Return on investment of fracture liaison services: a systematic review and analysis

Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.

Phase II clinical trial of neoadjuvant anti-PD-1 (toripalimab) combined with axitinib in resectable mucosal melanoma

BACKGROUND

The outcome of patients with resectable mucosal melanoma is poor. Toripalimab combined with axitinib has shown impressive results in metastatic mucosal melanoma with an objective response rate of 48.3% and a median progression-free survival of 7.5 months in a phase Ib trial. It was hypothesized that this combination administered in the neoadjuvant setting might induce a pathologic response in resectable mucosal melanoma, so we conducted this trial.

PATIENTS AND METHODS

This single-arm phase II trial enrolled patients with resectable mucosal melanoma. Patients received toripalimab 3 mg/kg once every 2 weeks (Q2W) plus axitinib 5 mg two times a day (b.i.d.) for 8 weeks as neoadjuvant therapy, then surgery and adjuvant toripalimab 3 mg/kg Q2W starting 2 ± 1weeks after surgery for 44 weeks. The primary endpoint was the pathologic response rate according to the International Neoadjuvant Melanoma Consortium recommendations.

RESULTS

Between August 2019 and October 2021, 29 patients were enrolled and received treatment, of whom 24 underwent resection. The median follow-up time was 34.2 months (95% confidence interval 20.4-48.0 months). The pathologic response rate was 33.3% (8/24; 4 pathological complete responses and 4 pathological partial responses). The median event-free survival for all patients was 11.1 months (95% confidence interval 5.3-16.9 months). The median overall survival was not reached. Neoadjuvant therapy was tolerable with 8 (27.5%) grade 3-4 treatment-related adverse events and no treatment-related deaths. Tissue samples of 17 patients at baseline and after surgery were collected (5 responders and 12 nonresponders). Multiplex immunohistochemistry demonstrated a significant increase in CD3+ (P = 0.0032) and CD3+CD8+ (P = 0.0038) tumor-infiltrating lymphocytes after neoadjuvant therapy, particularly in pathological responders.

CONCLUSIONS

Neoadjuvant toripalimab combined with axitinib in resectable mucosal melanoma demonstrated a promising pathologic response rate with significantly increased infiltrating CD3+ and CD3+CD8+ T cells after therapy.

Versatile Double Bandgap Photonic Crystals of High Color Saturation

Double bandgap photonic crystals (PCs) exhibit significant potential for applications in various color display-related fields. However, they show low color saturation and inadequate color modulation capabilities. This study presents a viable approach to the fabrication of double bandgap photonic inks diffracting typical secondary colors and other composite colors by simply mixing two photonic nanochains (PNCs) of different primary colors as pigments in an appropriate percentage following the conventional RGB color matching method. In this approach, the PNCs are magnetically responsive and display three primary colors that can be synthesized by combining hydrogen bond-guided and magnetic field (H)-assisted template polymerization. The as-prepared double bandgap photonic inks present high color saturation due to the fixed and narrow full-width at half-maxima of the parent PNCs with a suitable chain length. Furthermore, they can be used to easily produce a flexible double bandgap PC film by embedding the PNCs into a gel, such as polyacrylamide, facilitating fast steady display performance without the requirement of an external magnetic field. This research not only presents the unique advantages of PNCs in constructing multi-bandgap PCs but also establishes the feasibility of utilizing PNCs in practical applications within the fields of anti-counterfeiting and flexible wearable devices.

Toripalimab (anti-PD-1) versus High-Dose Interferon-α2b as Adjuvant Therapy in Resected Mucosal Melanoma: A Phase II Randomized Trial

BACKGROUND

No standard of care for mucosal melanoma (MM) in the adjuvant setting has been established. Meanwhile, relapse-free survival (RFS) is only about five months after surgery alone. This phase II trial aimed to compare toripalimab vs. high-dose interferon-α2b (HDI) as an adjuvant therapy for resected MM.

PATIENTS AND METHODS

From July 2017 to May 2019, 145 patients with resected MM were randomized (1:1) to receive HDI (N = 72) or toripalimab (N = 73) for one year until disease relapse/distant metastasis, unacceptable toxicity, or withdrawal of consent. The primary endpoint was RFS. The secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), and safety.

RESULTS

After a median follow-up of 26.3 months, the numbers of RFS, OS, and DMFS events were 51 vs. 46, 33 vs. 29, and 49 vs. 44 in the toripalimab arm and the HDI arm, respectively. The median RFS were 13.6 (95%CI: 8.31-19.02) months and 13.9 (95%CI: 8.28-19.61) months in the toripalimab arm and HDI arm, respectively. The DMFS was not significantly different between the two arms (HR: 1.00, 95%CI: 0.65-1.54). The median OS was 35.1 months (95%CI: 27.93-NR) in the toripalimab arm, with no significant difference in all-cause death (HR: 1.11, 95% CI: 0.66-1.84) for the two arms. The median sums of the patients' actual infusion doses were 3672 mg and 1054.5 MIU in the toripalimab arm and HDI arm, respectively. The incidence of treatment-emergent adverse events with a grade ≥ 3 was much higher in the HDI arm than in the toripalimab arm (87.5% vs. 27.4%).

CONCLUSION

Toripalimab showed a similar RFS and a more favorable safety profile than HDI, both better than historical data, suggesting that toripalimab might be the better treatment option. However, additional translational studies and better treatment regimens are still warranted to improve the clinical outcome of MM.

Glucose-Sensing Photonic Nanochain Probes with Color Change in Seconds

Glucose-sensing photonic crystals are promising for the significant advance of continuous glucose monitoring systems due to the naked-eye colorimetric readouts and noninvasive detection of diabetes, but the long response time hampers their practical applications. Here, for the first time probes of photonic nanochains (PNCs) are demonstrated that are capable of continuously and reversibly sensing glucose concentration ([glucose]) variation within seconds by color change without power consumption, much faster by 2-3 orders of magnitude than previous ones. They are comprised of 1D equidistant arrays of magnetic nanoparticles enveloped by tens-of-nanometer-thick phenylboronic acid-functionalized hydrogels, and fabricated by developing selective concentration polymerization of monomers in binary microheterogeneous solvents of dimethyl sulfoxide (DMSO) and H₂ O. In this process, both 3-acrylamido phenylboronic acid (AAPBA) and N-2-hydroxyethyl acrylamide (HEAAm) are preferentially dissolved in the small volume of free DMSO concentrated in the vicinity of poly vinylpyrrolidone coated Fe₃ O₄ colloidal nanoparticles (Fe₃ O₄ @PVP), yielding Fe₃ O₄ @PVP@poly(AAPBA-co-HEAAm) PNCs after UV irradiation under magnetic field. The PNCs in phosphate buffered solution have a wavelength-shift range up to 130 nm when [glucose] changes from 0 to 20 × 10^-3 m. The results can facilitate real-time glucose monitoring and provide an alternative to produce functional organic-inorganic nanostructures.

[Preliminary effects of toripalimab combined with axitinib in the treatment of advanced renal cell carcinoma]

Objective: To analyze the efficacy and safety of toripalimab combined with axitinib in the treatment of advanced renal cell carcinoma. Methods: Clinical data of 50 patients with advanced renal cell carcinoma who received axitinib combined with toripalimab were retrospectively collected from the database of Peking University Cancer Hospital. ORR, DCR, PFS, and OS were analyzed. Results: Among the 50 patients, 37 were males; median age was 56 (22-73) years; 38 were pathologically diagnosed as clear cell renal cell carcinoma and 12 were non-clear cell carcinoma. Common metastatic sites included lung, bone, lymph node, liver, and so on. 90% of the patients had received at least one-line of systemic therapy. With a median follow-up time of 11.9 months (0.8-24), 27 of the 50 patients are still on treatment, ORR was 34%, DCR was 86%, median PFS was 13.1 months (95%CI 5.8-20.4), and median OS has not yet reached. One-year OS rate was 84.6%. Common adverse reactions were proteinuria, diarrhea, hypertension, abnormal thyroid function, elevated transaminase, and hand-foot syndrome. Most adverse events were grade 1-2. Conclusion: Toripalimab combined with axitinib was efficient in the treatment of advanced renal cell carcinoma, and had manageable adverse reactions.

Development and validation of the risk engine for an Australian Health Economics Model of Osteoporosis

The Australian Health Economics Model of Osteoporosis (AusHEMO) has shown good face, internal and cross validities, and can be used to assist healthcare decision-making in Australia.

PURPOSE

This study aimed to document and validate the risk engine of the Australian Health Economics Model of Osteoporosis (AusHEMO).

METHODS

AusHEMO is a state-transition microsimulation model. The fracture risks were simulated using fracture incidence rates from the Dubbo Osteoporosis Epidemiology Study. The AusHEMO was validated regarding its face, internal and cross validities. Goodness-of-fit analysis was conducted and Lin's coefficient of agreement and mean absolute difference with 95% limits of agreement were reported.

RESULTS

The development of AusHEMO followed general and osteoporosis-specific health economics guidelines. AusHEMO showed good face validity regarding the model's structure, evidence, problem formulation and results. In addition, the model has been proven good internal and cross validities in goodness-of-fit test. Lin's coefficient was 0.99, 1 and 0.94 for validation against the fracture incidence rates, Australian life expectancies and residual lifetime fracture risks, respectively.

CONCLUSIONS

In summary, the development of the risk engine of AusHEMO followed the best practice for osteoporosis disease modelling and the model has been shown to have good face, internal and cross validities. The AusHEMO can be confidently used to predict long-term fracture-related outcomes and health economic evaluations when costs data are included. Health policy-makers in Australia can use the AusHEMO to select which osteoporosis interventions such as medications and public health interventions represent good value for money.

Long-term Clinical Performance of Composite Resin or Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis

CLINICAL RELEVANCE

Composite resin or ceramic inlays, onlays, and overlays can achieve high long-term survival and success rates.

SUMMARY

Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective.

INTRODUCTION

This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications.

METHODS

A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed.

RESULTS

Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education (n = 9), (2) drug regimen (n = 3), (3) monitoring and supervision (n = 2), and (4) interdisciplinary collaboration (n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications.

CONCLUSION

This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.

Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing

The multidisciplinary co-management program for geriatric patients with hip fracture is cost-effective in the Chinese population and it has the potential to be scaled up in China.

INTRODUCTION

The study aimed to investigate the cost-effectiveness of a multidisciplinary co-management program for patients with hip fracture in China.

METHODS

Hip fracture patients who were admitted to an orthopedic hospital in Beijing were included in the multidisciplinary co-management program. The cost-effectiveness of intervention was evaluated compared to the conventional management. A Markov microsimulation model was developed to simulate lifetime costs and effectiveness. Costs including intervention, hospitalization, medications, and long-term care costs were expressed using 2019 US dollars and the healthcare perspective was adopted. Effectiveness was evaluated using both 1-year mortality-averted and quality-adjusted life years (QALYs). Costs and effectiveness were discounted at 5% per annum. The willingness-to-pay (WTP) threshold was set at $26,481 per QALY gained which was three times gross domestic product (GDP) per capita in China. One-way and probabilistic sensitivity analyses were conducted.

RESULTS

The lifetime cost for the conventional management (n = 1839) and intervention group (n = 1192) was $11,975 and $13,309 respectively. The lifetime QALYs were 2.38 and 2.45 years and the first-year mortality was 17.8% and 16.1%. The incremental cost-effectiveness ratio was $19,437 per QALY gained or $78,412 per 1-year mortality-averted. Given the Chinese WTP threshold, the intervention had a 78% chance being cost-effective. The cost-effectiveness of the intervention was sensitive to cost of intervention and the proportion of patients who underwent surgery within 48 h.

CONCLUSIONS

The multidisciplinary co-management program for patients with hip fracture is cost-effective and it has the potential to be scaled up in the Chinese population.

BRAF inhibitors: efficacious and tolerable in BRAF-mutant acral and mucosal melanoma

BRAF inhibitors substantially have impressive clinical efficacy in cutaneous melanoma. However, their role in acral and mucosal melanoma remains unclear. Records were reviewed of patients with metastatic or unresectable BRAF-mutant acral and mucosal melanoma hospitalized and administrated BRAF inhibitors during January 2011 and March 2016. Clinical data were collected to determine PFS, ORR, DCR, OS, and safety. Among 28 acral and 12 mucosal melanoma patients treated with BRAF inhibitors, median PFS were 3.6 (95%CI 3.0-6.4) and 4.4 (95%CI 0.8-12.7) months, median OS were 6.2 (95%CI 6.1-12.1) and 8.2 (95%CI 6.6-19.9) months; ORRs were 38.1% and 20.0%, DCRs were 81.0% and 70.0% in acral and mucosal melanoma, respectively. BRAF inhibitors were well tolerated. The most common adverse effects (AEs) were cutaneous and hematological. Grade 3/4 AEs were relatively rare. In conclusion, BRAF inhibitors have acceptable efficacy and good tolerance in BRAF mutant acral and mucosal melanoma.

Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts' consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation

Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards.

INTRODUCTION

This paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards.

METHODS

A working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted.

RESULTS

Recommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed.

CONCLUSION

While the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers.

Treatment effect of CDKN1A on rheumatoid arthritis by mediating proliferation and invasion of fibroblast-like synoviocytes cells

The objective of the present study was to evaluate the role of CDKN1A in rheumatoid arthritis (RA). Related gene expression data screened from Gene Expression Omnibus (GEO) were processed with network analysis. Protein-protein interaction was analysed through string database. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was used to measure mRNA and microRNA expression. Cell proliferation and cell cycle were tested by MTT assay and flow cytometry, respectively. Transwell migration and invasion assay was used to test cell migration and invasion. CDKN1A screened by bioinformatics methods showed differential expression in RA cells compared with healthy controls (HC), and was at an important position in the protein-protein interaction network of RA. Compared with the HC group, CDKN1A was down-regulated in human RA synovium tissues and human fibroblast-like synoviocytes (HFLS). Contrary to CDKN1A silencing, CDKN1A over-expression significantly inhibited the proliferation and invasion of HFLS-RA, arrested HFLS-RA in G0/G1 phase and down-regulated the expressions of tumour necrosis factor (TNF)-α and interleukin (IL)-6, while it up-regulated the expression of IL-10. CDKN1A over-expression could also suppress phosphorylated signal transducers and activators of transcription 1 (pSTAT-1) expression. MiR-146a, highly expressed in RA tissues, could regulate CDKN1A negatively. Anti-146a suppressed cell proliferation and invasion, and at the same time enhanced IL-10 expression but inhibited IL-6, TNF-α and pSTAT-1 expression. The results indicated that CDKN1A over-expression, which could be enhanced by miR-146a suppression, inhibited the proliferation of invasion in HFLS-RA. This was probably a result of suppressed pSTAT-1, IL-6 and TNF-α expression and enhanced IL-10 expression.

[Impact of first-line chemotherapy on renal function in patients with advanced upper tract urothelial carcinoma]

Objective: To observe the impact of first-line chemotherapy on renal function in patients with unresectable/metastatic upper tract urothelial carcinoma(UTUC). Methods: A total of 222 (130 males and 92 females) unresectable/metastatic upper tract urothelial carcinoma patients were included in the study between January 2005 and May 2017, with age of 29 to 87 (62.4±10.1) years old. The serum creatinine level and estimated glomerular filtration rate (eGFR) were compared before and after first-line chemotherapy. And predictive factors for decreased renal function were analyzed in logistic regression model. Results: After the first-line chemotherapy, the average serum creatinine level increased, with a median changing value of 1.5 μmol/L. Howerver, the eGFR improved, with a median changing value of 0.5 ml·min^-1· (1.73 m²)^-1, but the differences were not statistically significant (all P>0.05). In 149 patients who were treated with cisplatin-based chemotherapy, the average serum creatinine level increased by 1.31 μmol/L and eGFR improved by 0.14 ml·min^-1·(1.73 m²)^-1, but the differences were not statistically significant (P>0.05). In multivariate logistic regression model, age more than and equal to 60 years old (OR=0.88, P=0.745) and cisplatin-based chemotherapy (OR=0.95, P=0.893) did not increase the risk of renal dysfunction after first-line chemotherapy. If the time interval between surgery and first-line chemotherapy was more than 1 year, the risk of renal dysfunction due to chemotherapy decreased (OR=0.54, P=0.196). Eastern Cooperative Oncology Group Performance Status (ECOG PS) Scale≥1 (OR=1.81, P=0.131), anemia before treatment (OR=1.14, P=0.764), the cycles of first-line chemotherapy (OR=1.41, P=0.398) may lead to increase the risk of renal dysfunction, but the differences were not statistically significant. However in the patients who accepted nephrectomy, the risk of renal dysfunction after chemotherapy increased, but the difference was still not statistically significant (OR=3.06, P=0.089). Conclusions: First-line chemotherapy, especially the cisplatin-based regimen, had no significant impact on renal function in the patients with UTUC. Nephrectomy maybe a predictive risk factor for decreased renal function after chemotherapy. Adequate assessment of renal function before treatment, hydration and close monitoring during chemotherapy can effectively protect renal function of the patients.

The influence of delipidation on triglyceride and LIPIN1 of porcine embryos derived from parthenogenetic activation

Proteins in the LIPIN family play key roles in lipid synthesis mainly on triacylglycerol (TAG) biosynthesis, and they also act as transcriptional coactivators to regulate the expression of genes involved in lipid metabolism with other nuclear factors. Hence, this study was designed to investigate LIPIN1 in pig oocytes and embryos by the delipidation. After delipidation, the content of lipids (LDs) and TAG in MII oocyte was significantly reduced; however, a similar increasing tendency of TAG was shown during embryos development. Subsequently, the expression of genes related to TAG biosynthesis including GPAT1, AGPAT1, AGPAT2, LIPIN1, DGAT and the nuclear factors interacted with LIPIN1 including PPARα and PPARγ was investigated. It is obvious that DGAT and GPAT1, and LIPIN1 increased significantly after delipidation at 1-cell and 4-cell stage, and the expression of PPARα and PPARγ also increased at 4-cell stage. By immunofluorescence staining and Western blots, LIPIN1 was found to exhibit a dynamic localization pattern and gradually increase with the development of delipated embryo. In the early developmental stages (1-, 2- and 4-cell stages), it was distributed over the cortical layer. But at the blastocyst stage, a homogeneous distribution of LIPIN1 was observed in cytoplasm. At 2-cell stage, the expression of PPARα decreased when LIPIN1 was interfered by small interfering RNA, but PPARγ has no significant difference. Therefore, in this study, we find after delipidation, the content of TAG and LIPIN1 will gradually increase during embryo development and nuclear factor PPARα and PPARγ can also be affected by delipidation. The interaction of LIPIN1 and PPARα exists in porcine embryo.

Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study

Screening and appropriate treatment for osteoporosis has been proven to be cost-effective in many populations; however, it is not clear in the Chinese population. Simulations using a validated health economics model suggest that screening for osteoporosis in Chinese women is cost-effective and may even be cost-saving in Chinese post-menopausal women.

INTRODUCTION

This study aimed at determining the cost-effectiveness of osteoporosis screening strategies in post-menopausal Chinese women.

METHODS

A validated state-transition microsimulation model with a lifetime horizon was used to evaluate the cost-effectiveness of different screening strategies with treatment of alendronate compared with current osteoporosis management in China. Osteoporosis screening strategies assessed were (1) universal screening with dual-energy X-ray absorptiometry (DXA) alone; (2) Osteoporosis Self-Assessment Tool for Asians (OSTA) + DXA; and (3) quantitative ultrasound (QUS) + DXA with rescreening at 2, 5 or 10-year intervals for patients screened negative by DXA. The study was performed from the Chinese healthcare payer's perspective. All model inputs were retrieved from publically available literature. Uncertainties were addressed by one-way and probabilistic sensitivity analysis.

RESULTS

Screening strategies all improved clinical outcomes at increased costs, and each were cost-effective compared with no screening in women aged 55 years given the Chinese willingness-to-pay threshold of USD 20,000 per quality-adjusted life year (QALY) gained. Pre-screening with QUS and subsequent DXA screening if the QUS T-score ≤ -0.5 with a 2-year rescreening interval was the most cost-effective strategy with the highest probability of being cost-effective across all non-dominated strategies. Screening strategies were cost-saving if screenings were initiated from age 65 years. One-way sensitivity analyses indicated that the results were robust.

CONCLUSIONS

Pre-screening with QUS with subsequent DXA screening if the QUS T-score ≤ -0.5 with a 2-year rescreening interval in the Chinese women starting at age 55 is the most cost-effective. In addition, screening and treatment strategies are cost-saving if the screening initiation age is greater than 65 years.

Infiltrating T-lymphocyte Receptor Vβ Gene Family Utilization in Autoimmune Thyroid Disease

The expression of T-cell antigen receptor (TCR) Vβ genes in autoimmune thyroid diseases (AITDs) was investigated. RNA was extracted from the thyroid tissue of 23 patients with early-stage Graves' disease, 19 patients with late-stage Graves' disease and 20 patients with Hashimoto's disease. Peripheral blood lymphocytes from patients and 20 normal subjects (controls) were analysed in parallel. AITD was found to be associated with diminished TCR Vβ gene family utilization. In addition, AITDs appeared to select for specific TCR Vβ families. The Vβ3, Vβ5 and Vβ8 families were expressed more frequently in thyroid-infiltrating T-lymphocytes of early-stage Graves' disease than other Vβ gene families. Selective expression was not observed in infiltrating T-lymphocytes obtained from thyroid tissue of patients with late-stage Graves' disease or Hashimoto's disease. Preferentially expressed TCR Vβ gene families may be useful as molecular targets for targeted immunotherapy of AITDs.

Surface Effects on the Mott-Hubbard Transition in Archetypal V{2}O{3}

We present an experimental and theoretical study exploring surface effects on the evolution of the metal-insulator transition in the model Mott-Hubbard compound Cr-doped V{2}O{3}. We find a microscopic domain formation that is clearly affected by the surface crystallographic orientation. Using scanning photoelectron microscopy and x-ray diffraction, we find that surface defects act as nucleation centers for the formation of domains at the temperature-induced isostructural transition and favor the formation of microscopic metallic regions. A density-functional theory plus dynamical mean-field theory study of different surface terminations shows that the surface reconstruction with excess vanadyl cations leads to doped, and hence more metallic, surface states, which explains our experimental observations.

Australian insurance costs of jockeys injured in a race-day fall

BACKGROUND

The risk of falls and injuries in horseracing varies with sex and experience of the jockey.

AIMS

To determine whether the incidence and costs of insurance claims also differ by such factors.

METHODS

A retrospective analysis of compensation claims by flat racing and jumps jockeys injured in a race-day fall in Australia between 2002 and 2009. Claim incidence, costs, absentee days and location, cause and type of injury sustained were described, stratified by jockey sex, age and experience.

RESULTS

The incidence of claims by flat and jumps racing was 0.6 and 6.5 per 1000 rides, respectively. The mean cost of a claim was 43374 Australian dollars (AUD) (SD 249612) in flat racing and AUD 52589 (SD 157808) in jumps racing. The incidence of claims was greater for experienced flat racing jockeys than apprentices but mean costs were higher for apprentices. After adjustment for experience, there were no sex differences in the average cost or incidence of flat racing jockeys' claims. In general, the fall incidence declined, but the claim incidence and median cost of a claim increased, with age. On average, jockeys were absent from work for 9 weeks following a substantive injury. Limb fractures (33%), muscular or soft tissue injuries (28%) and contusions (17%) were the most commonly reported injuries.

CONCLUSIONS

The economic costs of jockey injuries sustained in race-day falls are considerable. Identification of differences in incidence and costs of insurance claims between jockey characteristics will assist decision makers in the development and assessment of targeted safety strategies.

Projection of osteoporosis-related fractures and costs in China: 2010-2050

A state-transition microsimulation model was used to project the substantial economic burden to the Chinese healthcare system of osteoporosis-related fractures. Annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050. Consequently, cost-effective intervention policies must urgently be identified in an attempt to minimize the impact of fractures.

INTRODUCTION

The aim of the study was to project the osteoporosis-related fractures and costs for the Chinese population aged ≥50 years from 2010 to 2050.

METHODS

A state-transition microsimulation model was used to simulate the annual incident fractures and costs. The simulation was performed with a 1-year cycle length and from the Chinese healthcare system perspective. Incident fractures and annual costs were estimated from 100 unique patient populations for year 2010, by multiplying the age- and sex-specific annual fracture risks and costs of fracture by the corresponding population totals in each of the 100 categories. Projections for 2011-2050 were performed by multiplying the 2010 risks and costs of fracture by the respective annual population estimates. Costs were presented in 2013 US dollars.

RESULTS

Approximately 2.33 (95 % CI 2.08, 2.58) million osteoporotic fractures were estimated to occur in 2010, costing $9.45 (95 % CI 8.78, 10.11) billion. Females sustained approximately three times more fractures than males, accounting for 76 % of the total costs from 1.85 (95 % CI 1.68, 2.01) million fractures. The annual number and costs of osteoporosis-related fractures were estimated to double by 2035 and will increase to 5.99 (95 % CI 5.44, 6.55) million fractures costing $25.43 (95 % CI 23.92, 26.95) billion by 2050.

CONCLUSIONS

Our study demonstrated that osteoporosis-related fractures cause a substantial economic burden which will markedly increase over the coming decades. Consequently, healthcare resource planning must consider these increasing costs, and cost-effective screening and intervention policies must urgently be identified in an attempt to minimize the impact of fractures on the health of the burgeoning population as well as the healthcare budget.

Screening for and treatment of osteoporosis: construction and validation of a state-transition microsimulation cost-effectiveness model

This study aimed to document and validate a new cost-effectiveness model of osteoporosis screening and treatment strategies. The state-transition microsimulation model demonstrates strong internal and external validity. It is an important tool for researchers and policy makers to test the cost-effectiveness of osteoporosis screening and treatment strategies.

INTRODUCTION

The objective of this study was to document and validate a new cost-effectiveness model of screening for and treatment of osteoporosis.

METHODS

A state-transition microsimulation model using a lifetime horizon was constructed with seven Markov states (no history of fractures, hip fracture, vertebral fracture, wrist fracture, other fracture, postfracture state, and death) describing the most important clinical outcomes of osteoporotic fractures. Tracker variables were used to record patients' history, such as fracture events, duration of treatment, and time since last screening. The model was validated for Chinese postmenopausal women receiving screening and treatment versus no screening. Goodness-of-fit analyses were performed for internal and external validation. External validity was tested by comparing life expectancy, osteoporosis prevalence rate, and lifetime and 10-year fracture risks with published data not used in the model.

RESULTS

The model represents major clinical facets of osteoporosis-related conditions. Age-specific hip, vertebral, and wrist fracture incidence rates were accurately reproduced (the regression line slope was 0.996, R(2) = 0.99). The changes in costs, effectiveness, and cost-effectiveness were consistent with changes in both one-way and probabilistic sensitivity analysis. The model predicted life expectancy and 10-year any major osteoporotic fracture risk at the age of 65 of 19.01 years and 13.7%, respectively. The lifetime hip, clinical vertebral, and wrist fracture risks at age 50 were 7.9, 29.8, and 18.7% respectively, all consistent with reported data.

CONCLUSIONS

Our model demonstrated good internal and external validity, ensuring it can be confidently applied in economic evaluations of osteoporosis screening and treatment strategies.

Polymorphisms in genes in the RANKL/RANK/OPG pathway are associated with bone mineral density at different skeletal sites in post-menopausal women

Association between 22 single nucleotide polymorphisms (SNPs) in the TNFSF11, TNFRSF11A, and TNFRSF11B genes in the RANKL/RANK/OPG pathway with bone mineral density (BMD) in 881 post-menopausal women. Our results suggest that TNFSF11 and TNFRSF11A, but not TNFRSF11B, genetic polymorphisms influence BMD mainly in the femoral neck in post-menopausal Chinese women.

INTRODUCTION

The aim of this study was to assess the relationship of polymorphisms in the TNFSF11, TNFRSF11A, and TNFRSF11B genes in the RANKL/RANK/OPG pathway with bone mineral density (BMD) in a cohort of Chinese post-menopausal women.

METHODS

A cross-sectional study was conducted in 881 post-menopausal women aged 50-89 years. All participants underwent lumbar spinal (LS) and femoral neck (FN) BMD evaluation by dual-energy X-ray absorptiometry. Twenty-two TNFSF11, TNFRSF11A, and TNFRSF11B SNPs were genotyped. We tested whether a single SNP or a haplotype was associated with BMD variations.

RESULTS

Two SNPs in the TNFSF11 gene (rs2277439 and rs2324851) and one in the TNFRSF11A gene (rs7239261) were found to be significantly associated with FN BMD (p = 0.014, 0.013, and 0.047, respectively). Haplotype TGACGT of TNFSF11 rs9525641-rs2277439-rs2324851-rs2875459-rs2200287-rs9533166 was a genetic risk factor toward a lower FN BMD (beta = -0.1473; p = 0.01126). In contrary, haplotype TAGCGT of TNFSF11 rs9525641-rs2277439-rs2324851-rs2875459-rs2200287-rs9533166 was genetic protective factor for LS BMD (beta = 0.3923; p = 0.04917).

CONCLUSIONS

Our findings suggest that TNFSF11 and TNFRSF11A, but not TNFRSF11B, genetic polymorphisms influence BMD mainly in the femoral neck in post-menopausal Chinese women. This contributes to the understanding of the role of genetic variation in this pathway in determining bone health.

A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions

This study aimed to statistically combine multiple health state utility values (HSUVs) reported in the literature for patients with osteoporosis and osteoporotic fractures. Fracture events were associated with decrements in HSUVs which differed between fracture sites. We have provided summary values for use in future health economics analyses in osteoporosis. Osteoporotic fractures have high financial and health burden. Economic evaluations on osteoporotic fracture prevention have been frequently performed in past decades. One of the challenges in the economic evaluations was to identify consistent health state utility values (HSUVs) to use for osteoporotic fracture-related conditions. The objective of this study was to determine summary measures of multiple HSUVs reported in the literature for patients with osteoporosis and osteoporotic fractures. We performed a systematic review, meta-analysis and meta-regression of published literature that reported HSUVs for osteoporotic fracture-related conditions. There were 62 studies representing 142,477 patients included. In total, 362 HSUVs were identified: 106 for pre-fracture; 89 for post-hip fracture; 130 for post-vertebral fracture and 37 for post-wrist fracture. The pooled HSUVs, using a random-effects model were 0.76 (95% CI 0.75, 0.77, I (2) = 0.99) for pre-fracture; 0.57 (95% CI 0.52, 0.63, I (2) =1) for post-hip fracture; 0.59 (95% CI 0.55, 0.62, I (2) = 0.99) for post-vertebral facture and 0.72 (95% CI 0.67, 0.78, I (2) = 1) for post-wrist fracture. Heterogeneities were addressed through meta-regression. HSUVs immediately following hip, vertebral and wrist fractures were 0.31, 0.44 and 0.61, respectively. Patients' HSUVs improved over time following fracture events: HSUVs for the first year after hip, vertebral and wrist fractures were 0.59, 0.55 and 0.78, respectively; and 0.66, 0.66 and 0.81 for subsequent years. Fractures were associated with significant decrements in HSUVs. This study provides a standard set of HSUVs that can be used in health economic assessments in osteoporosis.

A systematic review of models used in cost-effectiveness analyses of preventing osteoporotic fractures

This review was aimed at the evolution of health economic models used in evaluations of clinical approaches aimed at preventing osteoporotic fractures. Models have improved, with medical continuance becoming increasingly recognized as a contributor to health and economic outcomes, as well as advancements in epidemiological data. Model-based health economic evaluation studies are increasingly used to investigate the cost-effectiveness of osteoporotic fracture preventions and treatments. The objective of this study was to carry out a systematic review of the evolution of health economic models used in the evaluation of osteoporotic fracture preventions. Electronic searches within MEDLINE and EMBASE were carried out using a predefined search strategy. Inclusion and exclusion criteria were used to select relevant studies. References listed of included studies were searched to identify any potential study that was not captured in our electronic search. Data on country, interventions, type of fracture prevention, evaluation perspective, type of model, time horizon, fracture sites, expressed costs, types of costs included, and effectiveness measurement were extracted. Seventy-four models were described in 104 publications, of which 69% were European. Earlier models focused mainly on hip, vertebral, and wrist fracture, but later models included multiple fracture sites (humerus, pelvis, tibia, and other fractures). Modeling techniques have evolved from simple decision trees, through deterministic Markov processes to individual patient simulation models accounting for uncertainty in multiple parameters. Treatment continuance has been increasingly taken into account in the models in the last decade. Models have evolved in their complexity and emphasis, with medical continuance becoming increasingly recognized as a contributor to health and economic outcomes. This evolution may be driven in part by the desire to capture all the important differentiating characteristics of medications under scrutiny, as well as the advancement in epidemiological data relevant to osteoporosis fractures.

Nicotine-induced impairments of spatial cognition and long-term potentiation in adolescent male rats

The aim of the present study was to investigate whether cognitive behavioral impairment, induced by nicotine in offspring rats, was associated with the alteration of hippocampal short-term potentiation (STP) and long-term potentiation (LTP) and to discuss the potential underlying mechanism. Young adult offspring rats were randomly divided into three groups. The groups include: control group (CC), nicotine group 1 (NC), in which their mothers received nicotine from gestational day 3 (GD3) to GD18, and nicotine group 2 (CN), in which young adult offspring rats received nicotine from postnatal day 42 (PD42) to PD56. Morris water maze (MWM) test was performed and then field excitatory postsynaptic potentials elicited by the stimulation of perforant pathway were recorded in the hippocampal dentate gyrus region. The results of the MWM test showed that learning and memory were impaired by either prenatal or postnatal nicotine exposure. In addition, it was found that there was no statistical difference of the MWM data between both nicotine treatments. In the electrophysiological test, LTP and STP were significantly inhibited in both NC and CN groups in comparison with the CC group. Notably, STP in CN group was also lower than that in the NC group. These findings suggested that both prenatal and postnatal exposure to nicotine induced learning and memory deficits, while the potential mechanism might be different from each other due to their dissimilar impairments of synaptic plasticity.