.46%, or 53 out of 174, were for renal dosage modification. Coming up as a close second, another therapeutic intervention involving indication made up 22.8% (114/500). A total of 124 interventions, or 24.8 percent of the total, had some kind of cost-related component, according to the study's findings on cost-saving treatments. The results of this research showed that clinical pharmacists have the potential to improve quality treatment for critically ill patients and lower healthcare expenditures. Furthermore, it provides helpful information on the incorporation of clinical pharmacists in intensive care units, particularly in areas with limited resources.

Cost-effectiveness analysis comparing single-pill combination of perindopril/amlodipine/indapamide to the free equivalent combination in patients with hypertension from an Italian national health system perspective

ABSTRACT Objective To evaluate the cost-effectiveness of a single-pill combination (SPC) of perindopril/amlodipine/indapamide versus its free equivalent combination (FEC) in adults with hypertension in Italy. Methods A Markov model was developed to perform a cost-utility analysis with a lifetime horizon and an Italian healthcare payer’s perspective. In the model, the additional effect of the SPC on blood pressure level compared with the FEC was translated into a decreased risk of cardiovascular events and CKD, which was modeled via Framingham risk algorithms. Difference in persistence rates of SPC and FEC were modeled via discontinuation rates. Results A perindopril/amlodipine/indapamide SPC is associated with lower cost and better health outcomes compared to its FEC. Over a lifetime horizon, it is associated with a 0.050 QALY gain and cost savings of €376, resulting from lower cardiovascular event rates. In the alternative scenario, where different approach for modeling impact of adherence was considered, incremental gain of 0.069 QALY and savings of €1,004 were observed. Results were robust to sensitivity and scenario analyses, indicating that use of this SPC is a cost-effective strategy. Conclusions The findings indicate that a perindopril/amlodipine/indapamide SPC is a cost-saving treatment option for hypertension in Italy, compared to its FEC.

The Impact of Transcatheter Aortic Valve Implantation on Health Care Costs and Clinical Outcomes Based on Frailty Risk: A Nationwide Cohort Analysis

BackgroundTranscatheter aortic valve implantation (TAVI) is preferred for treating severe aortic stenosis in older, frail populations, yet the impact of frailty on economic and clinical outcomes of TAVI is not well studied. MethodsThis retrospective cohort study included 2175 TAVI patients from 2015 to 2019, using Korea's National Health Insurance Service database, stratifying patients into low, intermediate, and high-frailty groups, using the Hospital Frailty Risk Score (HFRS). Health care costs, admissions, and total length of hospitalization were analyzed using Wilcoxon-rank test 12 months pre- and post-TAVI. Composite endpoint of death, stroke, and major bleeding, with individual outcomes, were compared using χ2 tests and Kaplan-Meier analysis. ResultsMean age was 80.2 years, and 47.3% were male; 747 (34.3%) were low frailty, 1159 (53.3%) were moderate frailty, and 269 (12.4%) were high frailty. After TAVI, medical costs decreased in the intermediate- (pre-TAVI: 2,269,000 KRW [$1668 USD], post-TAVI: 1,607,000 KRW [$1181 USD]; P < 0.001) and high-frailty groups (pre-TAVI: 3,949,000 KRW [$2904 USD], post-TAVI: 2,188,000 KRW [$1609 USD]; P < 0.001). All frailty groups had shorter length of hospital stay post-TAVI (26 to 21 days in the low-frailty, 44 to 31 days in the intermediate-frailty, and 65 to 41 days in the high-frailty group; all P <0.001). The composite outcome was higher in the frailer groups (27.8% in the low-frailty vs 31.5% in the intermediate-frailty vs 37.9% in the high-frailty group; P = 0.008). All groups showed comparable rates of cardiovascular death, stroke, or bleeding. ConclusionsTAVI is clinically viable and cost-saving treatment option for frail patients with severe aortic stenosis.

EE244 Estimating Treatment Cost Savings of Gender-Neutral Nonavalent HPV Vaccination in Mexico

EE244 Estimating Treatment Cost Savings of Gender-Neutral Nonavalent HPV Vaccination in Mexico

Impact of Adjuvant Atezolizumab on Recurrences Avoided and Treatment Cost Savings for Patients with Stage II-IIIA Non-Small Cell Lung Cancer in Canada.

This epidemiological model forecasted reductions in recurrences and recurrence treatment cost savings with adjuvant atezolizumab vs best supportive care among Canadians with stage II-IIIA non-small cell lung cancer (NSCLC) at national and provincial levels. The population had resected, programmed cell death 1 ligand 1 (PD-L1)-high (≥50%), EGFR-, ALK-, stage II-IIIA NSCLC eligible for adjuvant treatment. Patients with recurrence or death and the costs of treating recurrences were estimated for those receiving adjuvant atezolizumab or best supportive care each year (2024-2034). Proportions of patients expected to be event free up to 10 years after treatment initiation were extrapolated with parametric survival analyses. In the base case analysis, 240 fewer recurrences were estimated to occur over 10 years (2024-2034) with adjuvant atezolizumab vs best supportive care across Canada, with 136 (57%) and 104 (43%) fewer locoregional and metastatic recurrences, respectively. Projected costs of treated recurrences were CAD 33.2 million less over 10 years with adjuvant atezolizumab at a national level (adjuvant atezolizumab, CAD 135.8 million; best supportive care, CAD 169.0 million). This model predicts a considerable long-term reduction in recurrences and substantial treatment cost savings with adjuvant atezolizumab vs best supportive care for patients with PD-L1-high early-stage NSCLC in Canada.

Nonpharmacological intervention therapies for dementia: potential break-even intervention price and savings for selected risk factors in the European healthcare system

BackgroundNew effective treatments for dementia are lacking, and early prevention focusing on risk factors of dementia is important. Non-pharmacological intervention therapies aimed at these factors may provide a valuable tool for reducing the incidence of dementia. This study focused on the development of a mathematical model to predict the number of individuals with neurodegenerative diseases, specifically Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis. Scenarios for non-pharmacological intervention therapies based on risk factor reduction were also assessed. The estimated total costs and potential cost savings from societal were included.MethodsBased on demographic and financial data from the EU, a mathematical model was developed to predict the prevalence and resulting care costs of neurodegenerative diseases in the population. Each disease (Alzheimer’s disease, Parkinson’s disease, vascular dementia, and amyotrophic lateral sclerosis) used parameters that included prevalence, incidence, and death risk ratio, and the simulation is related to the age of the cohort and the disease stage.ResultsA replicable simulation for predicting the prevalence and resulting cost of care for neurodegenerative diseases in the population exhibited an increase in treatment costs from 267 billion EUR in 2021 to 528 billion EUR by 2050 in the EU alone. Scenarios related to the reduction of the prevalence of dementia by up to 20% per decade led to total discounted treatment cost savings of up to 558 billion EUR.ConclusionThe model indicates the magnitude of the financial burden placed on EU healthcare systems due to the growth in the population prevalence of neurodegenerative diseases in the coming decades. Lifestyle interventions based on reducing the most common risk factors could serve as a prevention strategy to reduce the incidence of dementia with substantial cost-savings potential. These findings could support the implementation of public health approaches throughout life to ultimately prevent premature mortality and promote a healthier and more active lifestyle in older individuals.

Cost-effectiveness analysis of minimally invasive surgical treatments for benign prostatic hyperplasia: implications for Japan’s public healthcare system

Aims Benign prostatic hyperplasia (BPH) represents a significant public health issue in Japan. This study evaluated the lifetime cost-effectiveness of water vapor energy therapy (WAVE) versus prostatic urethral lift (PUL) for men with moderate-to-severe BPH from a public healthcare payer’s perspective in Japan. Materials and methods A decision analytic model compared WAVE to PUL among males in Japan. Clinical effectiveness and adverse event (AE) inputs were obtained from a systematic literature review. Resource utilization and cost inputs were derived from the Medical Data Vision database and medical service fee national data in Japan. Experts reviewed and validated model input parameters. One-way and probabilistic sensitivity analyses were conducted to determine how changes in the values of uncertain parameters affect the model results. Results Throughout patients’ lifetimes, WAVE was associated with higher quality-adjusted life years (0.920 vs. 0.911 year 1; 15.564 vs. 15.388 lifetime) and lower total costs (¥734,134 vs. ¥888,110 year 1; ¥961,595 vs. ¥1,429,458 lifetime) compared to PUL, indicating that WAVE is a more effective and less costly (i.e. dominant) treatment strategy across all time horizons. Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower WAVE surgical retreatment rates (4.9% vs. 19.2% for WAVE vs PUL, respectively, at 5 years) and AE rates (hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3% for WAVE vs PUL, respectively, at 3 months). Model findings were robust to changes in parameter input values. Limitations The model represents a simplification of complex factors involved in resource allocation decision-making. Conclusions Driven by lower retreatment and AE rates, WAVE was a cost-effective and cost-saving treatment for moderate-to-severe BPH in Japan compared to PUL, providing better outcomes at lower costs to the healthcare system.

Unleashing the potential of leather waste: Biogas generation and cost savings through semi-continuous anaerobic co-digestion

Leather processing is notorious for generating substantial amounts of polluting and putrescible organic waste, usually ending up in landfills or incineration. This study aimed to assess the potential of biogas production, waste treatment efficiency, and energy and cost savings benefits when scaling up the anaerobic co-digestion of leather processing wastes. The study focused on three waste types: tannery primary sludge (TPS), leather fleshings waste (LFW), and tannery wastewater (TWW). Semi-continuous anaerobic digestion experiments were conducted using three bench-scale reactors (R1-R3) over five phases; phases I and II were the startup and stabilization. In phase III, with an organic loading rate (OLR) of 0.6 kgVS/m3/d, the R2 reactor achieved an average of 0.323 m3 methane/kgVS added/day. This performance surpassed the other reactors by 39.14% (R1) and 41.29% (R3). In phases IV and V, using TWW instead of tap water for substrate dilution at different ratios (25–100%) reduced methane yield by 3.32–11.73% compared to the reactor that used tap water. The study further revealed that a medium-sized anaerobic reactor treating tannery wastes could reduce electric energy consumption by 3.64% and thermal energy consumption by 5.20%. This showcases the energy-saving benefits of co-digesting tannery wastes rather than disposing them in landfills. Using tannery wastes instead of traditional disposal methods resulted in approximately 94.68% savings in electric consumption and 45.03% in thermal energy consumption. This study offers a promising approach for sustainable leather waste treatment, biogas production, and considerable energy and cost savings compared to conventional disposal methods like landfilling.

Cost Effectiveness of Bariatric Surgical Treatment Methods: A Systematic Review

Obesity has become an epidemic today and has become one of the important public health problems. Pharmacological treatment, exercise, cognitive behavioural therapy, medical nutrition and bariatric surgery are used in the treatment of obesity. The aim of this study was to systematically identify and evaluate the national and international literature on the cost-effectiveness of bariatric surgery methods. In this context, a systematic search of electronic databases was conducted. Screening, data extraction, and critical assessment of methodological quality were evaluated according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life year (QALY) were interpreted using the outcome measure. A total of 448 articles were accessed and the full text of 164 articles was analysed. Within the framework of inclusion and exclusion criteria, 20 articles were included in the study. According to the studies in the literature, bariatric surgery is a low-cost or cost-saving treatment option in the long term. There is limited evidence about the long-term clinical effects and safety of bariatric surgery. Therefore, further studies in this context will significantly contribute to the results of cost-effectiveness studies.

Before dinner: The health value of gaseous fuels

In this paper, we study the impact of gaseous fuels used for cooking on the middle-aged and elderly's health in China. By using 2011, 2013, 2015, and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS), we find that gaseous fuel use reduces the probability of respiratory disease in middle-aged and elderly adults. Health effects are stronger for the people aged between 45 and 79, female, high-income, urban, and gas-importing province groups. The quantification of health benefits allows to find that from 2010 to 2018, the reduction in the number of respiratory illnesses due to gaseous fuel use ranges from 22.905 to 23.721 million people, resulting in treatment cost savings of between 9.29 and 14.47 billion RMB ($26.4 - $34.2 billion). The monetary valuation of indoor clean air according to self-rated health find that for each additional unit of indoor clean air, middle-aged and elderly adults are willing to pay a price of 4.5 RMB ($1.06). We provide new evidence of the considerable health and welfare effects of gaseous fuels.

Budget impact of increasing uptake of denosumab for the treatment of postmenopausal osteoporosis in Malaysia.

The study aimed to evaluate the budget impact of increasing the uptake of denosumab for the management of postmenopausal osteoporosis in Malaysia. A Markov budget impact model was developed to estimate the financial impact of osteoporosis treatment. We modelled a scenario in which the uptake of denosumab would increase each year compared with a static scenario. A 5-year time horizon from the perspective of a Malaysian MOH healthcare provider was used. Model inputs were based on Malaysian sources where available. Sensitivity analyses were performed to examine the robustness of the modelled results. An increase in denosumab uptake of 8% per year over a 5-year time horizon would result in an additional budget impact, from MYR 0.26 million (USD 0.06 million) in the first year to MYR 3.25 million (USD 0.78 million) in the fifth year. When expressed as cost per-member-per-month (PMPM), these were less than MYR 0.01 across all five years of treatment. In sensitivity analyses, the acquisition cost of denosumab and medication persistence had the largest impact on the budget. From the perspective of a Malaysian MOH healthcare provider, moderately increasing uptake of denosumab would have a minimal additional budget impact, partially offset by savings in fracture treatment costs. Increasing the use of denosumab appears affordable to reduce the economic burden of osteoporosis in Malaysia.

Feasibility Study of Using Excess Sludge Fermentation Broth as a Co-Metabolic Carbon Source for 2,4,6-Trichlorophenol Degradation

Excess sludge fermentation is a commonly employed method for carbon sources in wastewater treatment plants, but its use as a carbon source for chlorophenol removal has been relatively underexplored. In this study, a laboratory-scale sludge fermentation SBR (FSBR) was integrated with a 2,4,6-trichlorophenol (2,4,6-TCP) degradation SBR (DSBR), resulting in a stable removal of 2,4,6-TCP without the need for external carbon sources. In this coupled system, the concentrations of volatile fatty acids in FSBR remained constant, with acetic acid, propionic acid, butyric acid, and valeric acid concentrations reaching 322.04 mg COD/L, 225.98 mg COD/L, 274.76 mg COD/L, and 149.58 mg COD/L, respectively, and the acid production efficiency increased to 88.40%. Throughout the 110-day operational period, the activated sludge concentration in the DSBR was consistently maintained at 3021 ± 110 mg/L, and the sludge SVI remained stable at 70 mL/g. The maximum amount of 2,4,6-TCP removed reached 240.13 mg/L within a 12 h operating cycle. The use of excess sludge fermentation can completely replace commercial carbon sources for 2,4,6-TCP removal, leading to cost savings in chlorophenol treatment and broadening the applicability of this technology.

Efficacy of stepped care treatment for chronic discogenic low back pain patients with Modic I and II changes

ObjectiveThis study investigated whether patients with Modic changes (MC) of types I, I/II, and II would respond to an anti-inflammatory-based, stepped care treatment with three treatment steps: first, oral administration of NSAIDs, 2 × 200 mg celecoxib daily for two weeks; second, an intradiscal steroid injection (ID) with dexamethasone and cefazolin; and third, oral treatment with antibiotics (AB), 3 × 1 g amoxicillin daily for 100 days. DesignThis was an observational clinical study based on analyses of categorical data of patient-reported outcome measurements. SubjectsSubjects were consecutive patients with chronic low back pain (CLBP), diagnosed by assessment of anamnestic signs of inflammation; a pain score ≥6 on the Numeric Pain Rating Scale (NPRS); a mechanical assessment; MC I, I/II, or II based on MRI; and lack of response to conservative treatment. MethodsFrom January 1, 2015, to December 31, 2021, 833 eligible patients were selected for the stepped care treatment. A total of 332 patients completed requested follow-up questionnaires at baseline and 12 months (optional at 3 and 6 months). Primary outcomes were pain (at least 50 % pain relief) and/or a minimum of 40 % improvement in functionality as measured by the Roland Morris Disability Questionnaire (RMDQ) or the Oswestry Disability Questionnaire (ODI). Secondary outcome measures were use of pain medication and return to work. ResultsAt 1 year of follow-up, 179 (53.6 %) of 332 patients reported improvement according to the responder criteria. Of the 138 patients that had received only NSAIDs, 88 (63.8 %) had improved. In addition, 50 (56.8 %) of the 183 patients that had received ID had improved, and 41 (38.7 %) of the 106 patients treated with AB had improved. None of the patients reported complications. 12.0 % of patients using AB stopped preterm due to undesirable side effects. ConclusionTreatment with a stepped care model for inflammatory pain produced clinically relevant, positive reported outcomes on pain and/or function. Our stepped care model appears to be a useful, safe, and cost-saving treatment option that is easily reproducible. Further studies, including randomized controlled trials and analyses of subgroups, may help to develop a more patient-tailored approach and further avoidance of less-effective treatments and costs.

Cost-minimization analysis of individually tailored or fixed-scheduled rituximab maintenance therapy for antineutrophil-cytoplasm antibody associated vasculitides

ObjectivePatients included in MAINRITSAN2 trial received either an individually tailored or a fixed-schedule therapy with rituximab as maintenance treatment of antineutrophil cytoplasm antibody associated vasculitides. The aim of this study was to compare the real-world costs of both arms. MethodWe performed a cost-minimization analysis over an 18-month time period, estimating direct costs –drug acquisition, preparation, administration and monitoring costs- from the health system perspective. We conducted a number of additional sensitivity analyses with different assumptions for unit costs, with further scenarios including the interquartile range of the tailored-infusion group results, different number of monitoring visits for fixed-schedule regimen and different number of reported severe adverse events. A cost-effectiveness analysis was conducted as a sensitivity analysis using the absolute difference in the relapse rate and its confidence interval. ResultsThe individually tailored maintenance therapy with rituximab was shown to be a cost-saving treatment compared to the fixed-schedule therapy (6,049 euros vs. 7,850 euros). Savings resulted primarily from lower drug acquisition costs (2,861 vs. 4,768 euros) and lower preparation and administration costs (892 vs. 1,486 euros), due to the lower number of infusions per patient in the tailored-infusion regimen. The tailored-infusion regimen presented higher monitoring costs (2,296 vs. 1,596 euros). This result was replicated in all assumptions considered in the sensitivity analysis of cost-minimization approach. ConclusionsFrom the perspective of the health system, the tailored-therapy regimen seems to be the preferable option in terms of direct costs. Further studies assessing all the effects and costs associated to vasculitides maintenance treatment with rituximab are needed to support clinical management and healthcare planning.

Faktor-faktor yang Berhubungan dengan Self-Care Management pada Pasien Penyakit Ginjal Kronik

This research aims to summarize the factors related to self-care management in chronic kidney disease (CKD) patients. A literature search was conducted using six databases: Pubmed, Scopus, EBSCOhost, Wiley Online Library, Taylor &amp; Francis, and Garuda. The keywords used were "chronic kidney disease" AND "self-care management" OR "self-care behaviors" OR "self-care practices." The quality of the articles was assessed using the Critical Appraisal Skill Program (CASP) instrument. The search yielded 11 articles included in the review. We identified factors related to self-care management in CKD patients, including individual characteristics, health literacy, self-efficacy, CKD stages, family and peer support, healthcare facility support, and psychological factors. In conclusion, understanding the factors related to self-care management in CKD patients can assist healthcare professionals in comprehending the variables that contribute to CKD patient self-care management from various aspects, leading to improved quality of life, cost savings in treatment, and reduced hospitalization rates.&#x0D; Keywords: Chronic Kidney Disease, Self-Care Behaviors, Self-Care Management, and Self-Care Practices.

A comprehensive review addressing the factors influencing generic drug substitution

Generic drug substitution is a common practice in healthcare systems worldwide to promote cost-saving treatments while maintaining therapeutic effectiveness. Several factors influence this substitution, including regulatory policies, safety and efficacy considerations, patient and physician preferences, and market dynamics. This review comprehensively analyzes how these factors interact and influence generic drug substitution in healthcare settings and across various therapeutic classes and highlight the importance of balancing cost-saving measures with maintaining patient safety and therapeutic efficacy. Policies and guidelines established by health authorities in each country influence the approval, interchangeability, and substitution of generic drugs. Bioequivalence and therapeutic equivalence are critical factors, particularly in drugs with narrow therapeutic indexes. Moreover, physicians’ acceptance and willingness to prescribe generic drugs, as well as patient acceptance and compliance with generic drug use, play a vital role in promoting generic substitution.

Cost-minimization Analysis in Iron-deficiency Anemia Comparing Intravenous Ferric Carboxymaltose to Standard of Care in Pregnant Women in Algeria

Abstract INTRODUCTION: Anemia due to iron deficiency is frequent during pregnancy and increases morbidity and mortality of mothers and infants. The objective of this study was to assess the economic consequences of intravenous ferric carboxymaltose (FCM) in anemic pregnant women in Algeria. METHODS: The economic analysis was a cost-minimization model comparing the strategy for treating pregnant women with intravenous iron sucrose to FCM. The perspective of Algerian health-care providers was adopted to calculate costs savings. Cost related to treatment of iron-deficiency anemia included infusion, iron workup, medical time, iron vials acquisition, and absenteeism. Data were obtained mostly from available scientific literature and public health data and were validated by expert opinion. A budget impact model was also developed for the population of Algerian women needing intravenous iron treatment to evaluate the gross impact on payers’ budget if FCM treatment was prescribed. RESULTS: Treatment of pregnant women with iron-deficiency anemia (mean weight, 65 kg; hemoglobin 7.5 g/dL) needed 7 hospital visits and 14.9 doses for iron sucrose treatment to be compared to 2 hospital visits and 2 doses for FCM treatment. Total cost was Algerian dinar (DZD) 69,222 per patient for iron sucrose and DZD 57,452 for FCM (cost savings per patient: DZD 11,769, i.e., 17%). If all 192,000 pregnant Algerian anemic women eligible for injectable iron treatment received FCM, global cost savings would be DZD 2,259,820,627 per year. CONCLUSION: This economic model suggests that FCM is a cost-saving treatment compared to standard iron sucrose treatment in pregnant women with iron-deficiency anemia in Algeria.

Clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with abiraterone with or without ongoing androgen deprivation therapy: A retrospective case-control study.

Abiraterone and concurrent androgen deprivation therapy (ADT) are used in the treatment of patients with metastatic castration-resistant prostate cancer. Recently, it has been suggested that the use of abiraterone alone (without ADT) may have comparable efficacy to abiraterone with ongoing ADT. Here, we sought to assess the impact of ADT cessation in patients beginning abiraterone for castration-resistant prostate cancer. We identified 39 patients at our institution who received abiraterone alone (with discontinuation of ADT) between 2011 and 2022. We then procured a comparable group of 39 patients (matched by age, Gleason score, and prostate-specific antigen [PSA] level) who received abiraterone with ongoing ADT during the same period. We assessed and compared clinical outcomes in the two groups (abiraterone-alone vs. abiraterone-ADT) with respect to PSA response rates, PSA progression-free survival, and overall survival. Results were adjusted using Cox proportional-hazards multivariable models. The median PSA before treatment initiation was 12.7 (range: 0.2-199) ng/mL in the abiraterone-alone group and 15.5 (range: 0.6-212) ng/mL in the abiraterone-ADT group. Use of abiraterone alone adequately suppressed testosterone levels in 35/37 (94.6%) patients. Patients receiving abiraterone alone had a median PSA reduction of 80.2% versus 79.5% in patients receiving abiraterone plus ADT. The median PSA progression-free survival in patients receiving abiraterone alone was 27.4versus 25.8 months in patients receiving abiraterone plus ADT (hazard ratio [HR] 1.10; 95% confidence interval [CI] 0.65-1.71; p = 0.82). In addition, abiraterone alone was associated with an overall survival of 3.6versus 3.1 years in patients receiving abiraterone plus ADT (HR 0.90; 95% CI 0.50-1.62; p = 0.72). There were no differences in PFS or OS between groups after performing Cox multivariable regression analyses. Use of abiraterone alone was associated with comparable clinical outcomes to patients who received abiraterone together with ADT. Further prospective studies are warranted to evaluate the impact of abiraterone alone on treatment outcomes and cost savings.

An Economic Analysis of Transjugular Intrahepatic Portosystemic Covered Stent Shunt for Variceal Bleeding and Refractory Ascites in a Spanish Setting.

The primary aim is to estimate the cost-effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in two indications from a Spanish perspective. Firstly, as pre-emptive treatment for patients with acute variceal bleeding (indication1) compared with endoscopic band ligation plus drug therapy. Secondly, to treat refractory ascites (indication2) compared with large volume paracentesis. A two-state (alive and dead) Markov model was developed to capture the costs and health impact for the two indications over a 2-year time horizon with monthly cycles. In the alive state, patients could experience adverse event(s), associated with costs and disutility, such as recurrent variceal bleeding, ascites, and hepatic encephalopathy. Discount rates of 3% for utilities and costs and a cost-effectiveness threshold of €25,000 per QALY were applied. In the base case analysis, TIPSS was estimated to be cost-effective as a pre-emptive treatment for indication1 (incremental cost and QALYs of - €230 and 0.211, respectively). TIPSS also remained cost-effective (€16,819/QALY) in a conservative scenario analysis, conducted with an alternate source for clinical parameters. The key drivers of the outcomes were survival for the comparator arm, mean band ligation outpatient procedures, and TIPSS treatment costs. TIPSS was estimated to dominate the comparator for indication2 (incremental cost and QALYs of - €25,687 and 0.531, respectively). The key drivers of the outcomes were monthly paracentesis sessions and cost per inpatient stay for those undergoing paracentesis. TIPSS is likely to be a cost-effective and a cost-saving treatment in patients with cirrhosis in indications 1 and 2, compared with standard treatments. The analyses estimate clinical benefits along with reduced healthcare costs from avoided downstream resource consumption.

Optimizing the Gas Carburization Process: Strategies for Reducing Total Cycle Time

Abstract: This case study presents the results of an experiment designed to reduce the total cycle time of the gas-Carburizing process for AISI 8620 steel. By optimizing process parameters such as carburizing temperature, soaking time, and carbon potential, the effective case depth was significantly improved. Previous research has indicated that optimizing the duration of the boost/diffusion stages and carbon potential in the carburizing process can lead to a 25% reduction in total process time [1].Our study showed that it is possible to achieve a reduction in total cycle time of up to 21%, leading to cost savings for heat treatment companies while also promoting a safer environmental outcome