Changes In System Research Articles

The Effect of Hypokinesia on the Dynamics of the Formed Elements of Blood during the Embryonic Period of Prenatal Development in Pregnant Rabbits

The erythroformula and leucoformula indicators changed in the rabbits that experienced hypokinesia during the embryonic stage of pregnancy. Compared to the rabbits that spent the pregnancy period under normal conditions, changes in concentrations of leukoformula indicators such as leukocytes, lymphocytes, monocytes, and granulocytes were detected in rabbits exposed to hypokinesia. While significant changes in erythroformula indicators: erythrocytes, average corpuscular volume of erythrocytes and hemoglobin capacity, erythrocyte sedimentation rate did not occur. The results of our studies have shown that prenatal hypokinesia causes noticeable changes in the blood coagulation system. On the other hand, changes in the coagulation system under the influence of prenatal hypokinesia were found to occur in the first periods of postnatal ontogenesis, had a continuous nature, and were maintained until the full maturity of postnatal development. Due to the effect of the hypokinesia factor, the changes in the mentioned indicators lead to the emergence of severe pathological diseases in most cases.

Quo Vadis, Historical International Relations? Geopolitical Marxism and the Promise of Radical Historicism

John Maclean’s 1988 call “Marxism and IR: A Strange Case of Mutual Neglect” has generated a rich bounty of Marxist studies and paradigms in International Relations (IR). This cross-pollination merged in the 1990s with the “historical turn” and shaped the sub-fields of International Historical Sociology and International Political Economy. But has it left its mark on how IR is practised today? We argue that while Marxism has spoken significantly to the discipline, mainstream IR, even Historical IR, has been largely impervious to Marxist arguments, drawing the standard charge of economism and structuralism. Rectifying these critiques, we suggest that conventional historical studies of “the international” remain methodologically and substantively impoverished. We exemplify this by showing how leading Historical IR studies of “systems change” fail to explain the inside/outside and public/private differentiations constitutive of the modern international order and to integrate the “levels of analysis” they presuppose. We further argue that this rejection has been facilitated by influential Marxist IR paradigms, which ultimately privilege structuralism over historicism: While Neo-Gramscians initially mobilised “historicism” to dissolve claims about the “sameness” of international relations across time and space, the approach became identified with the reified master-category of “hegemony”. Uneven and Combined Development, in turn, has gravitated towards matching Neo-realism’s claim to theoretical universality by insisting on transhistorical model-building and nomological “grand theory”. Both approaches remain over-sociologised and fail to address international politics. Drawing on radically historicist Political Marxism, this article shows how its substantive socio-political premises explain the historical formation of the contemporary international order and re-unite the “levels of analysis” theoretically to provide a framework for non-reductionist and non-economistic accounts of historical international relations. This requires an answer to the agentic challenge of Neo-Classical Realism by reincorporating grand strategy, diplomacy, and international politics into a reformulated perspective of Geopolitical Marxism to track the full historicity of the making of international orders.

Gender-differentiated capture of agro-based climate adaptation interventions: implications for agricultural systems and practices in Cameroon’s Western highlands

In climate change adaptation, studies exist on extension interventions in sub-Saharan Africa, albeit the dearth of scientific evidence on the differential “capture1” of agro-based adaptation packages. This paper contributes to provide evidence by (1) analyzing the typology of agro-based climate adaptation packages, and (2) exploring gender variations in the capture of agro-based climate adaptation packages. We use key informant interviews (N = 89) and focus group discussions (N = 14) to obtain data, analyzed using content analysis. Variations were observed in the capture of agro-based adaptation packages introduced by state and non-state actors. While men (adult male) mostly employed dominant information, women (adult female) drew from group formation. Agro-based adaptation capture led to major shifts in agricultural systems in the western highlands from monocropping to mixed cropping, mixed farming and agroforestry systems. The results show changes in agricultural systems from monocropping to mixed cropping. It was observed that women (adult female) and youths (both male and female) capture adaptation strategies encouraged by state agencies than the men (adult male) who adopt various adaptation strategies by both state agencies and non-governmental organizations. While these findings shed light on the dynamics of gender differentiated capture, it further calls for an in-depth exploration of other factors which shape agricultural system change.

Modulation of macrophage transcript and secretion profiles by Sargassum Serratifolium extract is associated with the suppression of muscle atrophy

Recent research has emphasized the role of macrophage-secreted factors on skeletal muscle metabolism. We studied Sargassum Serratifolium ethanol extract (ESS) in countering lipopolysaccharide (LPS)-induced changes in the macrophage transcriptome and their impact on skeletal muscle. Macrophage-conditioned medium (MCM) from LPS-treated macrophages (LPS-MCM) and ESS-treated macrophages (ESS-MCM) affected C2C12 myotube cells. LPS-MCM upregulated muscle atrophy genes and reduced glucose uptake, while ESS-MCM reversed these effects. RNA sequencing revealed changes in the immune system and cytokine transport pathways in ESS-treated macrophages. Protein analysis in ESS-MCM showed reduced levels of key muscle atrophy-related proteins, TNF-α, IL-6, IL-1, and GDF-15. These proteins play crucial roles in muscle function. These findings highlight the intricate relationship between the macrophage transcriptome and their secreted factors in either impairing or enhancing skeletal muscle function. ESS treatment has the potential to reduce macrophage-derived cytokines, preserving skeletal muscle function.

Mitochondrial injury induced by triclopyr in the rat liver

The herbicide triclopyr (3,5,6-trichloro-2-pyridinyloxyacetic acid) is already considered an environmental problem due to damage caused by incorrect disposal, leaching, and aerial dispersion, which may pose risks to the environment and human health. Studies have evaluated metabolism, absorption, excretion, and active transport but there is no clear information about its mode of action (MoA) and its cytotoxic action potential remains unknown. In this context, mitochondria have been used to assess the toxicity of xenobiotics, for this reason, to identify the toxic mechanism of triclopyr, hepatic mitochondria from Wistar rats were exposed in vitro to different concentrations of triclopyr (0.5–500 µM). There was neither formation/accumulation of reactive oxygen and nitrogen species, nor lipid peroxidation or changes in the mitochondrial antioxidant system, in addition to proper functioning of oxidative phosphorylation and ATP production. Changes were found in NAD(P)H oxidation, membrane potential dissipation and mitochondrial calcium gradient. These results demonstrate that mitochondria suffer damage related to their bioenergetics and redox status but not to their structure when exposed to concentrations of triclopyr considered higher than those described as found in the environment so far. Highlights Triclopyr has a low mitochondrial uncoupling potential. The damage caused to the bioenergetics and redox state of the mitochondria is related to concentrations considered higher than those found in the environment. Even at high concentrations, triclopyr was not able to change the structure of the organelle after exposure. Oxidative phosphorylation and ATP production were not impaired after exposure. NAD(P)H oxidation resulted in potential membrane dissipation and mitochondrial calcium gradient dissipation. Triclopyr does not have RONS-forming properties, as well as it does not peroxide membrane lipids, it preserves membrane sulfhydryl groups and maintains the normality of the GSH/GSSG ratio.

Inclusion explored through student voices within the framework of formal teacher-student conversations

ABSTRACT A great deal of research has addressed the field of inclusive education. However, yet we know little about the phenomenon of inclusion explored though student voices. This qualitative study draws on data from a research-practice partnership in Norway, where the parties together developed a framework for the school’s formal teacher–student conversations to find out more about the students’ experiences of inclusion. As a result of inductive analysis of the voices of three students, we discovered a tension between each student’s current childlike lifeworld and a school system emphasising conformity and future academic achievement. Analysis revealed that there were several barriers to students expressing themselves during the conversations. Despite this, the students asserted their own capability and agency, guiding the subject of those conversations towards their own desires and needs. The findings suggests that teachers ought to be given the opportunity to increase their competency in what should be an ongoing process of listening to and acting upon student voices in inclusive education, potentially going so far as to become agents for change in the school system.

Lung cancer screening provider recommendation and completion in black and White patients with a smoking history in two healthcare systems: a survey study

BackgroundAnnual lung cancer screening (LCS) with low dose CT reduces lung cancer mortality. LCS is underutilized. Black people who smoke tobacco have high risk of lung cancer but are less likely to be screened than are White people. This study reports provider recommendation and patient completion of LCS and colorectal cancer screening (CRCS) among patients by race to assess for utilization of LCS.Methods3000 patients (oversampled for Black patients) across two healthcare systems (in Rhode Island and Minnesota) who had a chart documented age of 55 to 80 and a smoking history were invited to participate in a survey about cancer screening. Logistic regression analysis compared the rates of recommended and received cancer screenings.Results1177 participants responded (42% response rate; 45% White, 39% Black). 24% of respondents were eligible for LCS based on USPSTF2013 criteria. One-third of patients eligible for LCS reported that a doctor had recommended screening, compared to 90% of patients reporting a doctor recommended CRCS. Of those recommended screening, 88% reported completing LCS vs. 83% who reported completion of a sigmoidoscopy/colonoscopy. Black patients were equally likely to receive LCS recommendations but less likely to complete LCS when referred compared to White patients. There was no difference in completion of CRCS between Black and White patients.ConclusionsPrimary care providers rarely recommend lung cancer screening to patients with a smoking history. Systemic changes are needed to improve provider referral for LCS and to facilitate eligible Black people to complete LCS.

Overview of Indonesian Community Pharmacy: Understanding Practice Changes

<p><span lang="EN-US">Community pharmacy practice in Indonesia has shifted to a patient-centered model, offering a </span><span lang="EN-US">range</span><span lang="EN-US"> of services that include treatment advice, chronic disease management, and public health promotion. This shift benefits consumers who visit community pharmacies as their initial healthcare point. The Indonesian healthcare system, a mix of public and private providers, is governed by a decentralized structure, fostering significant investment in private healthcare despite access limitations due to financial capacity. Medicines distribution, managed by the District Health Office, ensures supply to primary healthcare facilities, with community pharmacies regulated by the Ministry of Health and the Indonesian National Food and Drug Agency. Despite stringent regulations mandating comprehensive services, most pharmacists are not remunerated for their services. Pharmacy staff, including formally qualified pharmacists and pharmacy technicians, are registered professionals, with recent trends indicating a shift towards employing pharmacy technicians to enable pharmacists to focus on clinical roles. Economic factors and innovative service delivery modes, such as telepharmacy and online purchasing, are expected to influence future practices, enhancing the pharmacist's role in chronic disease management and other health conditions. The evolving community pharmacy practice in Indonesia reflects broader changes in the healthcare system and professional roles, with continued progression anticipated.</span></p>

Convergence in action: framing the climate crisis at the 2021 Pre-COP counter-summit in Milan

ABSTRACT With the emergence of Fridays for Future and Extinction Rebellion, youth climate activism has attracted increasing attention. Climate strikes are part of a long trajectory of mobilizations for climate justice, rooted in global justice and environmental struggles. Although research on social movements has analyzed differences and continuities within these, there have been few systematic comparisons between youth climate strikes and ‘traditional’ climate justice marches. Our paper contributes to fill this gap. We focus on the framing of climate change in two different protest actions that took place in Milan, Italy, during the Pre-COP26 of the United Nations Framework Convention on Climate Change in 2021: a climate strike by Fridays for Future, and a ‘traditional’ climate justice march by a wide coalition of actors. Relying on protest surveys and qualitative interviews, we discuss differences, similarities, and spaces for convergence among activists in these different fora, focusing on the framing of climate change, and on the meanings attached to ‘system change’.

Barriers to primary care among immigrants and refugees in Peterborough, Ontario: a qualitative study of provider perspectives

BackgroundCanada’s immigrants and refugees have often settled in large Canadian cities, but this is changing with rising costs of living and rural settlement initiatives. However, little consideration is made regarding systemic changes needed to accommodate this distribution, particularly in healthcare in medium-sized cities or smaller communities. For most Canadians, primary care is an entry point into the healthcare system but immigrants and refugees face unique barriers to accessing care compared to the general Canadian population. This project aimed to better understand the barriers to accessing primary care among newcomers in Peterborough, Ontario from the perspective of newcomer service providers.MethodologyParticipants were recruited from community organizations identified by the local settlement agency, the New Canadians Centre, as having regular interactions with newcomer clients including clinics, not-for-profit organizations, and volunteer groups. Four focus groups were completed, each with three participants (n=12). A coding grid was deductively developed to guide thematic analysis by adapting Levesque et al.’s conceptual framework defining access to healthcare with five specific dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsParticipants identified lack of awareness of the healthcare system, stigma, competing priorities, and direct costs as some of the barriers for newcomers. Participants highlighted barriers unique to Peterborough including proximity to services, social isolation, and a shortage of family physicians. The results also highlighted strengths in the community such as its maternal-child health programming.ConclusionThe results provide a glimpse of the challenges to accessing primary care among newcomers in medium-sized communities and identify opportunities to prepare for changing settlement patterns.

Synthesis and characterization of cellulose Grewia optiva yarn and woven mat using an alkali solution

PurposeThe production of commodities from renewable organic material has gained enormous interest due to the rising public understanding of conscious development. Natural fibers are accessible in environment, and their parameters depend on their physical traits and chemically engineered makeup. Grewia optiva (GO) comes under the category of bast fibers, also known as Bhimal. This study aims to realize the consequences of alkali treatment on the characterization of natural fibers, their developed yarn and then the woven mat.Design/methodology/approachRaw fiber was treated with 20% alkali solution. After treatment, it was evaluated for changes in the general laboratory system. This treatment is known as mercerization, through which the parameters of cellulose fibers can be enhanced. After this process, the content of cellulose increases due to the removal of the hydroxyl group. The removal of microfibrils, hemicellulose and the introduction of hydrogen bonds increase the interactive capacity of fiber. The job was divided into different sections, including acquiring fiber, developing yarn and creating a mat.FindingsThe quality of the surface of the fiber was enhanced after the treatment. Its diameter was reduced to 54.72 microns. In the developed woven mat, it was densified using water treatment and attained grams per square meter (GSM) of 389.7.Originality/valueThe usage of mercerization softens the fiber to twist into yarn, which is finally woven into a mat. Treatment of fabric or mat makes it denser to impart better strength. A woven mat of natural fibers provides maximum strength to the composites.

Theoretical foundations of developing school management skills of future teachers: Global trends and analysis of training in the education system of Kazakhstan

Relevance. The relevance of this study is due to the rapid changes in the educational environment caused by the development of information technologies and the increasing socio-cultural diversity of school communities. Purpose. The purpose of this study was to identify the best methods of developing school management skills of future teachers in the face of contemporary challenges and changes. Methodology. The study employed systematic approach and methods of analysis, comparison, synthesis, deduction, induction, and classification. Results. A comprehensive review of the education system in Kazakhstan was undertaken, including the changes brought to the system within the framework of the renewed content of education. The analysis of the statistics of students enrolled in pedagogical specialities revealed a steady interest in pedagogical sciences, as the number of enrolments for the decade increased by 45%. The dynamics of the number of general-education schoolteachers revealed in the study also suggested that the demand for representatives of this profession is steadily growing. As a result of investigating the practices of training future teachers for school management in educational leader countries, the unique characteristics of each training system were revealed. Conclusions. Based on the findings of this study, concrete teaching methods and techniques were presented to develop effective communication and cooperation skills in different educational and social contexts to effectively prepare future teachers for school management. Furthermore, it was substantiated that the specificity of school management training consists in mastering modern educational technologies, analysing data, and applying effective assessment strategies, which ensures readiness for prompt response to changes in the educational system and introduction of innovations in pedagogical practice. Keywords: professional competences; leadership; pedagogical training; modernisation of training; international practices

Genital Tuberculosis as a Socially Significant Disease (Literature Review)

Globally, TB is the second leading cause of death from infectious diseases after COVID-19. Tuberculosis of the female genital organs is a type of extrapulmonary tuberculosis.It is known that both clinically pronounced and latent forms of this disease can cause both primary and secondary infertility due to pathogenetically caused disruption of the structure of the fallopian tubes and changes in the susceptibility of the uterine endometrium. It can be assumed that the problem of genital tuberculosis in Russia is still very relevant, although its true prevalence is unknown. This assumption is based on the facts of the projected growth of indicators the incidence of extrapulmonary tuberculosis, the obvious discrepancy between the real incidence and the official figures, as well as the increasing incidence of tubal-peritoneal infertility, which is often caused by genital tuberculosis. It is known that tuberculosis of the female genital organs is a difficult disease to diagnose. This is determined, in particular, by the fact that it does not have specific (so-called "marker") manifestations. Low rates of diagnosis of extrapulmonary forms of TB create a false sense of well-being, which does not reflect its true epidemiological picture. An obvious need today is the development of an optimal diagnostic complex, the use of which would contribute to accelerating the diagnosis of genital tuberculosis in women and, as a result, preventing the occurrence of irreversible changes in the female reproductive system caused by it. The authors used the scientific databases CyberLeninka, ELibrary and PubMed. Articles were searched for the following keywords: "tuberculosis", "genital tuberculosis", "infertility and tuberculosis". The paper analyzes articles published over the past 10 years.

Using Community Engagement to Move Upstream to Address Social Determinants of Health.

Given its role as a safety net institution, the University of Florida Health (UF Health) Jacksonville has responded to the community's needs through partnerships with the community for decades. Such academic-community partnerships have a broad emphasis on population health and primary care that expands the model of care to include community engagement, which allows such partnerships to promote health and well-being and reduce health inequalities by addressing social determinants of health (SDOH).This report describes the UF Health Jacksonville and University of Florida College of Medicine - Jacksonville's creation of the Urban Health Alliance (UHA) in June 2019 due to continued poor health outcomes and inequities within the community. The mission of the UHA is to improve community health using community-focused, self-sustainable strategies and solutions to impact SDOH (i.e., more upstream interventions). Using the tenets of the collective impact model, the UHA acts as a backbone organization to achieve these objectives by empowering community partners to affect changes in policy, systems, and other structures necessary for the optimal health of the community. The UHA's work is divided across 4 pillars: services, research, education, and policy. These pillars reflect the traditional missions of academic medical centers-clinical care, research, and education-and the need to address structural changes to improve community health-namely, policy. By addressing the issues that most impact the patients and community of UF Health Jacksonville, the UHA can serve as an example of how an academic medical center can use the traditional missions to improve the community's health and move toward health equity.

Theoretical foundations of developing school management skills of future teachers: Global trends and analysis of training in the education system of Kazakhstan

Relevance. The relevance of this study is due to the rapid changes in the educational environment caused by the development of information technologies and the increasing socio-cultural diversity of school communities. Purpose. The purpose of this study was to identify the best methods of developing school management skills of future teachers in the face of contemporary challenges and changes. Methodology. The study employed systematic approach and methods of analysis, comparison, synthesis, deduction, induction, and classification. Results. A comprehensive review of the education system in Kazakhstan was undertaken, including the changes brought to the system within the framework of the renewed content of education. The analysis of the statistics of students enrolled in pedagogical specialities revealed a steady interest in pedagogical sciences, as the number of enrolments for the decade increased by 45%. The dynamics of the number of general-education schoolteachers revealed in the study also suggested that the demand for representatives of this profession is steadily growing. As a result of investigating the practices of training future teachers for school management in educational leader countries, the unique characteristics of each training system were revealed. Conclusions. Based on the findings of this study, concrete teaching methods and techniques were presented to develop effective communication and cooperation skills in different educational and social contexts to effectively prepare future teachers for school management. Furthermore, it was substantiated that the specificity of school management training consists in mastering modern educational technologies, analysing data, and applying effective assessment strategies, which ensures readiness for prompt response to changes in the educational system and introduction of innovations in pedagogical practice. Keywords: professional competences; leadership; pedagogical training; modernisation of training; international practices

‘I didn’t know they could one-shot me!’

This article presents a corpus study spanning 11 years (2011–2022) of language referring to Gwyndolin, a boss in the videogame Dark Souls. Like many aspects of Dark Souls, Gwyndolin’s gender is open to interpretation, and this study tracks how both players’ readings of Gwyndolin’s gender and the pronouns they use to refer to Gwyndolin have changed over the past decade. The results show that, while players overwhelmingly read Gwyndolin as a cis man and use the pronoun ‘he’, there have been significant increases in trans and nonbinary interpretations, as well as the use of ‘they’ after 2015. The observed patterns can be linked to social changes inside and outside videogame culture occurring around 2014–2016. The study provides valuable real-time support for the existence of a change in the pronoun system (and its relation to trans/nonbinary identities), which had previously only been proposed on the basis of apparent-time data.

Functional changes in sleep-related arousal after ketamine administration in individuals with treatment-resistant depression

The glutamatergic modulator ketamine is associated with changes in sleep, depression, and suicidal ideation (SI). This study sought to evaluate differences in arousal-related sleep metrics between 36 individuals with treatment-resistant major depression (TRD) and 25 healthy volunteers (HVs). It also sought to determine whether ketamine normalizes arousal in individuals with TRD and whether ketamine’s effects on arousal mediate its antidepressant and anti-SI effects. This was a secondary analysis of a biomarker-focused, randomized, double-blind, crossover trial of ketamine (0.5 mg/kg) compared to saline placebo. Polysomnography (PSG) studies were conducted one day before and one day after ketamine/placebo infusions. Sleep arousal was measured using spectral power functions over time including alpha (quiet wakefulness), beta (alert wakefulness), and delta (deep sleep) power, as well as macroarchitecture variables, including wakefulness after sleep onset (WASO), total sleep time (TST), rapid eye movement (REM) latency, and Post-Sleep Onset Sleep Efficiency (PSOSE). At baseline, diagnostic differences in sleep macroarchitecture included lower TST (p = 0.006) and shorter REM latency (p = 0.04) in the TRD versus HV group. Ketamine’s temporal dynamic effects (relative to placebo) in TRD included increased delta power earlier in the night and increased alpha and delta power later in the night. However, there were no significant diagnostic differences in temporal patterns of alpha, beta, or delta power, no ketamine effects on sleep macroarchitecture arousal metrics, and no mediation effects of sleep variables on ketamine’s antidepressant or anti-SI effects. These results highlight the role of sleep-related variables as part of the systemic neurobiological changes initiated after ketamine administration. Clinical Trials Identifier: NCT00088699.

Trauma-informed systems change training has transcultural, transcontinental transformative healing power: An analysis of leaders in the United States and Angola, Africa.

The Institute for Trauma-Informed Systems Change (ITISC) facilitated a 2-day, 12-hr trauma-informed workshop, delivered virtually, using the Training for Change curriculum. The workshop took place in Portuguese in September 2021 with a group of Angolan leaders (N = 51) and in May 2022, in English, with neonatal intensive care unit (NICU) workers from the United States (N = 73). Surveys were administered before (Time [T] 0) and after the workshop (T1) and consisted of demographic questions and the Survey for Trauma-Informed Systems Change (STISC), which assesses system-wide knowledge and attitudes about trauma-informed systems change and the intersection of culture, safety, and acceptance in the workplace. At T1, 18 (35.3%) participants in the Angolan leaders' group and 46 (63.0%) in the NICU group completed the surveys. Mean scores on the STISC Self-Assessed Knowledge and Attitudes subscale and STISC System-Wide Knowledge and Attitudes subscale increased significantly in both groups after the training. Effect sizes were large for self-assessed knowledge and attitudes, Angolan leaders: d = 1.11, NICU: d = 1.97, and small-to-medium for system-wide knowledge and attitudes, Angolan leaders: d = 0.52, NICU: d = 0.38. Limitations include the relatively small sample size and low participation rates for survey responses. Future research should examine the efficacy of the curriculum in larger samples that include individuals from diverse professions and additional countries. Together, the findings provide initial support that this training can be directly translated and implemented on a global scale.

Modeling MobilityCoins—Charges, Incentives and Multi-period Budgets in Multimodal Transportation Networks

MobilityCoins are a tradable mobility credit (TMC) scheme variant. TMC schemes are a cap-and-trade scheme for managing mobility that are designed to limit negative externalities, e.g., congestion, of traffic. Next to having link-specific or origin–destination-specific charges for cars as in the common TMC scheme, the MobilityCoin scheme’s distinctive elements are accommodating link-specific and origin-and-destination-specific charges and incentives for all modes of transport as well as being considered a mobility currency that can be earned, saved, and spent in multiple time periods. These distinctive features of the MobilityCoin scheme does not alter the core behavioral mechanism of TMC schemes of increasing car travel costs, but these features interfere with the credit market in terms of market volume and market price that ultimately affects traffic outcomes, e.g., an uncontrolled market volume increase can lower the market price that in turns increases the attractiveness of using the car. In this paper, we develop a mathematical model of multimodal macroscopic network flows and a MobilityCoin market to investigate the impacts of charges, incentives, and multi-period budgets. The model is implemented as a single-day model with an integration of sensitivity for multi-period budgets to study how the outcomes in the transportation system change with charges, incentives, and multi-period budgets. Further, we discuss implications for the policy design of MobilityCoins schemes.

Budget Impact Analysis of Olaparib in Combination with Bevacizumab for Maintenance Therapy for Ovarian Cancer in Argentina.

To perform a budget impact analysis (BIA) of introducing olaparib as maintenance therapy in women who have BRCA mutations (BRCAm) with platinum-sensitive recurrent ovarian cancer (PSROC) in combination with bevacizumab in Argentina. A BIA model was used to analyse over a 5-year time horizon the change in the health system's budget following the adoption of olaparib as maintenance therapy in BRCAm patients with PSROC. The BIA for each year was estimated by comparing the cost difference between the current scenario (treatment with bevacizumab) and the new scenario (the addition of olaparib) for a third-party payer. The BIA is estimated at the national health system level, and by healthcare sectors in Argentina (public sector, social security and private sector). International and national epidemiological data were used to determine the target patient population. Clinical efficacy, safety outcomes and duration of treatments were obtained from the pivotal clinical study report. Relevant direct medical costs were obtained from public data in Argentina and expert consultation. All the costs are reported in US dollars as of October 2022 ($1 = 152.59 Argentine pesos). A scenario analysis assessed the full coverage of the homologous recombination deficiency (HRD) test in Argentina. In addition, one-way sensitivity analysis was conducted to evaluate the model robustness. For a third-party payer with a cohort of 1,000,000 women covered, the estimated target population was 2 individuals in year 1 and 6 individuals in year 5. The incorporation of olaparib, with a wholesale price per pack of $3176.32, was associated with a weighted average of the budget impact per member per month (PMPM) of $0.062 for the national health system, being above the estimated health system budget impact threshold ($0.0153). By healthcare sector, the results of budget impact PMPM for year 5 ranged between $0.08 (public sector) and $0.114 (private sector). For all perspectives, the variables that most influenced the budget impact was the incidence of ovarian cancer, the drug acquisition cost and the treatment duration. The introduction of olaparib for the treatment of BRCAm women with PSROC has a high budget impact for all three health systems in Argentina.