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 of robotic-assisted spinal surgery:A single-center retrospective study

Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.

A generalized nonlinear three-dimensional Hoek‒Brown failure criterion

To understand the strengths of rocks under complex stress states,a generalized nonlinear threedimensional(3D)Hoek‒Brown failure(NGHB)criterion was proposed in this study.This criterion shares the same parameters with the generalized HB(GHB)criterion and inherits the parameter advantages of GHB.Two new parameters,b,and n,were introduced into the NGHB criterion that primarily controls the deviatoric plane shape of the NGHB criterion under triaxial tension and compression,respectively.The NGHB criterion can consider the influence of intermediate principal stress(IPS),where the deviatoric plane shape satisfies the smoothness requirements,while the HB criterion not.This criterion can degenerate into the two modified 3D HB criteria,the Priest criterion under triaxial compression condition and the HB criterion under triaxial compression and tension condition.This criterion was verified using true triaxial test data for different parameters,six types of rocks,and two kinds of in situ rock masses.For comparison,three existing 3D HB criteria were selected for performance comparison research.The result showed that the NGHB criterion gave better prediction performance than other criteria.The prediction errors of the strength of six types of rocks and two kinds of in situ rock masses were in the range of 2.0724%-3.5091%and 1.0144%-3.2321%,respectively.The proposed criterion lays a preliminary theoretical foundation for prediction of engineering rock mass strength under complex in situ stress conditions.

Nonlinear empirical failure criterion for rocks under triaxial compression

Based on existing triaxial compression experimental data,a new empirical failure criterion with wide applicability was proposed considering hydrostatic pressure,second stress invariance,and maximum shear stress.Four fitting evaluation indicators were used to verify the consistency of the new failure criterion,and the differences with the other 6 failure criteria were discussed.The characteristics of the new failure criteria in the principal stress space were finally analyzed.The results indicate that(1)the new failure criterion exhibits strong predictive ability for triaxial experiments and has good applicability for both intact and jointed rocks;(2)the influence of hydrostatic pressure on the failure surface exhibits a non-linear trend,and different hydrostatic pressure also exhibits different distribution patterns on the deviatoric stress plane,with a distribution characteristic pattern of hexagonal snowflake-regular hexagon.The maximum shear stress has a torsional effect on the new criterion,in the three-dimensional failure surface.The parameters a and b of the rock have an impact on the failure surface morphology of the new criterion function on the offset surface.

Rockburst criterion and evaluation method for potential rockburst pit depth considering excavation damage effect

Excavation-induced disturbances in deep tunnels will lead to deterioration of rock properties and formation of excavation damaged zone(EDZ).This excavation damage effect may affect the potential rockburst pit depth.Taking two diversion tunnels of Jinping II hydropower station for example,the relationship between rockburst pit depth and excavation damage effect is first surveyed.The results indicate that the rockburst pit depth in tunnels with severe damage to rock masses is relatively large.Subsequently,the excavation-induced damage effect is characterized by disturbance factor D based on the Hoek-Brown criterion and wave velocity method.It is found that the EDZ could be further divided into a high-damage zone(HDZ)with D=1 and weak-damage zone(WDZ),and D decays from one to zero linearly.For this,a quantitative evaluation method for potential rockburst pit depth is established by presenting a three-element rockburst criterion considering rock strength,geostress and disturbance factor.The evaluation results obtained by this method match well with actual observations.In addition,the weakening of rock mass strength promotes the formation and expansion of potential rockburst pits.The potential rockburst pit depth is positively correlated with HDZ and WDZ depths,and the HDZ depth has a significant contribution to the potential rockburst pit depth.

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.

Enhanced Hoek-Brown(H-B)criterion for rocks exposed to chemical corrosion

Underground constructions often encounter water environments,where water–rock interaction can increase porosity,thereby weakening engineering rocks.Correspondingly,the failure criterion for chemically corroded rocks becomes essential in the stability analysis and design of such structures.This study enhances the applicability of the Hoek-Brown(H-B)criterion for engineering structures operating in chemically corrosive conditions by introducing a kinetic porosity-dependent instantaneous mi(KPIM).A multiscale experimental investigation,including nuclear magnetic resonance(NMR),X-ray diffraction(XRD),scanning electron microscopy(SEM),pH and ion chromatography analysis,and triaxial compression tests,is employed to quantify pore structural changes and their linkage with the strength responses of limestone under coupled chemical-mechanical(C-M)conditions.By employing ion chromatography and NMR analysis,along with incorporating the principles of free-face dissolution theory accounting for both congruent and incongruent dissolution,a kinetic chemical corrosion model is developed.This model aims to calculate the kinetic porosity alterations within rocks exposed to varying H+concentrations and durations.Subsequently,utilizing the generalized mixture rule(GMR),the kinetic porositydependent mi is formulated.Evaluation of the KPIM-enhanced H-B criterion using compression test data from 5 types of rocks demonstrated a high level of consistency between the criterion and the experimental results,with a coefficient of determination greater than 0.96,a mean absolute percentage error less than 4.84%,and a root-mean-square deviation less than 5.95 MPa.Finally,the physical significance of the porosity-dependent instantaneous mi is clarified:it serves as an indicator of a rock’s capacity to leverage the confining pressure effect.

Maximum Correntropy Criterion-Based UKF for Loosely Coupling INS and UWB in Indoor Localization

Indoor positioning is a key technology in today’s intelligent environments,and it plays a crucial role in many application areas.This paper proposed an unscented Kalman filter(UKF)based on the maximum correntropy criterion(MCC)instead of the minimummean square error criterion(MMSE).This innovative approach is applied to the loose coupling of the Inertial Navigation System(INS)and Ultra-Wideband(UWB).By introducing the maximum correntropy criterion,the MCCUKF algorithm dynamically adjusts the covariance matrices of the system noise and the measurement noise,thus enhancing its adaptability to diverse environmental localization requirements.Particularly in the presence of non-Gaussian noise,especially heavy-tailed noise,the MCCUKF exhibits superior accuracy and robustness compared to the traditional UKF.The method initially generates an estimate of the predicted state and covariance matrix through the unscented transform(UT)and then recharacterizes the measurement information using a nonlinear regression method at the cost of theMCC.Subsequently,the state and covariance matrices of the filter are updated by employing the unscented transformation on the measurement equations.Moreover,to mitigate the influence of non-line-of-sight(NLOS)errors positioning accuracy,this paper proposes a k-medoid clustering algorithm based on bisection k-means(Bikmeans).This algorithm preprocesses the UWB distance measurements to yield a more precise position estimation.Simulation results demonstrate that MCCUKF is robust to the uncertainty of UWB and realizes stable integration of INS and UWB systems.

Estimating shear strength of high-level pillars supported with cemented backfilling using the HoekeBrown strength criterion

Deep metal mines are often mined using the high-level pillars with subsequent cementation backfilling(HLSCB)mining method.At the design stage,it is therefore important to have a reasonable method for determining the shear strength of the high-level pillars(i.e.cohesion and internal friction angle)when they are supported by cemented backfilling.In this study,a formula was derived for the upper limit of the confining pressure σ3max on a high-level pillar supported by cemented backfilling in a deep metal mine.A new method of estimating the shear strength of such pillars was then proposed based on the Hoek eBrown failure criterion.Our analysis indicates that the horizontal stress σhh acting on the cemented backfill pillar can be simplified by expressing it as a constant value.A reasonable and effective value for σ3max can then be determined.The value of s3max predicted using the proposed method is generally less than 3 MPa.Within this range,the shear strength of the high-level pillar is accurately calculated using the equivalent MohreCoulomb theory.The proposed method can effectively avoid the calculation of inaccurate shear strength values for the high-level pillars when the original HoekeBrown criterion is used in the presence of large confining pressures,i.e.the situation in which the cohesion value is too large and the friction angle is too small can effectively be avoided.The proposed method is applied to a deep metal mine in China that is being excavated using the HLSCB method.The shear strength parameters of the high-level pillars obtained using the proposed method were input in the numerical simulations.The numerical results show that the recommended level heights and sizes of the high-level pillars and rooms in the mine are rational.

Three-dimensional limit variation analysis on the ultimate pullout capacity of the anchor cables based on the Hoek-Brown failure criterion

Only simplified two-dimensional model and a single failure mode are adopted to calculate the ultimate pullout capacity(UPC)of anchor cables in most previous research.This study focuses on a more comprehensive combination failure mode that consists of bond failure of an anchorage body and failure of an anchored rock mass.The three-dimensional ultimate pullout capacity of the anchor cables is calculated based on the Hoek-Brown failure criterion and variation analysis method.The numerical solution for the curvilinear function in fracture plane is obtained based on the finite difference theory,which more accurately reflects the failure state of the anchor cable,as opposed to that being assumed in advance.The results reveal that relying solely on a single failure mode for UPC calculations has limitations,as changes in parameter values not only directly impact the UPC value but also can alter the failure model and thus the calculation method.

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 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$18495.00for the XELOX group and$21,352.68 for the FOLFOX4group.The base-case analysis showed that FOLFOX4was 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.

Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn's disease in China

BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.

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.

Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

BACKGROUND Cyanoacrylate(CYA)injection can be performed using a standard upper endoscopy technique or under endoscopic ultrasound(EUS)guidance alone or in combination with coils.There is little information available on the economic impact of these treatment methods.AIM To compare the cost-effectiveness of treating gastric varices by CYA injection via upper endoscopy vs coils plus CYA guided by EUS.METHODS This was an observational,descriptive,and retrospective study.Patients were allocated into two groups:A CYA group and coils plus CYA group.The baseline characteristics were compared,and a cost analysis was performed.RESULTS Overall,36 patients were included(19 in the CYA group and 17 in the coils+CYA group).All patients in the CYA group had acute bleeding.They underwent a higher mean number of procedures(1.47 vs 1,P=0.025),and the mean volume of glue used was 2.15 vs 1.65 mL,P=0.133.The coils+CYA group showed a higher technical success rate(100%vs 84.2%),with a complication rate similar to the CYA group.The majority of CYA patients required hospitalization,and although the mean total per procedure cost was lower(United States$1350.29 vs United States$2978),the mean total treatment cost was significantly different(United States$11060.89 for CYA vs United States$3007.13 for coils+CYA,P=0.03).CONCLUSION The use of EUS-guided coils plus cyanoacrylate is more cost-effective than cyanoacrylate injection when the total costs are evaluated.Larger,randomized trials are needed to validate the cost-effectiveness of the EUS-guided approach to treat gastric varices.

Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 €/success), as compared to the DES strategy(15588 €/success). Incremental costeffectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

A failure criterion for shale considering the anisotropy and hydration based on the shear slide failure model

A failure criterion fully considering the anisotropy and hydration of shale is essential for shale formation stability evaluation.Thus,a novel failure criterion for hydration shale is developed by using Jaeger’s shear failure criterion to describe the anisotropy and using the shear strength reduction caused by clay minerals hydration to evaluate the hydration.This failure criterion is defined with four parameters in Jaeger’s shear failure criterion(S_(1),S_(2),a andφ),three hydration parameters(k,ω_(sh)andσ_(s))and two material size parameters(d and l0).The physical meanings and determining procedures of these parameters are described.The accuracy and applicability of this failure criterion are examined using the published experimental data,showing a cohesive agreement between the predicted values and the testing results,R^(2)=0.916 and AAREP(average absolute relative error percentage)of 9.260%.The error(|D_(p)|)is then discussed considering the effects ofβ(angle between bedding plane versus axial loading),moisture content and confining pressure,presenting that|Dp|increases whenβis closer to 30°,and|D_(p)|decreases with decreasing moisture content and with increasing confining pressure.Moreover,|D_(p)|is demonstrated as being sensitive to S1and being steady with decrease in the data set whenβis 0°,30°,45°and 90°.

Cost-effectiveness in Clostridium difficile treatment decision-making

AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.