The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.

Cost-Effectiveness Analysis of Atezolizumab plus Pemetrexed and Platinum in First-Line Treatment of Non-Squamous Non-Small Cell Lung Cancer in China

Objective: To evaluate the cost-effectiveness of atezolizumab plus pemetrexed and platinum-based (APP) in the first-line treatment of non-squamous non- small cell lung cancer (NSCLC). Methods: A partitioned survival model (PSM) was constructed based on the IMpower132 clinical trial. Total cost, quality- adjusted life years (QALY), and incremental cost-effectiveness ratio (ICER) were the main outputs of the model. Deterministic sensitivity analysis and probabilistic sensitivity analysis were adopted to test the uncertainty of the parameters. Results: The results of the base-case analysis illustrated that compared with PP, the incremental cost of APP was CNY 591040.94, the incremental utility was 0.46 QALY, and the ICER was CNY 1291414.83/QALY. Deterministic sensitivity analysis results illustrated that atezolizumab and other parameters have a greater impact on ICER. Probabilistic sensitivity analysis results show that no matter how each parameter changes, under the willingness to pay threshold of 3-times Chinese per capita GDP, the probability of APP has cost-effectiveness is 0. Conclusion: From the perspective of the Chinese health system, APP is not cost-effective for first-line treatment of non-squamous non-small cell lung cancer without sensitizing EGFR or ALK genetic alterations.

Cost-effectiveness Analysis of Insulin Degludec and Liraglutide Injection in the Treatment of Type 2 Diabetes

Objective To analyze the cost-effectiveness of insulin degludec and liraglutide injection(IDegLira)compared with insulin glargine plus insulin aspart(IGar plus IAsp)in the treatment of type 2 diabetes mellitus(T2DM)based on the price of IDegLira before and after it was successfully admitted to the National Reimbursable Drug List(NRDL).Methods Cost and effectiveness parameters were obtained through systematic retrieval from PubMed,ScienceDirect,CNKI,and Wanfang database.A cost-effectiveness analysis(CEA)model was established to analyze the economics using IDegLira for T2DM patients with 1 to 5 years of medication.Results and Conclusion Before IDegLira was admitted to NRDL,its economic advantages over the IGlar plus Iasp regimen became more significant as patients’medication time prolonged.After being admitted to NRDL,with 1 year of medication,the medical cost of IDegLira decreased by 2853.91 yuan and the quality adjusted life years(QALY)increased by 0.12055 than IGar plus IAsp.The sensitivity analysis was highly consistent with the results of the baseline result.After being admitted to NRDL,for patients with T2DM who have poor blood glucose control,IDegLira is absolutely an economic advantage scheme compared with IGar plus IAsp.

High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis

AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.

Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Cost-effectiveness analysis of chemotherapy for advancedgastric cancer in China

AIM： To assess the economics of various chemotherapeutic regimens for advanced gastric cancer （AGC）, and to select the best cost-effective regimen for the common Chinese patients. METHODS： Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time （MST） and percentage of complete and partial response （CR＋PR）. Economic statistics was per capita direct medical cost （DMC） of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out costeffectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness- to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity. RESULTS： Seven retrospective economics studies on 760 patients were included. S-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, andoxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil （ELF） regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR＋PR ratio of 2543 RMB/53.3%. Uraciltegafur, etoposide and cisplatin （FEP） or 5-fluorouracil, adrimycin/epirubin and mitomycin （FAM） regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil （DCF） regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR＋PR ratio of 9979 RMB/56.3%. CONCLUSION： 5-fluorouracial regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

Influenza vaccination in acute coronary syndromes patients in Thailand： the cost-effectiveness analysis of the prevention for cardiovascular events and pneumonia

Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.

Cost-effectiveness analysis of colon cancer treatments from MOSIAC and No.16968 trials

AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.

Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma

BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.

Cost-Effectiveness Analysis of Neoadjuvant Chemotherapy with Zoledronic Acid for HER2-Negative Breast Cancer in Japan: The JONIE1 Study

Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.

Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis

AIM To determine whether contrast-enhanced ultrasonography(CEUS) as the first-line method is more costeffective in evaluating incidentally discovered focal liver lesions(FLLs) than is computed tomography(CT) and magnetic resonance imaging(MRI). METHODS Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The resultswere compared. RESULTS The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar(USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD(4%) and that between MRI and CEUS was 308352 USD(406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent(P < 0.001).CONCLUSION While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more costeffective in comparison to MRI.

Cost-Effectiveness Analysis of Combined Chemotherapy Regimen Containing Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis in China

Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.

Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices

AIM: To evaluate the most cost-effectiveness strategy for preventing variceal growth and bleeding in patients with cirrhosis and small esophageal varices.

Cost-effectiveness analysis of treatments for metastatic castration resistant prostate cancer

Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.

Cost-effectiveness analysis of tele-retinopathy of prematurity screening in Iran

AIM:To conduct a cost-utility analysis of the teleretinopathy of prematurity(ROP)screening program against no screening.METHODS:A decision tree model was developed to identify and treat the infants with threshold ROP through the tele-screening system compared with no screening program from the societal perspective.We used the quality adjusted life years(QALY)index to measure the scenarios’effectiveness,which was discounted for the future years by 0.058.One hundred twenty-six randomly selected newborns with ROP required treatment were investigated to extract the treatment information.We considered the direct medical and non-medical costs in cost calculations analysed by the bottom-up approach.The figures of the model’s inputs were calculated using the Monte Carlo simulation that generated 1000 random iteration of the data,and a one-way sensitivity analysis was performed on the model to cope with the potential uncertainties.RESULTS:The total and per capita needed the budget to establish a tele-ROP screening system were estimated at over 1.5 million and 35.13 USD,respectively.The total cost of identifying and treating an ROP case in tele-screening and no screening strategies were obtained as 108.72 and 63.52 USD,respectively,and their lifetime discounted QALY gained were calculated as 15.39 and 15.11,respectively.Therefore,incremental cost-effectiveness ratio(ICER)of tele-screening strategy against the competitive strategy was achieved as 161.43 USD.CONCLUSION:Tele-ROP screening program is one of the most cost-effective interventions in the Iranian health system and has a high priority to receive a budget for implementation.

Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse;erosion;infection;transfusion;cystotomy;chronic pain;lower urinary tract symptoms;and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of $22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs for robotic surgery was $207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Cost-Effectiveness Analysis of Oral Hypoglycemics for Type-2 Diabetes Mellitus at a Tertiary Care Hospital, Nepal

An observational follow-up study on 63 newly diagnosed Type-Ⅱ diabetic patients was conducted at Tribhuvan University Teaching Hospital, a tertiary care centre, Kathmandu, Nepal. The aims of the study were to determine demographics, prescribing patterns, drug costs and to analyze the effectiveness of different hypoglycemic therapies. The effectiveness of glucose control was analyzed by Wilcoxon signed rank test. The majority of patients (31%) fell into the age strata of 50-60 years. A total of 63 prescriptions were screened including anti-diabetics drugs and other drugs. The average number of drugs per prescription sheet was 2.72 ± 2.23. Eighty-two percent (82%) of the patients were recommended oral hypoglycemic agents. The prescribing frequency of biguanides was more than sulphonylureas. Biguanides were prescribed more frequently than sulfonylureas. The biguanide monotherapy group (p = 0.001) and the combination of biguanide and sulfonylureas (p = 0.028) were the most effective treatment methods, and the p-value of fasting blood glucose was the lowest at follow-up. Nearly 55% of patients receiving the combination achieved glucose control. In summary, this study reflects the best treatment for patients with diabetes. Future studies of larger patient populations need to evaluate existing treatment models to ensure good practice and quality of care.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.

Cost-effectiveness analysis of tyrosine kinase inhibitors(erlotinib,gefitinib,afatinib and osimertinib)as first-line therapy for epidermal growth factor receptor-mutated advanced non-small cell lung cancer

Gefitinib,erlotinib,afatinib and osimertinib have been recommended as the first-line treatment for epidermal growth factor receptor(EGFR)-mutated advanced non-small cell lung cancer(NSCLC),whereas no studies have compared the cost-effectiveness of these four tyrosine kinase inhibitors(TKIs)simultaneously in China.In the present study,we aimed to estimate the cost-effectiveness of erlotinib,gefitinib,afatinib and osimertinib for untreated EGFR-mutated advanced NSCLC.A Markov model was constructed to compare the 10-year impact of four TKIs for patients with treatment-naive EGFR-mutated advanced NSCLC from the perspective of the Chinese medical system.Clinical data and utility values were derived from published literature,and costs were obtained from Chinese official websites.The primary output indicator was the incremental cost-effectiveness ratio(ICER).Sensitivity analyses were performed to test the robustness of the model.We found that afatinib was estimated to spend the lowest cost with minimum life-years(LYs),while osimertinib was the most expensive regimen with maximum LYs.The ICER of gefitinib versus afatinib was$732/quality-adjusted life-year(QALY),which was less than the willingness-to-pay(WTP)of$29382/QALY.Compared with gefitinib,erlotinib yielded a higher cost and a shorter lifetime,hence it was identified as a dominated strategy.Then,osimertinib was compared to gefitinib,which produced an ICER of$71330/QALY,exceeding the WTP.It suggested that gefitinib was the most cost-effective regimen as the first-line treatment for EGFR-mutated advanced NSCLC.Decreasing the osimertinib price or increasing the WTP threshold to$68558/QALY might enhance the favorability of the outcome,by which osimertinib might become more cost-effective.One-way sensitivity analysis manifested that the model was robust.