Budget impact analysis of venetoclax for the management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina

OBJECTIVE

This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina.

METHODS

A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos).

RESULTS

For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and $0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results.

CONCLUSION

The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML.

Facial tremors in patients with and without parkinsonism

Facial (lip and jaw) tremors can be an early sign of Parkinson's disease (PD), essential tremor and other parkinsonisms. Its response to acute dopaminergic therapy and further predictive clinical diagnosis has not been previously addressed. The aim of this study was to evaluate facial tremors response to acute dopaminergic therapy and further predictive value for clinical diagnosis. A retrospective review of medical records from patients with recent onset of facial tremor, with or without parkinsonism, submitted to acute levodopa challenge for clinical prediction of sustained long-term dopaminergic response was conducted. Twenty-eight out of 559 patients (5 %) had facial tremors, which responded to levodopa in 46 % of patients. Facial tremors response to acute levodopa challenge showed 92 % sensitivity and 93 % specificity to predict a final PD diagnosis. In PD patients, facial tremor magnitude of response to levodopa was not different from that of hand rest tremor (p = 0.8). Facial tremors, although infrequent, can be an early sign of PD. Positive response to acute levodopa challenge predicts long-term PD diagnosis.

La plasticité phénotypique des caractères anatomiques foliaires chez le Festuca rubra L. (Pcaceae)

The phenotypic plasticity of nine anatomical leaf characters of Festuca rubra was studied through a transplantation experiment. Twelve genotypes from four habitats (salt marshes, coastal rocks, coastal sands, and ruderal places) were submitted to five treatments in a garden. An analysis of variance shows that almost all these characters were modified by treatments. Nevertheless, in most cases, the greatest part of the variation observed was genetic rather than plastic. Morever, it appears that genotypes responded quite differently to the treatments. The use of these characters in the taxonomy of F. rubra is discussed. Keywords: Festuca rubra, leaf anatomy, phenotypic plasticity.

Nouvelles observations cytologiques chez Festuca rubra sensu lato (Poaceae) dans l'Est du Canada

Sixty-one chromosome number determinations in Festuca rubra L. from eastern Canada show that hexaploids plants (n = 21) are found in both natural habitats and ruderal places, octoploids rhizomatous plants (n = 28) are mostly found in ruderal places, but also in disturbed natural habitats. Morever, one aneuploid (2n = ca. 48) is found from a natural habitat and intercytotype hybrids are found in ruderal places or disturbed natural habitats. Key words: Festuca rubra, cytotypes, hybrids.

Étude de la plasticité phénotypique chez le Chrysanthemum leucanthemum. II Démographie des parties

The technique of demography of parts was used to study the phenotypic plasticity of Chrysanthemum leucanthemum (ox-eye daisy). Plants were cloned and submitted to two separate experiments: three treatments of light intensity and three treatments of nutrient levels. Plant parts (leaves, branches, capitula, stems) were marked at regular intervals during the growing season. Leaves present at the time of transplant generally died earlier when light and nutrient treatments were reduced. However, the number and survivorship of the main stem leaves did not show any significant difference among treatments. In general the number of first-order branches, stems, capitula, and rosette leaves decreased with low light intensity and low nutrient levels. Demography of parts is a dynamic approach, allowing the study of cumulative production of leaves, branches, and capitula. Other techniques, such as traditional growth analysis and study of resource allocation, are more static and descriptive.

Étude de la plasticité phénotypique chez le Chrysanthemum leucanthemum. I. Croissance, allocation de la biomasse et reproduction

Phenotypic plasticity was experimentally studied in plants sampled from two tetraploid populations of ox-eye daisy, Chrysanthemum leucanthemum L. Plants were cloned and ramets were grown in an outdoor garden, in two independent experiments aimed at measuring the effects of light intensity (three treatments) and nutrient level (three treatments). When plants of the same genotype were grown under different light intensities, phenotypic plasticity was high for the following characteristics: total biomass, root weight to total weight ratio, leaf area, leaf area to total weight or specific leaf weight ratio, stem height, branching, number of heads, and time of flowering and fruiting. Genotypes grown under the three nutrient levels showed less plasticity, especially for leaf-related features. Biomass allocation patterns were also measured. Generally, lower light intensities resulted in an increase of allocation to leaves and a corresponding decrease of allocation to roots. On the other hand, lower nutrient levels caused an increase of allocation to roots accompanied by a decrease of allocation to heads, but had little effects on allocation to leaf material. The effective reproductive effort (percentage of biomass allocated to mature achenes) was higher under the lowest light intensity level, but did not change significantly with nutrient levels. The results are discussed in relation to the specificity of plastic responses with respect to the nature of environmental stresses. The prolific production of heads that remained immature at the onset of cold autumn temperatures is interpreted as a nonadaptative tactic in C. leucanthemum.

Chromosomes du Lynx roux, Lynx rufus

The chromosomes of the bobcat (Lynx rufus Schreber) were studied in five males and one female. Karyotypes were obtained both from fibroblast and lymphocyte cultures. The karyotype (2n = 38) includes three morphological types: metacentrics (5 pairs), submetacentrics (11 pairs), and acrocentrics (2 pairs). The gonosomic formula is of the XY-type and both sex chromosomes are submetacentric. The X can be safely identified with G-bands, but not with standard staining techniques. The Y is the smallest chromosome within the complement. In general, the karyotype of the bobcat is similar to karyotypes of other Felidae described in the literature.

Morphological and leaf anatomical variation in Festuca rubra sensu lato (Poaceae) from eastern Quebec

The variation of 52 morphological and anatomical characters was analysed in 32 populations of Festuca rubra L. sensu lato from salt marshes, coastal rocks, coastal sands, and anthropogenic sites in eastern Quebec. The results show that the variation of characters is essentially continuous within and between populations, that some populations are much more variable than others, and that on the whole, character variation patterns are mainly related to ecological rather than geographical factors. The weak structure revealed by a similarity analysis of populations is the source of the classification problems within this species.

Le caryotype de la Hyène rayée, Hyaena hyaena

The chromosomes of the striped hyena (Hyaena hyaena) were studied from fibroblast and lymphocyte cultures. The diploid number is 40, including 32 metacentric–submetacentric and 6 acrocentric autosomes. The gonosomatic formula is of the XY type. The X, a medium-sized metacentric, can be unambiguously identified through its G-banding pattern. The Y is a minute acrocentric. A pair of submetacentric marker chromosomes is also present.

Chromosome studies on natural hybrids between maritime species of Carex (sections Phacocystis and Cryptocarpae) in northeastern North America, and their taxonomic implications

Morphological descriptions, chromosome numbers, and meiotic behaviour are presented for nine different hybrids of Carex in sections Cryptocarpae and Phacocystis from northeastern North America, mainly salt-marsh species from the St. Lawrence estuary and gulf. They are C. aquatilis × subspathacea (2n = 79), C. nigra × subspathacea (2n = 81, 83), C. nigra × salina (2n = 80), C. paleacea × salina (2n = ca. 74, 75), C. aquatilis × recta (2n = 74), C. nigra × recta (2n = 78, 79), C. paleacea × recta (2n = 73), C. aquatilis × paleacea (2n = 74), and C. nigra × paleacea (2n = 78 + fragment, 79). Hybrids showed a mixture of morphological characters from both putative parent species, and chromosome numbers were mostly intermediate between those of their parents. Meiosis of hybrids was disturbed with variable numbers of univalents, trivalents, and quadrivalents, such as in two of the parent species, C. salina and C. recta. In general, hybrids differed from parent species by the frequent occurrence of desynaptic bivalents and higher numbers of trivalents. Pollen stainability was low in hybrids (10.0–56.6%, with two exceptionally high values of 71.8 and 92.2%). Pollen stainability was also low though quite variable in C. salina (23.7–62.8%) and C. recta (16.2–80.7%), but it was much higher in C. paleacea (92.7–100%), C. nigra (63.1–92.9%), and C. aquatilis (78.0–97.2%). Almost all hybrids and parents produced some well-formed achenes. A formula indicating the maximum affinity pairing (MAP formula) and two euploidy indexes were used to compare hybrid individuals and their parent species. Carex salina and C. recta are cytologically considered of hybrid origin, but they behave ecologically as stable species.

Races chromosomiques chez Festuca rubra sensu lato (Poaceae) dans l'est du Québec

Twenty-eight chromosome number determinations in Festuca rubra L. s.l. from eastern Québec show the occurrence of both hexaploids (n = 21) and octoploids (n = 28). Some characters distinguish both cytotypes, but they can be modified by cultivation. All the octoploids are identified as F. diffusa Dumort., an introduced species.

The chromosomes of the Canadian Beaver Castor canadensis

A chromosome analysis of 24 Canadian beavers, Castor canadensis Kuhl (12 males and 12 females), captured in Laurentides Park, Qébec, has been performed from preparations of blood lymphocyte and skin cultures. The chromosome number was found to be 2n = 40. Measurements were made to determine relative lengths and arm ratios of chromosomes, which are metacentric or submetacentric. Results are in agreement with those already published regarding the chromosome number, but differ in the identification of the X chromosome, and in the morphology of the Y and some autosomes. C- ad G-banding techniques allowed the precise identification of individual chromosome pairs. A detailed idiogram of G-bands is presented.

CYTOMIXIS IN POLLEN MOTHER CELLS OF ONONIS (LEGUMINOSAE)

Cytomixis occurred regularly in pollen mother cells (PMCs) of Ononis spinosa L., O. repens L. and O. arvensis L., from early meiotic prophase to telophase II. Usually only a few PMCs were affected in any anther, but occasionally whole anthers showed cytomictic patterns. Cytomixis generally was found at extremities but rarely in the median parts of anthers. Since it appeared to lead to the degeneration of affected PMCs or young microspores, it, therefore, could not give rise to aneuploidy. Cytomixis is interpreted as a pathological abnormality induced by pressure building up within the developing flower bud; it occurred where anthers pressed strongly against each other due to competition for space. It is suggested that uncoordinated growth rates of anthers and floral envelopes could account for intense cytomixis described in hybrids by various authors.