Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralate...Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralateral procedure for symmetry and the potential benefit of a superior cosmetic outcome. Our aim was to examine the cost-effectiveness of this treatment strategy comparing it to standard lumpectomy in treating breast cancer patients. Methods: A literature review was performed of the probabilities and outcomes related to treatment of unilateral breast cancer via oncoplastic resection or unilateral lumpectomy. Utility score surveys were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure, additional margins excision and post-operative complications. A decision analysis tree was developed to highlight the more cost-effective strategy. An Incremental Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to check the robustness of our data. Results: Oncoplastic resection was associated with fewer positive margins relative to standard lumpectomy (10.0% versus 18%). In cases with positive margins, a greater percentage of oncoplastic resection patients chose a mastectomy compared to the lumpectomy patients (72% versus 19%). Utility scores for a successful operation favored oncoplastic resection (92.6 versus 86.55), but in instances of positive margins, favored the lumpectomy patients (74.2 versus 70.2). Decision tree analysis revealed that oncoplastic resection was more cost-effective with an ICUR of $2609.66/QALY gained. Conclusion: Oncoplastic resection represents a cost-effective strategy for the large breasted patient and provides the surgical team yet another reasonable option for the appropriate patient.展开更多
Objective: To evaluate the cost-utility of nivolumab plus chemotherapy compared with chemotherapy alone as the first-line treatment for advanced gastric, gastro-oesophageal junction, and esophageal adenocarcinoma in C...Objective: To evaluate the cost-utility of nivolumab plus chemotherapy compared with chemotherapy alone as the first-line treatment for advanced gastric, gastro-oesophageal junction, and esophageal adenocarcinoma in China. Methods: Based on CheckMate649, a partitioned survival model was carried out with a circulation cycle of 6 weeks to simulate the patient’s lifetime. Sensitivity analysis were adopted to verify the robustness of the results. Results: The results of the base-case analysis showed that both the total cost and utility of the nivolumab group were higher, and the ICUR value was CNY 267498.67/QALY, more than 3 times the GDP per capita of China in 2020. The results of deterministic sensitivity analysis indicated that the three most influential factors were the utility value of PFS state, the cost of nivolumab and the discount rate. The results of probabilistic sensitivity analysis were consistent with those of base-case analysis, proving that the results were robust. The scenario analysis illustrated that economical price of nivolumab was CNY 3652.71. Conclusions: Under the willing-to-pay threshold of three times the GDP per capita of China in 2020, compared with chemotherapy alone, nivolumab plus chemotherapy is not a cost-effective option in China.展开更多
Background:The 13‐MD is a new generic instrument developed to measure general health‐related quality of life(GHRQoL).This instrument considers all aspects of health(i.e.,physical,mental,and social)in a balanced way....Background:The 13‐MD is a new generic instrument developed to measure general health‐related quality of life(GHRQoL).This instrument considers all aspects of health(i.e.,physical,mental,and social)in a balanced way.A previous study led to minor changes in the original version of the 13‐MD.The objective of this study was to confirm the validity of the modified 13‐MD.Methods:Validity was assessed with recent data from the general population of Quebec,Canada.The meta‐dimensions and items composing the 13‐MD were also subjected to a ranking procedure,which allowed to determine the most important aspects for respondents.Results:A total of 1337 French‐speaking participants were recruited with 1099 completing the 13‐MD for validation purposes and 1084 completing the ranking procedure.The 13‐MD showed very satisfactory results and confirmed to be a valid instrument.The ranking of the meta‐dimensions revealed that“Well‐being”received the most points,followed by“Sleep and energy”and“Body functioning.”Conclusion:These results will be very useful in the continuous improvement of the 13‐MD,ultimately leading to the valuation stage(i.e.,development of a value set).展开更多
The production cycle of open-cast coal mines generally in eludes drilling, blasting, loading, hauling and coal preparation activities. Individual optimization of these activities does not mean that the whole system is...The production cycle of open-cast coal mines generally in eludes drilling, blasting, loading, hauling and coal preparation activities. Individual optimization of these activities does not mean that the whole system is optimized. This paper proposes a cost model considering all activities in mining cycle and system-wide approach to minimize the total mining cost of bench production. Since the fragmentation size and blast-hole diameter are linked to all activities of mining system, they are considered as decision variables in the problem form ul at io n. The operatio n costs are then minimized by using the evolutionary algorithm. Moreover, the impact of the change in the explosive price, and the hourly unit cost of equipment on total mining cost is quantified by sensitivity analysis. A case study is implemented to demonstrate the developed model.展开更多
目的:评价阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的经济性,为骨质疏松及骨量低下患者选择经济、有效的药物治疗方案提供参考。方法:选择Markov经济学模型,以基础用药(钙剂与维生素D3)和基础用药联合阿仑膦酸钠的随机对照试验文献数据...目的:评价阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的经济性,为骨质疏松及骨量低下患者选择经济、有效的药物治疗方案提供参考。方法:选择Markov经济学模型,以基础用药(钙剂与维生素D3)和基础用药联合阿仑膦酸钠的随机对照试验文献数据作为基线数据,使用Tree Age Pro 2011软件进行成本-效用分析。以质量调整生命年(QALY)及增量成本效用比(ICUR)作为经济学评价指标,通过单因素敏感度分析考察所建模型的稳定性。结果:基础用药组的QALY为0.704年,联合用药组的QALY为0.708年,两组间的ICUR为714 252.44。对于髋部骨折后期和发生其他骨折的人群,联合用药组均是高成本、低收益,明显不具有经济学优势;但是对于发生椎体骨折的人群,联合用药组发生骨折的累计概率明显低于基础用药组,两组间的ICUR仅为13 902.17,显示出经济学优势;对于发生髋部骨折的人群,基础用药组和联合用药组发生骨折的累计概率相同,两组间的ICUR为19 109.00,显示出经济学优势;对于发生腕部骨折的人群而言,疗效与经济性有待进一步探讨。结论:对于骨质疏松性骨折的低风险人群使用钙剂和维生素D3来预防骨折更为经济;而对于易发生椎体和髋部骨折的高风险人群,选择阿仑膦酸钠联合基础用药则兼顾了有效性与经济性。展开更多
文摘Purpose: Ablative options, beyond mastectomy, for large breasted patients with breast cancer include oncoplastic resection via reduction pattern and standard lumpectomy. Oncoplastic resection also entails a contralateral procedure for symmetry and the potential benefit of a superior cosmetic outcome. Our aim was to examine the cost-effectiveness of this treatment strategy comparing it to standard lumpectomy in treating breast cancer patients. Methods: A literature review was performed of the probabilities and outcomes related to treatment of unilateral breast cancer via oncoplastic resection or unilateral lumpectomy. Utility score surveys were used to estimate the quality adjusted life years (QALYs) associated with a successful procedure, additional margins excision and post-operative complications. A decision analysis tree was developed to highlight the more cost-effective strategy. An Incremental Cost-Utility Ratio (ICUR) was calculated. Sensitivity analysis was performed to check the robustness of our data. Results: Oncoplastic resection was associated with fewer positive margins relative to standard lumpectomy (10.0% versus 18%). In cases with positive margins, a greater percentage of oncoplastic resection patients chose a mastectomy compared to the lumpectomy patients (72% versus 19%). Utility scores for a successful operation favored oncoplastic resection (92.6 versus 86.55), but in instances of positive margins, favored the lumpectomy patients (74.2 versus 70.2). Decision tree analysis revealed that oncoplastic resection was more cost-effective with an ICUR of $2609.66/QALY gained. Conclusion: Oncoplastic resection represents a cost-effective strategy for the large breasted patient and provides the surgical team yet another reasonable option for the appropriate patient.
文摘Objective: To evaluate the cost-utility of nivolumab plus chemotherapy compared with chemotherapy alone as the first-line treatment for advanced gastric, gastro-oesophageal junction, and esophageal adenocarcinoma in China. Methods: Based on CheckMate649, a partitioned survival model was carried out with a circulation cycle of 6 weeks to simulate the patient’s lifetime. Sensitivity analysis were adopted to verify the robustness of the results. Results: The results of the base-case analysis showed that both the total cost and utility of the nivolumab group were higher, and the ICUR value was CNY 267498.67/QALY, more than 3 times the GDP per capita of China in 2020. The results of deterministic sensitivity analysis indicated that the three most influential factors were the utility value of PFS state, the cost of nivolumab and the discount rate. The results of probabilistic sensitivity analysis were consistent with those of base-case analysis, proving that the results were robust. The scenario analysis illustrated that economical price of nivolumab was CNY 3652.71. Conclusions: Under the willing-to-pay threshold of three times the GDP per capita of China in 2020, compared with chemotherapy alone, nivolumab plus chemotherapy is not a cost-effective option in China.
基金the ethics committee of the CIUSSS de l'Est de l’île de Montréal(#2021‐2389).
文摘Background:The 13‐MD is a new generic instrument developed to measure general health‐related quality of life(GHRQoL).This instrument considers all aspects of health(i.e.,physical,mental,and social)in a balanced way.A previous study led to minor changes in the original version of the 13‐MD.The objective of this study was to confirm the validity of the modified 13‐MD.Methods:Validity was assessed with recent data from the general population of Quebec,Canada.The meta‐dimensions and items composing the 13‐MD were also subjected to a ranking procedure,which allowed to determine the most important aspects for respondents.Results:A total of 1337 French‐speaking participants were recruited with 1099 completing the 13‐MD for validation purposes and 1084 completing the ranking procedure.The 13‐MD showed very satisfactory results and confirmed to be a valid instrument.The ranking of the meta‐dimensions revealed that“Well‐being”received the most points,followed by“Sleep and energy”and“Body functioning.”Conclusion:These results will be very useful in the continuous improvement of the 13‐MD,ultimately leading to the valuation stage(i.e.,development of a value set).
文摘The production cycle of open-cast coal mines generally in eludes drilling, blasting, loading, hauling and coal preparation activities. Individual optimization of these activities does not mean that the whole system is optimized. This paper proposes a cost model considering all activities in mining cycle and system-wide approach to minimize the total mining cost of bench production. Since the fragmentation size and blast-hole diameter are linked to all activities of mining system, they are considered as decision variables in the problem form ul at io n. The operatio n costs are then minimized by using the evolutionary algorithm. Moreover, the impact of the change in the explosive price, and the hourly unit cost of equipment on total mining cost is quantified by sensitivity analysis. A case study is implemented to demonstrate the developed model.
文摘目的:评价阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的经济性,为骨质疏松及骨量低下患者选择经济、有效的药物治疗方案提供参考。方法:选择Markov经济学模型,以基础用药(钙剂与维生素D3)和基础用药联合阿仑膦酸钠的随机对照试验文献数据作为基线数据,使用Tree Age Pro 2011软件进行成本-效用分析。以质量调整生命年(QALY)及增量成本效用比(ICUR)作为经济学评价指标,通过单因素敏感度分析考察所建模型的稳定性。结果:基础用药组的QALY为0.704年,联合用药组的QALY为0.708年,两组间的ICUR为714 252.44。对于髋部骨折后期和发生其他骨折的人群,联合用药组均是高成本、低收益,明显不具有经济学优势;但是对于发生椎体骨折的人群,联合用药组发生骨折的累计概率明显低于基础用药组,两组间的ICUR仅为13 902.17,显示出经济学优势;对于发生髋部骨折的人群,基础用药组和联合用药组发生骨折的累计概率相同,两组间的ICUR为19 109.00,显示出经济学优势;对于发生腕部骨折的人群而言,疗效与经济性有待进一步探讨。结论:对于骨质疏松性骨折的低风险人群使用钙剂和维生素D3来预防骨折更为经济;而对于易发生椎体和髋部骨折的高风险人群,选择阿仑膦酸钠联合基础用药则兼顾了有效性与经济性。
