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Elliott RA, Rogers G, Evans ML, Neupane S, Rayman G, Lumley S, Cranston I, Narendran P, Sutton CJ, Taxiarchi VP, Burns M, Thabit H, Wilmot EG, Leelarathna L. Estimating the cost-effectiveness of intermittently scanned continuous glucose monitoring in adults with type 1 diabetes in England. Diabet Med 2024; 41:e15232. [PMID: 37750427 DOI: 10.1111/dme.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE We previously showed that intermittently scanned continuous glucose monitoring (isCGM) reduces HbA1c at 24 weeks compared with self-monitoring of blood glucose with finger pricking (SMBG) in adults with type 1 diabetes and high HbA1c levels (58-97 mmol/mol [7.5%-11%]). We aim to assess the economic impact of isCGM compared with SMBG. METHODS Participant-level baseline and follow-up health status (EQ-5D-5L) and within-trial healthcare resource-use data were collected. Quality-adjusted life-years (QALYs) were derived at 24 weeks, adjusting for baseline EQ-5D-5L. Participant-level costs were generated. Using the IQVIA CORE Diabetes Model, economic analysis was performed from the National Health Service perspective over a lifetime horizon, discounted at 3.5%. RESULTS Within-trial EQ-5D-5L showed non-significant adjusted incremental QALY gain of 0.006 (95% CI: -0.007 to 0.019) for isCGM compared with SMBG and an adjusted cost increase of £548 (95% CI: 381-714) per participant. The lifetime projected incremental cost (95% CI) of isCGM was £1954 (-5108 to 8904) with an incremental QALY (95% CI) gain of 0.436 (0.195-0.652) resulting in an incremental cost-per-QALY of £4477. In all subgroups, isCGM had an incremental cost-per-QALY better than £20,000 compared with SMBG; for people with baseline HbA1c >75 mmol/mol (9.0%), it was cost-saving. Sensitivity analysis suggested that isCGM remains cost-effective if its effectiveness lasts for at least 7 years. CONCLUSION While isCGM is associated with increased short-term costs, compared with SMBG, its benefits in lowering HbA1c will lead to sufficient long-term health-gains and cost-savings to justify costs, so long as the effect lasts into the medium term.
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Affiliation(s)
- Rachel A Elliott
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, Division of Population Health, Health Service Research & Primary Care, University of Manchester, Manchester, UK
| | - Mark L Evans
- Wellcome-MRC Institute of Metabolic Science, NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals and University of Cambridge, Cambridge, UK
| | - Sankalpa Neupane
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Gerry Rayman
- The Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | | | - Iain Cranston
- Academic Department of Diabetes & Endocrinology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher J Sutton
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vicky P Taxiarchi
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew Burns
- Manchester Clinical Trials Unit, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK
| | - Hood Thabit
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Emma G Wilmot
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Lalantha Leelarathna
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Guthrie B, Rogers G, Livingstone S, Morales DR, Donnan P, Davis S, Youn JH, Hainsworth R, Thompson A, Payne K. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. Health Soc Care Deliv Res 2024; 12:1-275. [PMID: 38420962 DOI: 10.3310/kltr7714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing to account for direct treatment disutility (i.e. the hassle of taking treatments). We explored these issues using two case studies: primary prevention of cardiovascular disease using statins and osteoporotic fracture using bisphosphonates. Objectives Externally validate three risk prediction tools [QRISK®3, QRISK®-Lifetime, QFracture-2012 (ClinRisk Ltd, Leeds, UK)]; derive and internally validate new risk prediction tools for cardiovascular disease [competing mortality risk model with Charlson Comorbidity Index (CRISK-CCI)] and fracture (CFracture), accounting for competing-cause death; quantify direct treatment disutility for statins and bisphosphonates; and examine the effect of competing risks and direct treatment disutility on the cost-effectiveness of preventative treatments. Design, participants, main outcome measures, data sources Discrimination and calibration of risk prediction models (Clinical Practice Research Datalink participants: aged 25-84 years for cardiovascular disease and aged 30-99 years for fractures); direct treatment disutility was elicited in online stated-preference surveys (people with/people without experience of statins/bisphosphonates); costs and quality-adjusted life-years were determined from decision-analytic modelling (updated models used in National Institute for Health and Care Excellence decision-making). Results CRISK-CCI has excellent discrimination, similar to that of QRISK3 (Harrell's c = 0.864 vs. 0.865, respectively, for women; and 0.819 vs. 0.834, respectively, for men). CRISK-CCI has systematically better calibration, although both models overpredict in high-risk subgroups. People recommended for treatment (10-year risk of ≥ 10%) are younger when using QRISK-Lifetime than when using QRISK3, and have fewer observed events in a 10-year follow-up (4.0% vs. 11.9%, respectively, for women; and 4.3% vs. 10.8%, respectively, for men). QFracture-2012 underpredicts fractures, owing to under-ascertainment of events in its derivation. However, there is major overprediction among people aged 85-99 years and/or with multiple long-term conditions. CFracture is better calibrated, although it also overpredicts among older people. In a time trade-off exercise (n = 879), statins exhibited direct treatment disutility of 0.034; for bisphosphonates, it was greater, at 0.067. Inconvenience also influenced preferences in best-worst scaling (n = 631). Updated cost-effectiveness analysis generates more quality-adjusted life-years among people with below-average cardiovascular risk and fewer among people with above-average risk. If people experience disutility when taking statins, the cardiovascular risk threshold at which benefits outweigh harms rises with age (≥ 8% 10-year risk at 40 years of age; ≥ 38% 10-year risk at 80 years of age). Assuming that everyone experiences population-average direct treatment disutility with oral bisphosphonates, treatment is net harmful at all levels of risk. Limitations Treating data as missing at random is a strong assumption in risk prediction model derivation. Disentangling the effect of statins from secular trends in cardiovascular disease in the previous two decades is challenging. Validating lifetime risk prediction is impossible without using very historical data. Respondents to our stated-preference survey may not be representative of the population. There is no consensus on which direct treatment disutilities should be used for cost-effectiveness analyses. Not all the inputs to the cost-effectiveness models could be updated. Conclusions Ignoring competing mortality in risk prediction overestimates the risk of cardiovascular events and fracture, especially among older people and those with multimorbidity. Adjustment for competing risk does not meaningfully alter cost-effectiveness of these preventative interventions, but direct treatment disutility is measurable and has the potential to alter the balance of benefits and harms. We argue that this is best addressed in individual-level shared decision-making. Study registration This study is registered as PROSPERO CRD42021249959. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/12/22) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Shona Livingstone
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Peter Donnan
- Population Health and Genomics Division, University of Dundee, Dundee, UK
| | - Sarah Davis
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Hainsworth R, Thompson AJ, Guthrie B, Payne K, Rogers G. International Systematic Review of Utility Values Associated with Cardiovascular Disease and Reflections on Selecting Evidence for a UK Decision-Analytic Model. Med Decis Making 2024; 44:217-234. [PMID: 38174427 PMCID: PMC10865747 DOI: 10.1177/0272989x231214782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to 1) systematically review utility estimates for CVDs published since 2013 and 2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. METHODS We searched MEDLINE and Embase (April 22, 2021) using CVD and utility terms. We screened results for primary studies reporting utility distributions for people with experience of heart failure, myocardial infarction, peripheral arterial disease, stable angina, stroke, transient ischemic attack, or unstable angina. We extracted characteristics from studies included. For UK estimates based on the EuroQoL 5-dimension (EQ-5D) measure, we assessed risk of bias and applicability to a decision-analytic model, pooled arms/time points as appropriate, and estimated baseline utility multipliers using predicted utility for age- and sex- matched populations without CVD. We sought utility sources from directly applicable studies with low risk of bias, prioritizing plausibility of severity ordering in our base-case model and highest population ascertainment in a sensitivity analysis. RESULTS Most of the 403 studies identified used EQ-5D (n = 217) and most assessed Organisation for Economic Co-operation and Development populations (n = 262), although measures and countries varied widely. UK studies using EQ-5D (n = 29) produced very heterogeneous baseline utility multipliers for each type of CVD, precluding meta-analysis and implying different possible severity orderings. We could find sources that provided a plausible ordering of utilities while adequately representing health states. CONCLUSIONS We cataloged international CVD utility estimates and calculated UK-relevant baseline utility multipliers. Modelers should consider unreported sources of heterogeneity, such as population differences, when selecting utility evidence from reviews. HIGHLIGHTS Published systematic reviews have summarized estimates of utility associated with cardiovascular disease published up to 2013.We 1) reviewed utility estimates for 7 types of cardiovascular disease published since 2013, 2) critically appraised UK-relevant studies, and 3) estimated the effect of each cardiovascular disease on baseline utility.Our review 1) recommends a consistent and reliable set of baseline utility multipliers for 7 types of cardiovascular disease and 2) provides systematically identified reference information for researchers seeking utility evidence for their own context.
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Affiliation(s)
- Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander J. Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Rogers G. Care to Ease the Slope? Differences in Canadian and Californian Medical Assistance in Dying Laws. Am J Bioeth 2023; 23:113-115. [PMID: 37879022 DOI: 10.1080/15265161.2023.2256266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- G Rogers
- Institute for Religion & Critical Inquiry, Australian Catholic University
- Queensland Bioethics Centre, Australian Catholic University
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Thompson A, Youn JH, Guthrie B, Hainsworth R, Donnan P, Rogers G, Morales D, Payne K. Quantifying the impact of taking medicines for primary prevention: a time-trade off study to elicit direct treatment disutility in the UK. BMJ Open 2023; 13:e063800. [PMID: 37734893 PMCID: PMC10514632 DOI: 10.1136/bmjopen-2022-063800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/03/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Direct treatment disutility (DTD) represents an individual's disutility associated with the inconvenience of taking medicine over a long period of time. OBJECTIVES The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence DTD values. METHODS Design: We used a cross-sectional study consisting of time-trade off exercises embedded within online surveys. Respondents were asked to compare a one-off pill ('Medicine A') assumed to have no inconvenience and a daily pill ('Medicine B') over 10 years (statins) or 5 years (bisphosphonates).Setting: Individuals from National Health Service (NHS) primary care and the general population were surveyed using an online panel company.Participants: Two types of participants were recruited. First, a purposive sample of patients with experience of taking a statin (n=260) or bisphosphonate (n=100) were recruited from an NHS sampling frame. Patients needed to be aged over 30, have experience of taking the medicine of interest and have no diagnosis of dementia or of using dementia drugs. Second, a demographically balanced sample of members of the public were recruited for statins (n=376) and bisphosphonates (n=359).Primary and secondary outcome measures: Primary outcome was mean DTD. Regression analysis explored factors which could influence DTD values. RESULTS A total of 879 respondents were included for analysis (514 for statins and 365 for bisphosphonates). The majority of respondents reported a disutility associated with medicine use. Mean DTD for statins was 0.034 and for bisphosphonates 0.067, respectively. Respondent characteristics including age and sex did not influence DTD. Experience of bisphosphonate-use reduced reported disutilities. CONCLUSIONS Statins and bisphosphonates have a quantifiable DTD. The size of estimated disutilities suggest they are likely to be important for cost-effectiveness, particularly in individuals at low-risk when treated for primary prevention.
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Affiliation(s)
- Alexander Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Ji-Hee Youn
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Robert Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Peter Donnan
- Dundee Epidemiology and Biostatistics Unit, University of Dundee, Dundee, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Daniel Morales
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Hubbard W, Walsh N, Hudson T, Heath A, Dietz J, Rogers G. Development and validation of paired MEDLINE and Embase search filters for cost-utility studies. BMC Med Res Methodol 2022; 22:310. [PMID: 36463100 PMCID: PMC9719242 DOI: 10.1186/s12874-022-01796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Search filters are standardised sets of search terms, with validated performance, that are designed to retrieve studies with specific characteristics. A cost-utility analysis (CUA) is the preferred type of economic evaluation to underpin decision-making at the National Institute for Health and Care Excellence (NICE). Until now, when searching for economic evidence for NICE guidelines, we have used a broad set of health economic-related search terms, even when the reviewer's interest is confined to CUAs alone. METHODS We developed search filters to retrieve CUAs from MEDLINE and Embase. Our aim was to achieve recall of 90% or better across both databases while reducing the overall yield compared with our existing broad economic filter. We used the relative recall method along with topic expert input to derive and validate 3 pairs of filters, assessed by their ability to identify a gold-standard set of CUAs that had been used in published NICE guidelines. We developed and validated MEDLINE and Embase filters in pairs (testing whether, when used together, they find target studies in at least 1 database), as this is how they are used in practice. We examined the proxy-precision of our new filters by comparing their overall yield with our previous approach using publications indexed in a randomly selected year (2010). RESULTS All 3 filter-pairs exceeded our target recall and led to substantial improvements in search proxy-precision. Our paired 'sensitive' filters achieved 100% recall (95% CI 99.0 to 100%) in the validation set. Our paired 'precise' filters also had very good recall (97.6% [95%CI: 95.4 to 98.9%]). We estimate that, compared with our previous search strategy, using the paired 'sensitive' filters would reduce reviewer screening burden by a factor of 5 and the 'precise' versions would do so by a factor of more than 20. CONCLUSIONS Each of the 3 paired cost-utility filters enable the identification of almost all CUAs from MEDLINE and Embase from the validation set, with substantial savings in screening workload compared to our previous search practice. We would encourage other researchers who regularly use multiple databases to consider validating search filters in combination as this will better reflect how they use databases in their everyday work.
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Affiliation(s)
- Wesley Hubbard
- grid.416710.50000 0004 1794 1878National Institute for Health and Care Excellence, Level 1A City Tower Piccadilly Plaza, M1 4BT Manchester, UK
| | - Nicola Walsh
- grid.416710.50000 0004 1794 1878National Institute for Health and Care Excellence, Level 1A City Tower Piccadilly Plaza, M1 4BT Manchester, UK
| | - Thomas Hudson
- grid.416710.50000 0004 1794 1878National Institute for Health and Care Excellence, Level 1A City Tower Piccadilly Plaza, M1 4BT Manchester, UK
| | - Andrea Heath
- grid.416710.50000 0004 1794 1878National Institute for Health and Care Excellence, Level 1A City Tower Piccadilly Plaza, M1 4BT Manchester, UK
| | - Jeremy Dietz
- grid.416710.50000 0004 1794 1878National Institute for Health and Care Excellence, Level 1A City Tower Piccadilly Plaza, M1 4BT Manchester, UK
| | - Gabriel Rogers
- grid.5379.80000000121662407Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, The University of Manchester, Jean McFarlane Building, Oxford Road, M13 9PL Manchester, UK
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Dietz J, Plumb J, Banfield P, Soe A, Chehadah F, Chang-Douglass S, Rogers G. Immediate birth for women between 34 and 37 weeks of gestation with prolonged preterm prelabour rupture of membranes and detection of vaginal or urine group B streptococcus: an economic evaluation. BJOG 2022; 129:1779-1789. [PMID: 35137528 PMCID: PMC9543209 DOI: 10.1111/1471-0528.17119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Objective What are the costs, benefits and harms of immediate birth compared with expectant management in women with prolonged preterm prelabour rupture of membranes (PPROM) at 34+0–36+6 weeks of gestation and detection of vaginal or urine group B streptococcus (GBS)? Design Mathematical decision model comprising three independent decision trees. Setting UK National Health Service (NHS) and personal social services perspective. Population Women testing positive for GBS with PPROM at 34+0–36+6 weeks of gestation. Methods The model estimates lifetime costs and quality‐adjusted life years (QALYs) using evidence from randomised trials, UK NHS data sources and further observational studies. Simulated events include neonatal infections, morbidity associated with preterm birth and consequences of caesarean birth. Deterministic and probabilistic sensitivity analyses (PSAs) were performed. Main outcome measures QALYs, costs and incremental cost‐effectiveness ratio (ICER). Results In this population, immediate birth dominates expectant management: it is more effective (average lifetime QALYs, 24.705 versus 24.371) and it is cheaper (average lifetime costs, £14,372 versus £19,311). In one‐way sensitivity analysis, results are robust to all but the odds ratio estimating the relative effect on incidence of infections. Threshold analysis shows that the odds of infection only need to be >1.5% with expectant management for the benefit of avoiding infections to outweigh the disadvantages of immediate birth. In PSA, immediate birth is the preferred option in >80% of simulations. Conclusions Neonatal GBS infections are expensive to treat and may result in substantial adverse health consequences. Therefore, immediate birth, which is associated with a reduced risk of neonatal infection compared with expectant management, is expected to generate better health outcomes and decreased lifetime costs. Tweetable abstract For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management. For women with preterm prelabour rupture of membranes and group B streptococcus in vaginal or urine samples, immediate birth is associated with improved health in their babies and reduced costs, compared with expectant management.
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Affiliation(s)
- Jeremy Dietz
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), London, UK
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, West Sussex, UK
| | | | - Aung Soe
- Oliver Fisher Neonatal Unit, Medway Maritime Hospital, Gillingham, Kent, UK
| | - Fadi Chehadah
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), Manchester, UK
| | - Stacey Chang-Douglass
- Centre for Guidelines, National Institute for Health and Care Excellence (NICE), London, UK
| | - Gabriel Rogers
- Division of Population Health, Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Barrett T, Khwaja A, Carmona C, Martinez Y, Nicholas H, Rogers G, Wierzbicki AS, Lewington AJP. Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media. Clin Radiol 2020; 76:193-199. [PMID: 33390251 DOI: 10.1016/j.crad.2020.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The National Institute for Health and Care Excellence (NICE) has recently updated the guideline for Acute kidney injury: prevention, detection and management (NG148), providing new recommendations on preventing acute kidney injury (AKI) in adults receiving intravenous iodine-based contrast media. The association between intravenous iodinated contrast media and AKI is controversial, particularly with widespread use of iso-osmolar agents. Associations between contrast media administration and AKI are largely based on observational studies, with inherent heterogeneity in patient populations, definitions applied, and timing of laboratory investigations. In an attempt to mitigate risk, kidney protection has typically been employed using intravenous volume expansion and/or oral acetylcysteine. Such interventions are in widespread use, despite lacking high-quality evidence of benefit. In the non-emergency setting, glomerular filtration rate (GFR) measurements should be obtained within the preceding 3 months before offering intravenous iodine-based contrast media. In the acute setting, adults should also have their risk of AKI assessed before offering intravenous iodine-based contrast media; however, this should not delay emergency imaging. Based on the evidence available from randomised controlled trials, the NICE committee recommends that oral hydration should be encouraged in adults at increased risk of AKI and that volume expansion with intravenous V fluids should only be considered for inpatients at particularly high risk.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Khwaja
- Renal Department, Sheffield Kidney Institute, Northern General Hospital, Sheffield S5 7AU, UK
| | - C Carmona
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - Y Martinez
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - H Nicholas
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - G Rogers
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - A S Wierzbicki
- Department of Chemical Pathology, Guy's & St. Thomas' Hospitals, London, UK
| | - A J P Lewington
- Renal Department, St. James's University Hospital, Beckett Street Leeds, LS9 7TF, UK
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Gilberg F, Hong A, Dréno B, Rogers G, Kunstfeld R. Quality‐of‐life analysis with intermittent vismodegib regimens in patients with multiple basal cell carcinomas: patient‐reported outcomes from the MIKIE study. J Eur Acad Dermatol Venereol 2020; 34:e526-e529. [DOI: 10.1111/jdv.16446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - A. Hauschild
- University Hospital Schleswig‐Holstein Kiel Germany
| | - S. Fosko
- Saint Louis University Medical School St. Louis MO USA
| | - D. Zloty
- University of British Columbia Vancouver BC Canada
| | - B. Labeille
- University Hospital of Saint‐Etienne Saint‐Priest‐en‐Jarez France
| | - J.‐J. Grob
- Aix‐Marseille University Marseille France
- Timone Hospital Marseille France
| | - S. Puig
- Hospital Clinic de Barcelona University of BarcelonaIDIBAPS (Institut d’Investigacions Biomediques August Pi i Sunyer) Barcelona Spain
- Centro de Investigación Biomedica en Red de Enfermedades Raras (CIBER ER) Barcelona Spain
| | | | - F. Gilberg
- F. Hoffmann‐La Roche Ltd Basel Switzerland
| | - A. Hong
- Genentech, Inc. South San Francisco CA USA
| | | | - G. Rogers
- Tufts University School of Medicine Boston MA USA
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Rosenthal Gelman C, Ghesquiere A, Rogers G, Williams L, Notto A. Elder Abuse, Mistreatment, and Interventions. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - G Rogers
- Brookdale Center for Healthy Aging
| | - L Williams
- Texas Department of Family and Protective Services
| | - A Notto
- Texas Department of Family and Protective Services
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Scott TM, Rogers G, Weiner DE, Livingston K, Selhub J, Jacques PF, Rosenberg IH, Troen AM. B-Vitamin Therapy for Kidney Transplant Recipients Lowers Homocysteine and Improves Selective Cognitive Outcomes in the Randomized FAVORIT Ancillary Cognitive Trial. J Prev Alzheimers Dis 2018; 4:174-182. [PMID: 29182708 DOI: 10.14283/jpad.2017.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Objectives: Elevated plasma total homocysteine (tHcy) is associated with increased risk of cardiovascular disease, stroke and dementia. Results of clinical trials using B-vitamins to reduce the cognitive risks attributed to tHcy have been inconsistent. The high prevalence of both hyperhomocysteinemia and cognitive impairment among kidney transplant recipients makes them an important population in which to evaluate the effect of lowering homocysteine on cognitive function. We therefore evaluated whether B-vitamin therapy to lower tHcy would prevent cognitive-decline in a cohort of stable kidney transplant recipients. DESIGN The study was a longitudinal ancillary of the FAVORIT trial, a randomized, placebo-controlled multi-site trial of high-dose B vitamins to reduce cardiovascular and cerebrovascular events in clinically stable kidney transplant recipients with elevated tHcy. PARTICIPANTS 584 participants from 18 sites across North America. INTERVENTION The intervention consisted of a daily multivitamin containing high-doses of folate (5.0 mg), vitamin B12 (1.0 mg) and vitamin B6 (50 mg). The placebo consisted of a daily multi-vitamin containing no folate and recommended daily allowances of vitamins B12 and B6 (0 mg folate; 2.0 µg vitamin B12; 1.4 mg vitamin B6). MEASUREMENTS Annual neuropsychological assessment for up to 5 years (mean 3.3 years) using a standardized test battery. Efficacy was analyzed on an intention-to-treat basis using end-of-trial data. Subgroup analyses included stratification for baseline plasma B-vitamin and tHcy concentrations. RESULTS At baseline, cognitive impairment was common with 61% of participants falling more than one standard deviation below published norms for at least one cognitive test. Fewer than 1% of participants had insufficient plasma folate < 5 ng/ml or vitamin B12 < 148 pmol/L. However, 44.6% had plasma B6 concentrations < 30 nmol/L. At follow-up, processing speed and memory scores were modestly but significantly better in the B-vitamin supplement group than in controls (p≤0.05). There was no interaction between baseline tHcy, B-vitamin status and treatment on the cognitive outcomes. CONCLUSIONS High-dose B-vitamin supplementation provided modest cognitive benefit for kidney transplant recipients with elevated baseline tHcy. Since nearly all participants were folate and vitamin B12 sufficient at baseline, the potential cognitive benefits of folate and B12 supplementation in individuals with poor B-vitamin status remains to be determined.
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Affiliation(s)
- T M Scott
- Prof. Aron M. Troen, Director, Nutrition and Brain Health Laboratory, Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 76100, Israel, Phone ++972-54-8820420, E-mail:
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Stockwell R, Leong L, Wheeler N, Bryant J, Wood M, Sherrard L, Thomson R, Rogers G, Wainwright C, Parkhill J, Floto R, Bell S. P058 Prevalence of shared Mycobacterium abscessus complex (MABSC) in the Queensland cystic fibrosis population. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fischer D, Kelleher D, Rogers G. Standardized Patient Simulation in a Didactic Program Utilizing Dietetic Interns as Actors. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Gabriel Rogers
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
| | | | - Joshua Pink
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
| | - Paul Cooper
- Greater Manchester Neuroscience Centre, Salford, UK
- University of Manchester, Manchester, UK
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Gelman C, Ghesquiere A, Halarewicz A, Rogers G. OPENING THE DOOR: A TRAINING PROMOTING ENGAGEMENT SKILLS IN ADULT PROTECTIVE SERVICES WORKERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C.R. Gelman
- Silberman School of Social Work, Hunter College, New York, New York,
- Silberman Center of Excellence in Diverse Aging, New York, New York,
| | - A. Ghesquiere
- Brookdale Center for Healthy Aging, New York, New York
| | - A. Halarewicz
- Silberman School of Social Work, Hunter College, New York, New York,
| | - G. Rogers
- Brookdale Center for Healthy Aging, New York, New York
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Affiliation(s)
| | - Nicola Goodson
- Rheumatology Research group, Department of Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool L69 3BX, UK
| | - Louise Warburton
- Shropshire Community Health NHS Trust, Shrewsbury SY3 8XL, UK
- Department of Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK
| | - Gabriel Rogers
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
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Rogers G. Microbiota composition and disease severity in bronchiectasis. Pneumologie 2016. [DOI: 10.1055/s-0036-1592243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Templeton I, Rogers G, Dreno B, Kunstfeld R. Evaluation of the pharmacokinetic (PK) profile of vismodegib (VISMO) in patients (pts) with multiple basal cell carcinomas (BCCs) across two intermittent treatment regimens in the MIKIE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
CASE HISTORY A herd of Holstein, Jersey, or Holstein-Jersey cross lactating cattle of mixed ages presented with a sudden drop in milk yield in 94/678 cows on 3 October 2014 (Day 0). The herd was located in Gretna in the Derwent Valley (Tasmania, Australia) and had been grazing dryland pasture. CLINICAL FINDINGS On Day 0 the cows variably showed recumbency, peracute photosensitisation, inflamed coronary bands, conjunctival erythema, periauricular oedema, distress indicated by kicking at the flank, bruxism, discomfort, weight shifting, vocalisation indicating pain and depression. Blood samples collected on Day 4 from five clinically affected cows showed high activities of aspartate aminotransferase, glutamate dehydrogenase and gamma-glutamyl transferase. Morbidity, based on the number of treated cases within 72 hours of clinical onset, was estimated at 165/678 cows (24.3%). Mortality over the first 30 days was 19/678 cows (2.8%). PATHOLOGICAL FINDINGS Necropsies of two cows on Day 4 showed marked distension of the gall bladder and extensive icterus. Necropsies of another two cows on Day 5 showed enlarged livers with severe damage and oedema of the distal abomasum. Severe ulcerative abomasal gastritis was present in both cows. Hepatic histopathology was consistent with chronic cholangiohepatitis. MYCOTOXICOLOGY Fifty-five different mycotoxins were detected from a barley grass (Hordeum murinum) sample from the presumably contaminated pasture. Concentrations of B-trichothecenes, fumonisins, and zearalenone metabolites from this sample were remarkably high. The leaf smut, Jamesdicksonia dactylidis, that has not been previously reported in Tasmania, was identified from the sample of barley grass, but it is not known whether the smut can produce toxins. DIAGNOSIS Probably an undescribed peracute mycotoxicosis associated with the ingestion of contaminated dryland pasture. CLINICAL RELEVANCE A definitive diagnosis could not be reached in this case of acute photosensitisation and mortality in dairy cattle grazing possibly contaminated dryland pasture. The findings differed from both facial eczema and acute bovine liver disease, suggesting an undescribed mycotoxicosis.
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Affiliation(s)
- H M Golder
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
| | - N Moss
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
| | - G Rogers
- b Dairy Systems , 6745 Lyell Highway, Ouse 7140 , TAS , Australia
| | - B Jackson
- c Department of Primary Industries Parks Water and Environment , Biosecurity Tasmania , PO Box 46, Kings Meadows , TAS , Australia
| | - N Gannon
- d Biomin Australia Pty Ltd , Level 4, 56 Clarence St, Sydney 2000 , NSW , Australia
| | - Ptw Wong
- e Plant Breeding Institute , The University of Sydney , 107 Cobbitty Rd, Cobbitty 2570 , NSW , Australia
| | - I J Lean
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
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Gladstone GR, Stern SA, Ennico K, Olkin CB, Weaver HA, Young LA, Summers ME, Strobel DF, Hinson DP, Kammer JA, Parker AH, Steffl AJ, Linscott IR, Parker JW, Cheng AF, Slater DC, Versteeg MH, Greathouse TK, Retherford KD, Throop H, Cunningham NJ, Woods WW, Singer KN, Tsang CCC, Schindhelm E, Lisse CM, Wong ML, Yung YL, Zhu X, Curdt W, Lavvas P, Young EF, Tyler GL, Bagenal F, Grundy WM, McKinnon WB, Moore JM, Spencer JR, Andert T, Andrews J, Banks M, Bauer B, Bauman J, Barnouin OS, Bedini P, Beisser K, Beyer RA, Bhaskaran S, Binzel RP, Birath E, Bird M, Bogan DJ, Bowman A, Bray VJ, Brozovic M, Bryan C, Buckley MR, Buie MW, Buratti BJ, Bushman SS, Calloway A, Carcich B, Conard S, Conrad CA, Cook JC, Cruikshank DP, Custodio OS, Ore CMD, Deboy C, Dischner ZJB, Dumont P, Earle AM, Elliott HA, Ercol J, Ernst CM, Finley T, Flanigan SH, Fountain G, Freeze MJ, Green JL, Guo Y, Hahn M, Hamilton DP, Hamilton SA, Hanley J, Harch A, Hart HM, Hersman CB, Hill A, Hill ME, Holdridge ME, Horanyi M, Howard AD, Howett CJA, Jackman C, Jacobson RA, Jennings DE, Kang HK, Kaufmann DE, Kollmann P, Krimigis SM, Kusnierkiewicz D, Lauer TR, Lee JE, Lindstrom KL, Lunsford AW, Mallder VA, Martin N, McComas DJ, McNutt RL, Mehoke D, Mehoke T, Melin ED, Mutchler M, Nelson D, Nimmo F, Nunez JI, Ocampo A, Owen WM, Paetzold M, Page B, Pelletier F, Peterson J, Pinkine N, Piquette M, Porter SB, Protopapa S, Redfern J, Reitsema HJ, Reuter DC, Roberts JH, Robbins SJ, Rogers G, Rose D, Runyon K, Ryschkewitsch MG, Schenk P, Sepan B, Showalter MR, Soluri M, Stanbridge D, Stryk T, Szalay JR, Tapley M, Taylor A, Taylor H, Umurhan OM, Verbiscer AJ, Versteeg MH, Vincent M, Webbert R, Weidner S, Weigle GE, White OL, Whittenburg K, Williams BG, Williams K, Williams S, Zangari AM, Zirnstein E. The atmosphere of Pluto as observed by New Horizons. Science 2016; 351:aad8866. [PMID: 26989258 DOI: 10.1126/science.aad8866] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- G. Randall Gladstone
- Southwest Research Institute, San Antonio, TX 78238, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - S. Alan Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - Kimberly Ennico
- National Aeronautics and Space Administration, Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | | | - Harold A. Weaver
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | | | - David P. Hinson
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | | | | | | | | | | | - Andrew F. Cheng
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | | | - Kurt D. Retherford
- Southwest Research Institute, San Antonio, TX 78238, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Henry Throop
- The Johns Hopkins University, Baltimore, MD 21218, USA
| | | | | | | | | | | | - Carey M. Lisse
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - Yuk L. Yung
- California Institute of Technology, Pasadena, CA 91125, USA
| | - Xun Zhu
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - Werner Curdt
- Max-Planck-Institut für Sonnensystemforschung, 37191 Katlenburg-Lindau, Germany
| | - Panayotis Lavvas
- Groupe de Spectroscopie Moléculaire et Atmosphérique, Université Reims Champagne-Ardenne, 51687 Reims, France
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Dudziak J, Bolton N, McNeil G, Paul V, Raithatha A, Rogers G, Booker K, Lima E, Jeanrenaud P, Sim K, Wong C, Mohammed A, Mahendran V, Welters I, Tridente A. The fice course and qualification - experience from the cheshire and merseyside group. Intensive Care Med Exp 2015. [PMCID: PMC4798501 DOI: 10.1186/2197-425x-3-s1-a610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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Stern SA, Bagenal F, Ennico K, Gladstone GR, Grundy WM, McKinnon WB, Moore JM, Olkin CB, Spencer JR, Weaver HA, Young LA, Andert T, Andrews J, Banks M, Bauer B, Bauman J, Barnouin OS, Bedini P, Beisser K, Beyer RA, Bhaskaran S, Binzel RP, Birath E, Bird M, Bogan DJ, Bowman A, Bray VJ, Brozovic M, Bryan C, Buckley MR, Buie MW, Buratti BJ, Bushman SS, Calloway A, Carcich B, Cheng AF, Conard S, Conrad CA, Cook JC, Cruikshank DP, Custodio OS, Dalle Ore CM, Deboy C, Dischner ZJB, Dumont P, Earle AM, Elliott HA, Ercol J, Ernst CM, Finley T, Flanigan SH, Fountain G, Freeze MJ, Greathouse T, Green JL, Guo Y, Hahn M, Hamilton DP, Hamilton SA, Hanley J, Harch A, Hart HM, Hersman CB, Hill A, Hill ME, Hinson DP, Holdridge ME, Horanyi M, Howard AD, Howett CJA, Jackman C, Jacobson RA, Jennings DE, Kammer JA, Kang HK, Kaufmann DE, Kollmann P, Krimigis SM, Kusnierkiewicz D, Lauer TR, Lee JE, Lindstrom KL, Linscott IR, Lisse CM, Lunsford AW, Mallder VA, Martin N, McComas DJ, McNutt RL, Mehoke D, Mehoke T, Melin ED, Mutchler M, Nelson D, Nimmo F, Nunez JI, Ocampo A, Owen WM, Paetzold M, Page B, Parker AH, Parker JW, Pelletier F, Peterson J, Pinkine N, Piquette M, Porter SB, Protopapa S, Redfern J, Reitsema HJ, Reuter DC, Roberts JH, Robbins SJ, Rogers G, Rose D, Runyon K, Retherford KD, Ryschkewitsch MG, Schenk P, Schindhelm E, Sepan B, Showalter MR, Singer KN, Soluri M, Stanbridge D, Steffl AJ, Strobel DF, Stryk T, Summers ME, Szalay JR, Tapley M, Taylor A, Taylor H, Throop HB, Tsang CCC, Tyler GL, Umurhan OM, Verbiscer AJ, Versteeg MH, Vincent M, Webbert R, Weidner S, Weigle GE, White OL, Whittenburg K, Williams BG, Williams K, Williams S, Woods WW, Zangari AM, Zirnstein E. The Pluto system: Initial results from its exploration by New Horizons. Science 2015; 350:aad1815. [DOI: 10.1126/science.aad1815] [Citation(s) in RCA: 367] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- S. A. Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - F. Bagenal
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - K. Ennico
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | | | | | - W. B. McKinnon
- Department of Earth and Planetary Sciences, Washington University, St. Louis, MO 63130, USA
| | - J. M. Moore
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - C. B. Olkin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. R. Spencer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. A. Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - L. A. Young
- Southwest Research Institute, Boulder, CO 80302, USA
| | - T. Andert
- Universität der Bundeswehr München, Neubiberg 85577, Germany
| | - J. Andrews
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Banks
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - B. Bauer
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J. Bauman
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - O. S. Barnouin
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - P. Bedini
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K. Beisser
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R. A. Beyer
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - S. Bhaskaran
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - R. P. Binzel
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - E. Birath
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Bird
- University of Bonn, Bonn D-53113, Germany
| | - D. J. Bogan
- NASA Headquarters (retired), Washington, DC 20546, USA
| | - A. Bowman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - V. J. Bray
- University of Arizona, Tucson, AZ 85721, USA
| | - M. Brozovic
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - C. Bryan
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - M. R. Buckley
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. W. Buie
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B. J. Buratti
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - S. S. Bushman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Calloway
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B. Carcich
- Cornell University, Ithaca, NY 14853, USA
| | - A. F. Cheng
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. Conard
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. A. Conrad
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. C. Cook
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D. P. Cruikshank
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - O. S. Custodio
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. M. Dalle Ore
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - C. Deboy
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - P. Dumont
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - A. M. Earle
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - H. A. Elliott
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - J. Ercol
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. M. Ernst
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Finley
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S. H. Flanigan
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - G. Fountain
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. J. Freeze
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Greathouse
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - J. L. Green
- NASA Headquarters, Washington, DC 20546, USA
| | - Y. Guo
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Hahn
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Cologne 50931, Germany
| | - D. P. Hamilton
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - S. A. Hamilton
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J. Hanley
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - A. Harch
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. M. Hart
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. B. Hersman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. E. Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. P. Hinson
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | - M. E. Holdridge
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Horanyi
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - A. D. Howard
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA 22904, USA
| | | | | | - R. A. Jacobson
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - D. E. Jennings
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J. A. Kammer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. K. Kang
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - P. Kollmann
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. M. Krimigis
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Kusnierkiewicz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. R. Lauer
- National Optical Astronomy Observatory, Tucson, AZ 26732, USA
| | - J. E. Lee
- NASA Marshall Space Flight Center, Huntsville, AL 35812, USA
| | - K. L. Lindstrom
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - C. M. Lisse
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. W. Lunsford
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - V. A. Mallder
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - N. Martin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D. J. McComas
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - R. L. McNutt
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - E. D. Melin
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Mutchler
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | - D. Nelson
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - F. Nimmo
- University of California, Santa Cruz, CA 95064, USA
| | - J. I. Nunez
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Ocampo
- NASA Headquarters, Washington, DC 20546, USA
| | - W. M. Owen
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - M. Paetzold
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Cologne 50931, Germany
| | - B. Page
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - A. H. Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. W. Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - J. Peterson
- Southwest Research Institute, Boulder, CO 80302, USA
| | - N. Pinkine
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Piquette
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - S. B. Porter
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S. Protopapa
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J. Redfern
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - D. C. Reuter
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J. H. Roberts
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. J. Robbins
- Southwest Research Institute, Boulder, CO 80302, USA
| | - G. Rogers
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Rose
- Southwest Research Institute, Boulder, CO 80302, USA
| | - K. Runyon
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | - P. Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | - E. Schindhelm
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B. Sepan
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. R. Showalter
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | - K. N. Singer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Soluri
- Michael Soluri Photography, New York, NY 10014, USA
| | | | - A. J. Steffl
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - T. Stryk
- Roane State Community College, Jamestown, TN 38556, USA
| | | | - J. R. Szalay
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - M. Tapley
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - A. Taylor
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - H. Taylor
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - H. B. Throop
- Planetary Science Institute, Tucson, AZ 85719, USA
| | | | - G. L. Tyler
- Stanford University, Stanford, CA 94305, USA
| | - O. M. Umurhan
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - A. J. Verbiscer
- Department of Astronomy, University of Virginia, Charlottesville, VA 22904, USA
| | - M. H. Versteeg
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - M. Vincent
- Southwest Research Institute, Boulder, CO 80302, USA
| | - R. Webbert
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. Weidner
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - G. E. Weigle
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - O. L. White
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - K. Whittenburg
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | - S. Williams
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - W. W. Woods
- Stanford University, Stanford, CA 94305, USA
| | - A. M. Zangari
- Southwest Research Institute, Boulder, CO 80302, USA
| | - E. Zirnstein
- Southwest Research Institute, San Antonio, TX 28510, USA
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Lacouture M, Guillen J, Kudchadkar R, Rogers G, Olencki T, Tang J, Yoo S, Dawson K, Mun Y, Sekulic A. 3332 Real-world treatment of vismodegib (VISMO)-related adverse events (AEs) in patients with locally advanced basal cell carcinoma: Report from the RegiSONIC Disease Registry Study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31850-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Sheryl Warttig
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
| | - Steven Ward
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
| | - Gabriel Rogers
- National Institute for Health and Care Excellence, Manchester M1 4BT, UK
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Van Zyl LM, Fernandes N, Rogers G, Du Toit N. Primary health eye care knowledge among general practitioners working in the Cape Town metropole. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2011.10874060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- LM Van Zyl
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - N Fernandes
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - G Rogers
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - N Du Toit
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
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Abstract
BACKGROUND High grade glioma (HGG) is an aggressive form of brain cancer. Treatment of HGG usually entails biopsy, or resection if safe, followed by radiotherapy. Temozolomide is a novel oral chemotherapy drug that penetrates into the brain and purportedly has a low incidence of adverse events. OBJECTIVES To assess whether temozolomide has any advantage for treating HGG in either primary or recurrent disease settings. SEARCH METHODS The following databases were searched: CENTRAL (Issue 10, 2012), MEDLINE, EMBASE, Science Citation Index, Physician Data Query and the Meta-Register of Controlled Trials in October, 2012. Reference lists of identified studies were searched. The Journal of Neuro-Oncology and Neuro-oncology were handsearched from 1999 to 2012 including conference abstracts. We contacted neuro-oncologists regarding ongoing and unpublished trials. SELECTION CRITERIA Randomised controlled trials (RCTs) where the interventions were the use of temozolomide during primary therapy or for recurrent disease. Comparisons included no chemotherapy, non-temozolomide chemotherapy or different dosing schedules of temozolomide. Patients included those of all ages with histologically proven HGG. DATA COLLECTION AND ANALYSIS Two review authors undertook the quality assessment and data extraction. Outcome measures included: overall survival (OS); progression-free survival (PFS); quality of life (QoL); and adverse events. MAIN RESULTS For primary therapy three RCTs were identified, enrolling a total of 745 patients, that investigated temozolomide in combination with radiotherapy versus radiotherapy alone for glioblastoma multiforme (GBM). Temozolomide increased OS (hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.46 to 0.79, P value 0.0003) and increased PFS (HR 0.63, 95% CI 0.43 to 0.92, P value 0.02), when compared with radiotherapy alone, although these benefits only appear to emerge when therapy is given in both concomitant and adjuvant phases of treatment. A single RCT found that temozolomide did not have a statistically significant effect on QoL. Risk of haematological complications, fatigue and infections were increased with temozolomide.In recurrent HGG, two RCTs enrolling 672 patients in total found that temozolomide did not increase OS compared to standard chemotherapy (HR 0.9, 95% CI 0.76 to 1.06, P value 0.2) but it did increase PFS in a subgroup analysis of grade IV GBM tumours (HR 0.68, 95% CI 0.51 to 0.90, P value 0.008). Adverse events were similar between arms.In the elderly, 2 RCTs of 664 patients found OS and PFS was similar with temozolomide alone versus radiotherapy alone. QoL did not appear to differ between arms in a single trial but certain adverse events were significantly more common with temozolomide. AUTHORS' CONCLUSIONS Temozolomide when given in both concomitant and adjuvant phases is an effective primary therapy in GBM compared to radiotherapy alone. It prolongs survival and delays progression without impacting on QoL but it does increase early adverse events. In recurrent GBM, temozolomide compared with standard chemotherapy improves time-to-progression (TTP) and may have benefits on QoL without increasing adverse events but it does not improve overall. In the elderly, temozolomide alone appears comparable to radiotherapy in terms of OS and PFS but with a higher instance of adverse events.
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Affiliation(s)
- Michael G Hart
- Academic Division of Neurosurgery, Department of Clinical Neurosciences, Department of Neurosurgery, Cambridge, UK.
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Hyde C, Peters J, Bond M, Rogers G, Hoyle M, Anderson R, Jeffreys M, Davis S, Thokala P, Moxham T. Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model. Age Ageing 2013. [PMID: 23179169 DOI: 10.1093/ageing/afs165] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION in 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. METHODS we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. RESULTS confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. CONCLUSION there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices.
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Affiliation(s)
- Christopher Hyde
- PCMD, University of Exeter, PenTAG, Veysey Building Salmon Pool Lane, Exeter, Devon EX2 4SG, UK.
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Barbero L, Villaseca C, Rogers G, Brown PE. Geochemical and isotopic disequilibrium in crustal melting: An insight from the anatectic granitoids from Toledo, Spain. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/95jb00036] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technol Assess 2012; 16:1-470. [PMID: 22541366 DOI: 10.3310/hta16210] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. OBJECTIVES Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). DATA SOURCES Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. REVIEW METHODS The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). INTERVENTIONS mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE < 10)--memantine. Comparators: mild AD (MMSE 21-26)--placebo or best supportive care (BSC); moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine, memantine, placebo or BSC; severe AD (MMSE < 10)--placebo or BSC. The outcomes were clinical, global, functional, behavioural, quality of life, adverse events, costs and cost-effectiveness. Where appropriate, data were pooled using pair-wise meta-analysis, multiple outcome measures, metaregression and mixedtreatment comparisons. The decision model was based broadly on the structure of the three-state Markov model described in the previous technology assessment report, based upon time to institutionalisation, parameterised with updated estimates of effectiveness, costs and utilities. RESULTS Notwithstanding the uncertainty of our results, we found in the base case that the AChEIs are probably cost saving at a willingness-to-pay (WTP) of £’30,000 per qualityadjusted life-year (QALY) for people with mild-to-moderate AD. For this class of drugs, there is a > 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. LIMITATIONS Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. CONCLUSIONS The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- M Bond
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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Rogers G, Hoyle M, Thompson Coon J, Moxham T, Liu Z, Pitt M, Stein K. Dasatinib and nilotinib for imatinib-resistant or -intolerant chronic myeloid leukaemia: a systematic review and economic evaluation. Health Technol Assess 2012; 16:1-410. [PMID: 22551803 DOI: 10.3310/hta16220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic myeloid leukaemia (CML) is a form of cancer affecting the blood, characterised by excessive proliferation of white blood cells in the bone marrow and circulating blood. In the UK, an estimated 560 new cases of CML are diagnosed each year. OBJECTIVES The purpose of this study was to assess the clinical effectiveness and cost-effectiveness of dasatinib and nilotinib in the treatment of people with imatinib-resistant (ImR) and imatinib-intolerant (ImI) CML. A systematic review of the clinical effectiveness literature, a review of manufacturer submissions and a critique and exploration of manufacturer submissions for accelerated phase and blast crisis CML were carried out and a decision-analytic model was developed to estimate the cost-effectiveness of dasatinib and nilotinib in chronic phase CML. SYSTEMATIC REVIEW METHODS: Key databases were searched for relevant studies from their inception to June 2009 [MEDLINE (including MEDLINE In-Process & Other Non-Indexed Citations), EMBASE, (ISI Web of Science) Conference Proceedings Citation Index and four others]. One reviewer assessed titles and abstracts of studies identified by the search strategy, with a sample checked by a second reviewer. The full text of relevant papers was obtained and screened against the full inclusion criteria independently by two reviewers. Data from included studies were extracted by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through narrative review. ECONOMIC EVALUATION METHODS: Cost-effectiveness analyses reported in manufacturer submissions to the National Institute of Health and Clinical Excellence were critically appraised and summarised narratively. In addition, the models for accelerated phase and blast crisis underwent a more detailed critique and exploration. Two separate decision-analytic models were developed for chronic phase CML, one simulating a cohort of individuals who have shown or developed resistance to normal dose imatinib and one representing individuals who have been unable to continue imatinib treatment owing to adverse events. One-way, multiway and probabilistic sensitivity analyses were performed to explore structural and parameter uncertainty. RESULTS Fifteen studies were included in the systematic review. Chronic phase: effectiveness data were limited but dasatinib and nilotinib appeared efficacious in terms of obtaining cytogenetic response and haematological response in both ImR and ImI populations. In terms of cost-effectiveness, it was extremely difficult to reach any conclusions regarding either agent in the ImR population. All three models (Novartis, PenTAG and Bristol-Myers Squibb) were seriously flawed in one way or another, as a consequence of the paucity of data appropriate to construct robust decision-analytic models. Accelerated and blast crisis: all available data originated from observational single-arm studies and there were considerable and potentially important differences in baseline characteristics which seriously undermined any process for making meaningful comparisons between treatments. Owing to a lack of available clinical data, de novo models of accelerated phase and blast crisis have not been developed. The economic evaluations carried out by the manufacturers of nilotinib and dasatinib were seriously undermined by the absence of evidence on high-dose imatinib in these populations. LIMITATIONS The study has been necessarily constrained by the paucity of available clinical data, the differences in definitions used in the studies and the subsequent impossibility of undertaking a meaningful cost-effectiveness analyses to inform all policy questions. CONCLUSIONS Dasatinib and nilotinib appeared efficacious in terms of obtaining cytogenetic and haematological responses in both ImR and ImI populations. It was difficult to reach any cost-effectiveness conclusions as a consequence of the paucity of the data. Future research should include a three-way, double-blind, randomised clinical trial of dasatinib, nilotinib and high-dose imatinib.
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Affiliation(s)
- G Rogers
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
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Parker HE, Adriaenssens A, Rogers G, Richards P, Koepsell H, Reimann F, Gribble FM. Predominant role of active versus facilitative glucose transport for glucagon-like peptide-1 secretion. Diabetologia 2012; 55:2445-55. [PMID: 22638549 PMCID: PMC3411305 DOI: 10.1007/s00125-012-2585-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/20/2012] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS Several glucose-sensing pathways have been implicated in glucose-triggered secretion of glucagon-like peptide-1 (GLP-1) from intestinal L cells. One involves glucose metabolism and closure of ATP-sensitive K(+) channels, and another exploits the electrogenic nature of Na(+)-coupled glucose transporters (SGLTs). This study aimed to elucidate the role of these distinct mechanisms in glucose-stimulated GLP-1 secretion. METHODS Glucose uptake into L cells (either GLUTag cells or cells in primary cultures, using a new transgenic mouse model combining proglucagon promoter-driven Cre recombinase with a ROSA26tdRFP reporter) was monitored with the FLII(12)Pglu-700 μδ6 glucose sensor. Effects of pharmacological and genetic interference with SGLT1 or facilitative glucose transport (GLUT) on intracellular glucose accumulation and metabolism (measured by NAD(P)H autofluorescence), cytosolic Ca(2+) (monitored with Fura2) and GLP-1 secretion (assayed by ELISA) were assessed. RESULTS L cell glucose uptake was dominated by GLUT-mediated transport, being abolished by phloretin but not phloridzin. NAD(P)H autofluorescence was glucose dependent and enhanced by a glucokinase activator. In GLUTag cells, but not primary L cells, phloretin partially impaired glucose-dependent secretion, and suppressed an amplifying effect of glucose under depolarising high K(+) conditions. The key importance of SGLT1 in GLUTag and primary cells was evident from the impairment of secretion by phloridzin or Sglt1 knockdown and failure of glucose to trigger cytosolic Ca(2+) elevation in primary L cells from Sglt1 knockout mice. CONCLUSIONS/INTERPRETATION SGLT1 acts as the luminal glucose sensor in L cells, but intracellular glucose concentrations are largely determined by GLUT activity. Although L cell glucose metabolism depends partially on glucokinase activity, this plays only a minor role in glucose-stimulated GLP-1 secretion.
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Affiliation(s)
- H. E. Parker
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - A. Adriaenssens
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - G. Rogers
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - P. Richards
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - H. Koepsell
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - F. Reimann
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - F. M. Gribble
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
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Cuthbertson L, Rogers G, Hoffman L, Oliver A, Wing P, Carroll M, Bruce K, Walker A, van der Gast C. 136 Impact of propidium monoazide treatment on CF bacterial community pyrosequencing analysis. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. [Assessment and referral after emergency treatment in suspected anaphylactic reaction: summary of the NICE guideline]. Praxis (Bern 1994) 2012; 101:473-476. [PMID: 22454309 DOI: 10.1024/1661-8157/a000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clincial Excellence, Piccadilly Plaza, Manchester, Grossbritannien
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Kehayias JJ, Ribeiro SML, Skahan A, Itzkowitz L, Dallal G, Rogers G, Khodeir M. Water homeostasis, frailty and cognitive function in the nursing home. J Nutr Health Aging 2012; 16:35-9. [PMID: 22238000 DOI: 10.1007/s12603-011-0079-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE - To develop and test a practical clinical method to assess frailty in nursing homes; - To investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. DESIGN AND SUBJECTS Cross-sectional study, conducted at two nursing homes in Boston-MA. METHODS Body mass and height (Ht) were evaluated to calculate BMI (body mass index, in Kg/m²). The cognitive decline was evaluated based on the scores obtained from the Mini-Mental State Examination (MMSE); The extracellular to total body water ratio (ECW/TBW) was calculated after the analysis of TBW from deuterium and tritium dilution and ECW from bromide dilution. Single-frequency BIA analysis data were investigated for resistance (R) and reactance (Xc), plotted in an R/Ht Xc/Ht graph (vectorial analysis-BIVA). The BIVA results of nursing home residents were compared against the data obtained from the NHANES III study. TBW and ECW values were compared with a group of free-living elderly volunteers. RESULTS The ECW/TBW was significantly higher in nursing home residents than in the free-living individuals. BIVA analysis showed significantly higher Xc/Ht values in the reference subjects. The MMSE did not present a significant correlation with ECW/TBW for either gender. CONCLUSION We proposed the ECW/TBW ratio and BIVA as surrogate methods for the clinical assessment of frailty. We tested successfully both approaches with nursing home patients and free-living volunteers and compared them to a national data base. The advent of new, portable instruments will enable field tests to further validate our proposed "Frailty Factor" in future studies. We found no correlation between frailty and cognitive decline in the nursing home.
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Affiliation(s)
- J J Kehayias
- Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University, Boston, MA 02111, USA.
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Bruhn S, Barrenäs F, Mobini R, Andersson BA, Chavali S, Egan BS, Hovig E, Sandve GK, Langston MA, Rogers G, Wang H, Benson M. Increased expression of IRF4 and ETS1 in CD4+ cells from patients with intermittent allergic rhinitis. Allergy 2012; 67:33-40. [PMID: 21919915 DOI: 10.1111/j.1398-9995.2011.02707.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transcription factor (TF) IRF4 is involved in the regulation of Th1, Th2, Th9, and Th17 cells, and animal studies have indicated an important role in allergy. However, IRF4 and its target genes have not been examined in human allergy. METHODS IRF4 and its target genes were examined in allergen-challenged CD4(+) cells from patients with IAR, using combined gene expression microarrays and chromatin immunoprecipitation chips (ChIP-chips), computational target prediction, and RNAi knockdowns. RESULTS IRF4 increased in allergen-challenged CD4(+) cells from patients with IAR, and functional studies supported its role in Th2 cell activation. IRF4 ChIP-chip showed that IRF4 regulated a large number of genes relevant to Th cell differentiation. However, neither Th1 nor Th2 cytokines were the direct targets of IRF4. To examine whether IRF4 induced Th2 cytokines via one or more downstream TFs, we combined gene expression microarrays, ChIP-chips, and computational target prediction and found a putative intermediary TF, namely ETS1 in allergen-challenged CD4(+) cells from allergic patients. ETS1 increased significantly in allergen-challenged CD4(+) cells from patients compared to controls. Gene expression microarrays before and after ETS1 RNAi knockdown showed that ETS1 induced Th2 cytokines as well as disease-related pathways. CONCLUSIONS Increased expression of IRF4 in allergen-challenged CD4(+) cells from patients with intermittent allergic rhinitis leads to activation of a complex transcriptional program, including Th2 cytokines.
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Affiliation(s)
- S Bruhn
- The Centre for Individualized Medication, Linköping University Hospital, Linköping, Sweden
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Anie KA, Grocott H, White L, Dzingina M, Rogers G, Cho G. Patient self-assessment of hospital pain, mood and health-related quality of life in adults with sickle cell disease. BMJ Open 2012; 2:bmjopen-2012-001274. [PMID: 22761289 PMCID: PMC3391376 DOI: 10.1136/bmjopen-2012-001274] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute pain is a hallmark of sickle cell disease (SCD) for which frequent hospital admissions may be required, affecting the quality of life of patients. OBJECTIVES To characterise the relationship between adult patient self-reported sickle cell pain, mood and quality of life during and after hospital admissions. DESIGN Longitudinal study across three time-points. SETTING Secondary care, single specialist sickle cell centre. PARTICIPANTS 510 adult patients with SCD admitted to hospital daycare or inpatient units. OUTCOME MEASURES Self-assessments of pain, mood and health-related quality of life with health utility (measured on the EQ-5D) on admission, before discharge and at 1-week postdischarge. RESULTS Mood, general health and quality of life showed significant steady improvements with reduction of pain in patients with SCD on admission to hospital, before discharge and at 1-week follow-up (p<0.01). Health utility scores derived from the EQ-5D showed a negative association with pain in regression analysis over the three time-points. CONCLUSION Examining health-related quality of life and health utility in relation to pain during hospital admissions is valuable in terms of targeting appropriate psychological interventions within the context of a multidisciplinary approach to managing sickle cell pain. This has implications for healthcare costs.
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Affiliation(s)
- Kofi A Anie
- Haematology and Sickle Cell Centre, Central Middlesex Hospital, London, UK
| | - Hannah Grocott
- Haematology and Sickle Cell Centre, Central Middlesex Hospital, London, UK
| | - Lauren White
- Haematology and Sickle Cell Centre, Central Middlesex Hospital, London, UK
| | - Mendwas Dzingina
- National Institute of Health and Clinical Excellence, Manchester, UK
| | - Gabriel Rogers
- National Institute of Health and Clinical Excellence, Manchester, UK
| | - Gavin Cho
- Haematology and Sickle Cell Centre, Central Middlesex Hospital, London, UK
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance. BMJ 2011; 343:d7595. [PMID: 22171344 DOI: 10.1136/bmj.d7595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clinical Excellence, Piccadilly Plaza, Manchester M1 4BT, UK
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Hoyle M, Rogers G, Moxham T, Liu Z, Stein K. Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or -intolerant chronic phase chronic myeloid leukemia. Value Health 2011; 14:1057-1067. [PMID: 22152175 DOI: 10.1016/j.jval.2011.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 06/24/2011] [Accepted: 07/01/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To estimate the cost-effectiveness of dasatinib and nilotinib compared with high-dose imatinib for people with chronic phase chronic myeloid leukemia, which are resistant to normal-dose imatinib and compared with interferon-α for people intolerant to imatinib, from the perspective of the UK National Health Service. METHODS An an area under the curve partitioned survival model was developed to estimate the cost-effectiveness of dasatinib and nilotinib. Clinical effectiveness evidence was taken mostly from single-arm trials. RESULTS Both progression-free survival and overall survival are highly uncertain. In the base case, patients take nilotinib for much less time than dasatinib. Nilotinib is expected to dominate high-dose imatinib, yielding slightly more (0.32) quality-adjusted life years (QALYs) at slightly less cost (£11,100 [pound sterling]) per person. Dasatinib is predicted to provide slightly more (0.53) QALYs at substantially greater cost (£48,900), yielding a very high incremental cost-effectiveness ratio of £91,500 QALY against high-dose imatinib. Cost-effectiveness, however, changes radically under the plausible assumption that the drugs are taken for the same time. For people intolerant to imatinib, nilotinib is expected to yield an incremental cost-effectiveness ratio of £104,700/QALY, and dasatinib £82,600/QALY compared with interferon-α. Further, both drugs represent poor value for money for a range of plausible structural assumptions. CONCLUSIONS The model should be viewed as an exploratory analysis of the cost-effectiveness of dasatinib and nilotinib because it relies on many assumptions. Whilst clinical data remains immature, the cost-effectiveness of dasatinib and nilotinib for imatinib-resistant people is highly uncertain. Both nilotinib and dasatinib are highly unlikely to be cost-effective versus interferon-α for people intolerant to imatinib.
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Affiliation(s)
- Martin Hoyle
- Peninsular College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom.
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Wang Q, Thompson E, Parsons R, Rogers G, Dunn D. Economic feasibility of converting cow manure to electricity: A case study of the CVPS Cow Power program in Vermont. J Dairy Sci 2011; 94:4937-49. [DOI: 10.3168/jds.2010-4124] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/04/2011] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Standard treatment for high grade glioma (HGG) usually entails surgery (either biopsy or resection) followed by radiotherapy plus or minus temozolomide. Implanting wafers impregnated with chemotherapy agents into the resection cavity represents a novel means of delivering drugs directly to the resection cavity with potentially fewer systemic side effects. It is not clear how effective this modality is or whether it should be recommended as part of standard care for patients with HGG. OBJECTIVES To estimate the clinical effectiveness of chemotherapy wafers for patients with HGG. SEARCH STRATEGY The following databases were searched: CENTRAL (issue 4. 2010); MEDLINE and EMBASE. The original search strategy also included: Science Citation Index; Physician Data Query; and the meta-Register of Controlled Trials. Reference lists of all identified studies were searched. The Journal of Neuro-Oncology and Neuro-oncology were hand searched from 1999 to 2010, including all conference abstracts. Neuro-oncologists, trial authors and drug manufacturers were contacted regarding ongoing and unpublished trials. SELECTION CRITERIA Patients included those of all ages with a histologically proven diagnosis of HGG (using intra-operative analysis when undergoing first resection). Therapy could be instigated for either newly diagnosed disease (primary therapy) or at recurrence. Interventions included insertion of chemotherapy wafers to the resection cavity. Included studies had to be randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Two independent review authors assessed the search results for relevance and undertook critical appraisal according to pre-specified guidelines. MAIN RESULTS In primary disease two RCTs assessing the effect of carmustine impregnated wafers (Gliadel®) and enrolling a total of 272 participants were identified. Survival was increased with Gliadel® compared to placebo (hazard ratio (HR) 0.65, 95% Confidence Interval (CI) 0.48 to 0.86, P = 0.003). In recurrent disease a single RCT was included comparing Gliadel® with placebo and enrolled 222 participants. It did not demonstrate a significant survival increase (HR 0.83, 95% CI 0.62 to 1.10, P = 0.2). There was no suitable data for any of the secondary outcome measures. Adverse events were not more common in either arm and are presented in a descriptive fashion. AUTHORS' CONCLUSIONS Carmustine impregnated wafers (Gliadel®) result in improved survival without an increased incidence of adverse events over placebo wafers when used for primary disease therapy. There is no evidence of benefit for any other outcome measures. In recurrent disease Gliadel® does not appear to confer any additional benefit.
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Affiliation(s)
- Michael G Hart
- Addenbrookes HospitalAcademic Division of Neurosurgery, Department of Clinical NeurosciencesBox 167CambridgeUKCB2 0QQ
| | - Ruth Garside
- University of Exeter Medical School, University of ExeterEuropean Centre for Environment and Human HealthKnowledge SpaRCHTruroUKTR1 3HD
| | - Gabriel Rogers
- National Institute for Health and Clinical ExcellenceCentre for Clinical PracticeLevel 1A, City TowerPiccadilly PlazaManchesterUKM1 4BT
| | - Margaret Somerville
- Universities of Exeter and PlymouthPeninsula College of Medicine and DentistryC308, Portland SquareDrake's CircusPlymouthUKPL4 8AA
| | - Ken Stein
- University of Exeter Medical School, University of ExeterPeninsula Technology Assessment Group (PenTAG)Salmon Pool LaneExeterUKEX2 4SG
| | - Robin Grant
- Western General HospitalEdinburgh Centre for Neuro‐Oncology (ECNO)Crewe RoadEdinburghScotlandUKEH4 2XU
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Laity G, Neuber A, Rogers G, Frank K. System for time resolved spectral studies of pulsed atmospheric discharges in the visible to vacuum ultraviolet range. Rev Sci Instrum 2010; 81:083103. [PMID: 20815599 DOI: 10.1063/1.3478016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vacuum ultraviolet (VUV) emission is believed to play a major role in the development of plasma streamers in pulsed atmospheric discharges, but detection of VUV light is difficult in pulsed experiments at atmospheric pressures. Since VUV light is absorbed in most standard optical materials as well, careful attention must be given to the selection of the lens and mirror optics used in these studies. Of highest interest is the VUV emission during the initial stage of pulsed atmospheric discharges, which has a typical duration in the nanosecond regime. An experiment was designed to study this fast initial stage of VUV emission coupled with fast optical imaging of streamer propagation, both with temporal resolution on the order of nanoseconds. A repetitive solid-state high voltage pulser was constructed which produces triggered flashover discharges with low jitter and consistent pulse amplitude. VUV emission is captured utilizing both photomultiplier and intensified charge-coupled device detectors during the fast stage of streamer propagation. These results are discussed in context with the streamer formation photographed in the visible wavelength regime with 3 ns exposure time.
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Affiliation(s)
- G Laity
- Department of Electrical and Computer Engineering, Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
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Thompson Coon JS, Liu Z, Hoyle M, Rogers G, Green C, Moxham T, Welch K, Stein K. Reply: SUN vs BEVþIFN in first-line mRCC therapy: no evidence for a statistically significant difference in progression-free survival. Br J Cancer 2010. [PMCID: PMC2813750 DOI: 10.1038/sj.bjc.6605447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dickens G, Rogers G, Rooney C, Mc Guinness A, Doyle D. An audit of the use of breakaway techniques in a large psychiatric hospital: a replication study. J Psychiatr Ment Health Nurs 2009; 16:777-83. [PMID: 19824971 DOI: 10.1111/j.1365-2850.2009.01449.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper describes an audit study of the effectiveness of breakaway training conducted in a specialist inpatient mental health hospital. Breakaway techniques comprise a set of physical skills to help separate or break away from an aggressor in a safe manner, but do not involve the use of restraint. Staff (n= 147) were assessed on their ability to break away from simulations of potentially life-threatening scenarios in a timely manner, and using the techniques taught in annual breakaway or refresher training. We found that only 14% (21/147) of participants correctly used the taught techniques to break away within 10 s. However, 80% of people were able to break away from the scenarios within 10 s but did not use the techniques taught to them. This audit reinforces questions about breakaway training raised in a previous study. It further demonstrates the need for a national curriculum for physical intervention training and development of the evidence base for the content of such training as a priority.
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Affiliation(s)
- G Dickens
- St Andrew's Academic Centre, Kings College London Institute of Psychiatry, UK.
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Thompson Coon JS, Liu Z, Hoyle M, Rogers G, Green C, Moxham T, Welch K, Stein K. Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness. Br J Cancer 2009; 101:238-43. [PMID: 19568242 PMCID: PMC2720220 DOI: 10.1038/sj.bjc.6605167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Two new agents have recently been licensed for use in the treatment of metastatic renal cell carcinoma (RCC) in Europe. This paper aims to systematically review the evidence from all available randomised clinical trials of sunitinib and bevacizumab (in combination with interferon-α (IFN-α)) in the treatment of advanced metastatic RCC. Methods: Systematic literature searches were performed in six electronic databases. Bibliographies of included studies were searched for further relevant studies. Individual conference proceedings were searched using their online interfaces. Studies were selected according to the predefined criteria. All randomised clinical trials of sunitinib or bevacizumab in combination with IFN for treating advanced metastatic RCC in accordance with the European licensed indication were included. Study selection, data extraction, validation and quality assessment were performed by two reviewers with disagreements being settled by discussion. The effects of sunitinib and bevacizumab (in combination with IFN-α) on progression-free survival were compared indirectly using Bayesian Markov Chain Monte-Carlo (MCMC) sampling in Win BUGS, with IFN as a common comparator. Results: Three studies were included. Median progression-free survival was significantly prolonged with both interventions (from approximately 5 months to between 8 and 11 months) compared with IFN. Overall survival was also prolonged, compared with IFN, although the published data are not fully mature. Indirect comparison suggests that sunitinib is superior to bevacizumab plus IFN in terms of progression-free survival (hazard ratios 0.796; 95% CI 0.63–1.0; P=0.0272). Conclusion: There is evidence to suggest that treatment with sunitinib and treatment with bevacizumab plus IFN has clinically relevant and statistically significant advantages over treatment with IFN alone in patients with metastatic RCC.
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Affiliation(s)
- J S Thompson Coon
- Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Plymouth and Exeter, Noy Scott House, Barrack Road, Exeter EX2 5DW, UK.
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Rogers G, Elston J, Garside R, Roome C, Taylor R, Younger P, Zawada A, Somerville M. The harmful health effects of recreational ecstasy: a systematic review of observational evidence. Health Technol Assess 2009. [DOI: 10.3310/hta13060] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G Rogers
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - J Elston
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - R Garside
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - C Roome
- Devon Primary Care Trust, Exeter, UK
| | - R Taylor
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - P Younger
- Exeter Health Library, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Zawada
- The Agency for Health Technology Assessment in Poland, Warsaw
| | - M Somerville
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
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Abstract
BACKGROUND High grade glioma (HGG) is an aggressive form of brain tumour the treatment of which usually entails biopsy or resection where possible followed by radiotherapy. Temozolomide is a novel oral chemotherapeutic drug that penetrates into the brain and has a low incidence of adverse effects. OBJECTIVES To assess whether temozolomide holds any advantage over conventional therapy for HGG in either primary or recurrent disease settings. SEARCH STRATEGY The following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2007. Medline, EMBASE, Science Citation Index, Physician Data Query and the Meta-Register of Controlled Trials. Reference lists of identified studies were searched. The Journal of Neuro-Oncology was hand searched from 1999 to 2007 including conference abstracts. Neuro-oncologists were contacted regarding ongoing and unpublished trials. SELECTION CRITERIA Randomised controlled trials (RCTs). Interventions included the use of temozolomide during primary therapy or for recurrent disease. Patients included those of all ages with a proven pathological diagnosis of HGG. DATA COLLECTION AND ANALYSIS Quality assessment and data extraction were undertaken by two review authors. Outcome measures included survival, time to progression, quality of life (QOL) and adverse events. MAIN RESULTS In primary disease two RCTs were identified, enrolling a total of 703 patients, that investigated concomitant and adjuvant temozolomide in Glioblastoma Multiforme (GBM). Temozolomide increased survival (hazard ratio (HR) 0.84, confidence interval (CI) 0.50 to 0.68, p < 0.001) and an increase in time to progression (HR 0.52 CI 0.42 to 0.64 p < 0.0001). This was without having a statistically significant negative effect on QOL and with a low incidence of early adverse events. Grade 3/4 haematological toxicity was found in 5 to14%. The long term effects of temozolomide are still to be assessed. In recurrent GBM a single trial enrolling 225 patients in total found that temozolomide did not increase overall survival but it did increase time to progression (HR 0.68 CI 0.51 to 0.90 p0.008). Severe adverse events were low in this setting. AUTHORS' CONCLUSIONS Temozolomide is an effective therapy in GBM for prolonging survival and delaying progression as part of primary therapy without impacting on QoL and with a low incidence of early adverse events. The frequency and severity of late adverse events is unknown. In recurrent GBM it improves time to progression but not overall survival. These findings are from three good quality but non-blinded RCTs of over 900 patients in total.
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Affiliation(s)
- Michael G Hart
- Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, Midlothian, UK, EH4 2XU.
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Main C, Shepherd J, Anderson R, Rogers G, Thompson-Coon J, Liu Z, Hartwell D, Loveman E, Green C, Pitt M, Stein K, Harris P, Frampton GK, Smith M, Takeda A, Price A, Welch K, Somerville M. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years. Health Technol Assess 2008; 12:1-174, iii-iv. [PMID: 18485272 DOI: 10.3310/hta12200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in children aged under 12 years. DATA SOURCES Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). REVIEW METHODS A systematic review of clinical and cost-effectiveness studies and economic analyses were carried out. A flexible framework was used to allow different types of economic analyses as appropriate, with either a cost comparison or cost-consequence comparison conducted. RESULTS Of 5175 records identified through systematic literature searching, 34 records describing 25 studies were included (16 were fully published randomised controlled trials, six were systematic reviews, and three were post-2004 conference abstracts). The most frequently reported relevant outcomes in the 16 RCTs were peak expiratory flow rate (13 trials), FEV1 (13 trials), symptoms (13 trials), adverse events or exacerbations (13 trials), use of rescue medication (12 trials), markers of adrenal function (e.g. blood or urine cortisol concentrations) (13 trials), height and/or growth rate (seven trials) and markers of bone metabolism (two trials). In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, no consistent significant differences or patterns in differential treatment effect among the outcomes were evident. Where differences were statistically significant at high doses, such as for lung function and growth, they favoured formoterol fumarate (FF), but this was generally in studies that did not compare the ICS at the accepted clinically equivalent doses. Differences between the drugs in impact on adrenal suppression were only significant in two studies. At doses of 200, 400 and 800 microg/day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. In the trials comparing ICS at a higher dose with ICS and LABA in combination, most outcomes favoured the combined inhaler. Only the combination inhaler, Seretide Evohaler, is slightly cheaper than the weighted mean cost of all types of ICS at increased dose except BDP 400 microg/day (including CFC-propelled products). Both the combination inhalers, Seretide Accuhaler and Symbicort Turbohaler, are more expensive than the weighted mean cost for all types of ICS at a two-fold increased dose. Compared with the lowest cost preparation for each ICS drug, all the combination inhalers are always more expensive than the ICS products at increased dose. CONCLUSIONS The limited evidence available indicates that there are no consistent significant differences in effectiveness between the three ICS licensed for use in children at either low or high dose. BDP CFC-propelled products are often the cheapest ICS currently available at both low and high dose, and may remain so even when CFC-propelled products are excluded. Exclusion of CFC-propelled products increases the mean annual cost of all budesonide (BUD) and BDP, while the overall cost differences between the comparators diminish. There is very limited evidence available for the efficacy and safety of ICS and LABAs in children. From this limited evidence, there appear to be no significant clinical differences in effects between the use of a combination inhaler versus the same drugs in separate inhalers. There is a lack of evidence comparing ICS at a higher dose with ICS and LABA in combination and comparing the combination products with each other. In the absence of any evidence concerning the effectiveness of ICS at higher dose with ICS and LABA, a cost-consequence analysis gives mixed results. There are potential cost savings with the use of combination inhalers compared to separate inhalers. At present prices, the BUD/FF combination is more expensive than those containing FP/SAL, but it is not known whether there are clinically significant differences between them. A scoping review is required to assess the requirements for additional primary research on the clinical effectiveness of treatment for asthma in children under 5 years old. Such a review could also usefully include all treatment options, pharmacological and non-pharmacological, for asthma. A direct head-to-head trial that compares the two combination therapies of FP/SAL and BUD/FF is warranted, and it is important to assess whether the addition of a LABA to a lower dose of ICS could potentially be as effective as an increased dose of ICS alone, but also be steroid sparing. There is also a need for the long-term adverse events associated with ICS use to be assessed systematically. Future trials of treatment for chronic asthma in children should aim to standardise further the way in which outcome measures are defined. There should be a greater focus on patient-centred outcomes to provide a more meaningful estimation of the impact of treatment on asthma control. Methods of reporting also require standardisation.
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Affiliation(s)
- C Main
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
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Shepherd J, Rogers G, Anderson R, Main C, Thompson-Coon J, Hartwell D, Liu Z, Loveman E, Green C, Pitt M, Stein K, Harris P, Frampton GK, Smith M, Takeda A, Price A, Welch K, Somerville M. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over. Health Technol Assess 2008; 12:iii-iv, 1-360. [PMID: 18485271 DOI: 10.3310/hta12190] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in adults and children aged over 12 years. DATA SOURCES Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). REVIEW METHODS A systematic review of clinical and cost-effectiveness studies was conducted. Cost comparison and cost-consequence analyses were performed where appropriate. RESULTS The assessment of clinical effectiveness was based on the 67 randomised controlled trials selected from the 5175 reports identified through the systematic literature search. The most frequently reported relevant outcomes were lung function, symptoms, use of rescue medication and adverse events. The trials varied considerably. In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, there were few significant differences in clinical effectiveness, although a few of the trials had assessed non-inferiority between the comparators rather than superiority. At doses of 400, 800 and 'high-level' doses of 1500 or 1600 microg/day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. A significant treatment benefit for combination ICS/LABA therapy across a range of outcomes compared with ICS alone was identified [when the ICS was double the accepted clinically equivalent dose of the ICS in the combination inhaler, and dry powder inhalers (DPIS) were used to deliver the drugs]. When a formoterol fumarate (FF)/salmeterol (SAL) combination inhaler and a budesonide (BUD)/FF combination inhaler were each compared with their constituent drugs delivered in separate inhalers, there were very few statistically significant differences between the treatments across the various efficacy outcomes and the rate of adverse events. Combination inhalers were more often cheaper than doubling the dose of ICS alone. However, the costs were highly variable and dependent on both the dose required and the preparation used in the trials. The estimated mean annual cost of FP/SAL combination varied from being 94 pounds cheaper to 109 pounds more expensive than the alternative of BUD at a higher dose. The BUD/FF combination varied from being 163 pounds cheaper to 66 pounds more expensive than the higher dose of either BUD or FP. When the combination inhalers were compared to each other, the results were mixed, with the FP/SAL combination significantly superior on some outcomes and the BUD/FF combination superior on others; however, meta-analysis showed that there were no significant differences between the two treatments in the rate of adverse events. Taking an ICS with a LABA as either of the two currently available combination products, FP/SAL and BUD/FF, is usually cheaper than taking the relevant constituent drugs in separate inhalers. At very high doses of BUD (1600 microg/day), however, the BUD/FF combination inhaler can be up to 156 pounds more expensive than having the same drugs in separate inhalers. In terms of the relative costs associated with taking one of the combination inhalers, at low dose (400 microg BUD or 200 microg FP/day) the cheapest combination inhaler is FP/SAL as a pressurised metered dose inhaler (pMDI) (Seretide Evohaler). However, this is only slightly cheaper than using BUD/FF as a DPI (Symbicort Turbohaler). At higher dose levels (800 microg BUD or 500 microg FP/day) FP/SAL as either pMDI aerosol (Seretide Evohaler) or a DPI (Seretide Accuhaler) is the cheapest combination product available, but again only slightly cheaper than the DPI BUD/FF combination (Symbicort Turbohaler). It should be highlighted, however, that the three head-to-head trials that compared the effects of FP/SAL with BUD/FF used the FP/SAL DPI combination inhaler, Seretide Accuhaler. CONCLUSIONS The evidence indicates that there are few consistent significant differences in effects between the five ICS licensed for use in adults and adolescents over the age of 12 years, at either low or high dose. On average, BDP products currently tend to be the cheapest ICS available and tend to remain so as the daily ICS dose required increases. There is evidence that the addition of a LABA to an ICS is potentially more clinically effective than doubling the dose of ICS alone, although consistent significant differences between the two treatment strategies are not observed for all outcome measures. The cost differences between combination therapy compared with ICS monotherapy are highly variable and dependent on the dose required and the particular preparations used. For the combination therapies of ICS/LABA there are potential cost savings with the use of combination inhalers compared with separate inhalers, with few differences between the two treatment strategies in terms of effects. The only exception to this cost saving is with BUD/FF at doses higher than 1200 microg/day, where separate inhaler devices can become equivalent to or cheaper than combination inhalers. Neither of the two combination inhalers (FP/SAL or BUD/FF) is consistently superior in terms of treatment effect. A comparison of the costs associated with each combination therapy indicates that at low dose FP/SAL delivered via a pMDI is currently the cheapest combination inhaler but only marginally cheaper than BUD/FF delivered as a DPI. At higher doses, both the FP/SAL combination inhalers (PMDI and DPI) are marginally cheaper than BUD/FF (DPI). Future trials of treatment for chronic asthma should standardise the way in which outcome measures are defined and measured, with a greater focus on patient-centred outcomes. For informing future cost-utility and cost-effectiveness analyses from a UK NHS perspective, there is a need for longitudinal studies that comprehensively track the care pathways followed when people experience asthma exacerbations of different severity. Further research synthesis, quantifying the adverse effects of the different ICS, is required for treatment choices by patients and clinicians to be fully informed.
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Affiliation(s)
- J Shepherd
- Southampton Health Technology Assessments Centre, Wessex Institute for Health Research and Development , University of Southampton, UK
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Abstract
BACKGROUND Standard treatment for high grade glioma (HGG) usually entails biopsy or surgical resection where possible followed by radiotherapy. Systemic chemotherapy is usually only given in selected cases and its use is often limited by side effects. Implanting wafers impregnated with chemotherapy agents into the resection cavity represents a novel means of delivering drugs to the central nervous system (CNS) with fewer side effects. It is not clear how effective this modality is or whether it should be recommended as part of standard care for HGG. OBJECTIVES To assess whether chemotherapeutic wafers have any advantage over conventional therapy for HGG. SEARCH STRATEGY The following databases were searched: The Cochrane Central Register of Controlled Trials (CENTRAL), Issue 2, 2007, MEDLINE, EMBASE, SCIENCE CITATION INDEX, Physician Data Query and the meta-Register of Controlled Trials. Reference lists of all identified studies were searched. The Journal of Neuro-Oncology was hand searched from 1999 to 2007, including all conference abstracts. Neuro-oncologists were contacted regarding ongoing and unpublished trials. SELECTION CRITERIA Patients included those of all ages with a presumed diagnosis of malignant glioma from clinical examination and radiology. Interventions included insertion of chemotherapeutic wafers to the resection cavity at either primary surgery or for recurrent disease. Included studies had to be randomised controlled trials (RCTs). DATA COLLECTION AND ANALYSIS Quality assessment and data extraction were undertaken by two review authors. Outcome measures included survival, time to progression, quality of life (QOL) and adverse events. MAIN RESULTS In primary disease two RCTs assessing the effect of carmustine impregnated wafers (Gliadel(R)) and enrolling a total of 272 participants were identified. Survival was increased (hazard ratio (HR) 0.65 confidence interval (CI) 0.48 to 0.86 p = 0.003). In recurrent disease a single RCT was included assessing the effect of Gliadel(R) and enrolling 222 participants. It did not demonstrate a significant survival increase (HR 0.83 CI 0.62 to 1.10 p = 0.2). There was no suitable data for time to progression or QOL. Adverse events were not more common in either arm, and were presented in a descriptive fashion. AUTHORS' CONCLUSIONS Gliadel(R) results in a prolongation of survival without an increased incidence of adverse events when used as primary therapy. There is no evidence of enhanced progression free survival (PFS) or QOL. In recurrent disease, Gliadel(R) does not appear to confer any added benefit. These findings are based on the results of three RCTs with approximately 500 patients in total.
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Affiliation(s)
- Michael G Hart
- Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, Midlothian, UK, EH4 2XU.
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Rogers G, Stressmann F, Carroll M, Bruce K. Analysis of fungal-bacterial community interactions in cystic fibrosis airway secretions. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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