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Tan CJ, Tan MSY, Nagarajan C, Chng WJ, Chee YL, Ooi M, Ng LCK, Chen Y, Yoong JSY, Wong XY, Jen WY. Factors Affecting Patient and Caregiver Preferences for Treatment of Myeloma and Indolent Lymphoma. JCO Oncol Pract 2023; 19:1168-1178. [PMID: 37844267 DOI: 10.1200/op.23.00336] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023] Open
Abstract
PURPOSE Treatment options for myeloma and indolent lymphoma are increasing exponentially, with distinct efficacy, side effects, and cost. We aim to determine the factors influencing patient and caregiver treatment preferences. METHODS Patients and caregivers of patients with myeloma and indolent lymphoma were recruited from two cancer centers in Singapore. Preferences were elicited using a discrete choice experiment. Attributes and levels were selected based on a previous qualitative study. The relative preference for levels within each attribute (part worth utility values) and the extent to which an attribute would influence decision making (relative importance) were calculated. Patient and caregiver participation in the treatment plan selection process were assessed using the Control Preference Scale. RESULTS One hundred ninety-nine patients and 169 caregivers were recruited. Patients placed the highest importance on out-of-pocket costs (relative importance = 35%), followed by efficacy (25%), persistent side effects (19%), administration route (8%), treatment duration (7%), and short-term side effects (5%). Caregivers ranked efficacy (27%) as the most important attribute, over out-of-pocket costs (24%). Most patients preferred a collaborative role in the shared decision-making process, while similar proportions of caregivers favored active and collaborative roles. CONCLUSION Our study demonstrates that both patients and caregivers consider cost seriously when making treatment decisions. Furthermore, as patient and caregiver preferences may differ, there are implications for treatment selection and counseling, especially in cultures where caregivers have more prominent roles in treatment planning.
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Affiliation(s)
- Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Melinda Si Yun Tan
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Yen-Lin Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Melissa Ooi
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yunxin Chen
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Joanne Su Yin Yoong
- Research for Impact, Singapore, Singapore
- Behavioral and Implementation Science Interventions, National University of Singapore, Singapore, Singapore
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
- Sim Kee Boon Institute for Financial Economics, Singapore Management University, Singapore, Singapore
| | - Xin Yi Wong
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Wei-Ying Jen
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
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See-Toh RSE, Wong XY, Mahboobani KSKH, Soon SS, Kearns B, Cooper K, Ho KW, Kuntjoro I, Ng K. Cost-effectiveness of transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis of intermediate surgical risk in Singapore. BMC Health Serv Res 2022; 22:994. [PMID: 35927703 PMCID: PMC9354430 DOI: 10.1186/s12913-022-08369-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The objective was to assess the cost-effectiveness of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis with intermediate surgical risk in Singapore. Methods A de novo Markov model with three health states – stroke with long-term sequelae, no stroke, and death – was developed and simulated using Monte Carlo simulations with 10,000 iterations over a five-year time horizon from the Singapore healthcare system perspective. A 3% annual discount rate for costs and outcomes and monthly cycle lengths were used. By applying the longest available published clinical evidence, simulated patients received either TAVI or surgical aortic valve replacement (SAVR) and were at risk of adverse events (AEs) such as moderate-to-severe paravalvular aortic regurgitation (PAR). Results When five-year PARTNER 2A data was applied, base-case analyses showed that the incremental cost-effectiveness ratio (ICER) for TAVI compared to SAVR was US$315,760 per quality-adjusted life year (QALY) gained. The high ICER was due to high incremental implantation and procedure costs of TAVI compared to SAVR, and marginal improvement of 0.10 QALYs as simulated mortality of TAVI exceeded SAVR at 3.75 years post-implantation. One-way sensitivity analysis showed that the ICERs were most sensitive to cost of PAR, utility values of SAVR patients, and cost of TAVI and SAVR implants and procedures. When disutilities for AEs were additionally applied, the ICER decreased to US$300,070 per QALY gained. TAVI was dominated by SAVR when the time horizon increased to 20 years. Clinical outcomes projected from one-year PARTNER S3i data further reduced the ICER to US$86,337 per QALY gained for TAVI, assuming early all-cause mortality benefits from TAVI continued to persist. This assumption was undermined when longer term data showed that TAVI’s early mortality benefits diminished at five years. Limitations and conclusion TAVI is unlikely to be cost-effective in intermediate surgical-risk patients compared to SAVR in Singapore. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08369-5.
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Affiliation(s)
| | - Xin Yi Wong
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | | | - Swee Sung Soon
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | - Benjamin Kearns
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
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Shadman S, Chin CMM, Sakundarini N, Yap EH, Fairuz S, Wong XY, Khalid PA, Karimi F, Karaman C, Mofijur M, Koyande AK, Show PL. A system dynamics approach to pollution remediation and mitigation based on increasing the share of renewable resources. Environ Res 2022; 205:112458. [PMID: 34863687 DOI: 10.1016/j.envres.2021.112458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/03/2021] [Accepted: 11/25/2021] [Indexed: 06/13/2023]
Abstract
This study explores the role of renewable energy (RE) penetration in Malaysia's energy security (ES) and its implications for the country's target of 20% capacity in the energy mix by 2025. Renewable energy (RE) is a critical driver of long-term energy security. In 2018, the share of renewable energy in Malaysia's energy mix was 9%, falling far short of the national target of 20% penetration by 2025. This study employs a system dynamics approach to investigate the relationship between RE penetration and correlated indicators from energy security (ES) dimensions: energy availability, environmental sustainability, and socio-economics. The causal relationships between the three-dimensional indicators of ES have been established using causal and stock and flow logic. Simulated results show that energy consumption has increased sharply, while energy efficiency and economic growth have only increased by a small margin with an increase in RE from 2015 to 2020. The energy intensity is expected to rise slightly by the end of the fifth year. As a result, the overall impact is positive for Malaysia's environmental sustainability while reducing its reliance on energy imports and meeting national economic growth demands.
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Affiliation(s)
- Saleh Shadman
- Department of Mechanical, Materials, and Manufacturing Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia; EcoThinkers, House 59, Road 1, Block i, Banani, 1213, Dhaka, Bangladesh
| | - Christina M M Chin
- Department of Mechanical, Materials, and Manufacturing Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia
| | - Novita Sakundarini
- Department of Mechanical, Materials, and Manufacturing Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia
| | - Eng Hwa Yap
- School of Robotics, XJTLU Entrepreneur College (Taicang), Xi'an Jiaotong-Liverpool University, Suzhou, 215123, Jiangsu, People's Republic of China
| | - Shadreen Fairuz
- School of Science, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Xin Yi Wong
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia
| | - Phahmee Ahanaf Khalid
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia
| | - Fatemeh Karimi
- Department of Chemical Engineering, Quchan University of Technology, Quchan, Iran
| | - Ceren Karaman
- Akdeniz University, Department of Electricity and Energy, Antalya, 07070, Turkey
| | - M Mofijur
- Centre for Green Technology, School of Civil and Environmental Engineering, University of Technology, Sydney, NSW, 2007, Australia; Mechanical Engineering Department, Prince Mohammad Bin Fahd University, Al Khobar, 31952, Saudi Arabia
| | - Apurav Krishna Koyande
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia.
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, 43500, Selangor, Malaysia.
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Wong XY, Chng WJ, Aziz MIA, Ng K. Cost-effectiveness of daratumumab in combination with lenalidomide and dexamethasone for relapsed and/or refractory multiple myeloma. Expert Rev Pharmacoecon Outcomes Res 2021; 22:207-215. [PMID: 34904498 DOI: 10.1080/14737167.2022.2017285] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study evaluates the cost-effectiveness of daratumumab (D) in combination with lenalidomide and dexamethasone (Rd) for treatment of relapsed and/or refractory multiple myeloma in patients who have received at least one prior therapy in Singapore. METHODS A 3-state partitioned survival model was developed to evaluate the cost-effectiveness of lenalidomide and dexamethasone with or without daratumumab from a healthcare system perspective over 10 years. Clinical inputs were obtained from the POLLUX trial. Health state utilities were derived from the literature and direct medical costs obtained from public healthcare institutions. Sensitivity and scenario analyses were conducted to explore uncertainties. RESULTS DRd was associated with a high base-case incremental cost-effectiveness ratio (ICER) of US$576,247 per quality-adjusted life year (QALY) gained, compared with Rd. According to one-way sensitivity analysis, ICER was most heavily influenced by time horizon, discount rate for outcomes, progression-free utility and cost of daratumumab. Regardless of the variation, DRd remained not cost-effective. Even when the cost of both daratumumab and lenalidomide dropped by 20% and 80%, the ICERs remained high at US$470,400 and US$152,860 per QALY gained. CONCLUSIONS At current prices, the addition of daratumumab to lenalidomide and dexamethasone does not represent cost-effective use of healthcare resources in Singapore.
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Affiliation(s)
- Xin Yi Wong
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Wee Joo Chng
- Division of Haematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, National University of Singapore (NUS), Singapore.,Yong Loo Lin School of Medicine, NUS, Singapore
| | | | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore
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Wong XY, Quesada-González D, Manickam S, Muthoosamy K. Fluorescence "turn-off/turn-on" biosensing of metal ions by gold nanoclusters, folic acid and reduced graphene oxide. Anal Chim Acta 2021; 1175:338745. [PMID: 34330444 DOI: 10.1016/j.aca.2021.338745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/17/2021] [Revised: 05/30/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
Metal ions homeostasis plays an important role in biological processes. The ability to detect the concentration of metal ions in biological fluids is often challenged by the obvious interference or competitive binding nature of other alkaline metals ions. Common analytical techniques employed for metal ions detection are electrochemical, fluorescence and colorimetric methods. However, most reported metal ions sensors are complicated, time-consuming and involve costly procedures with limited effectiveness. Herein, a nanobiosensor for detecting sodium and potassium ions using folic acid-functionalised reduced graphene oxide-modified RNase A gold nanoclusters (FA-rGO-RNase A/AuNCs) based on fluorescence "turn-off/turn-on" is presented. Firstly, a facile and optimised protocol for the fabrication of RNase A/AuNCs is developed. The activity of RNase A protein after the formation of RNase A/AuNCs is studied. RNase A/AuNCs is then loaded onto FA-rGO, in which FA-rGO is used as a potential carrier and fluorescence quencher for RNase A/AuNCs. Finally, a fluorescence "turn-on" sensing strategy is developed using the as-synthesised FA-rGO-RNase A/AuNCs to detect sodium and potassium ions. The developed nanobiosensor revealed an excellent sensing performance and meets the sensitivity required to detect both sodium and potassium ions. To the best of our knowledge, this is the first work done on determining the RNase A protein activity in RNase A/AuNCs and exploring the potential application of RNase A/AuNCs as a metal ion sensor. This work serves as a proof-of-concept for combining the potential of drug delivery, active targeting and therapy on cancer cells, as well as biosensing of metal ions into a single platform.
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Affiliation(s)
- Xin Yi Wong
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Semenyih, Selangor, Malaysia
| | - Daniel Quesada-González
- Paperdrop Diagnostics, Av. de Can Domènech S/n, Eureka Building, Campus UAB, 08193, Bellaterra, Barcelona, Spain
| | - Sivakumar Manickam
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500, Semenyih, Selangor, Malaysia; Nanotechnology Research Group, Centre of Nanotechnology and Advanced Materials, University of Nottingham Malaysia, 43500, Semenyih, Selangor, Malaysia; Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Bandar Seri Begawan, BE1410, Brunei Darussalam
| | - Kasturi Muthoosamy
- Nanotechnology Research Group, Centre of Nanotechnology and Advanced Materials, University of Nottingham Malaysia, 43500, Semenyih, Selangor, Malaysia.
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Chootipongchaivat S, Wong XY, Ten Haaf K, Hartman M, Tan KB, van Ravesteyn NT, Wee HL. Cost-effectiveness Analysis of Breast Cancer Screening Using Mammography in Singapore: A Modeling Study. Cancer Epidemiol Biomarkers Prev 2021; 30:653-660. [PMID: 33531436 PMCID: PMC8026695 DOI: 10.1158/1055-9965.epi-20-1230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/31/2020] [Revised: 11/15/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Limited research is available on the cost-effectiveness of breast cancer screening programs in Asian countries. We evaluated the cost-effectiveness of Singapore's national mammography screening program, implemented in 2002, recommending annual screening between ages 40 and 49 and biennial screening between ages 50 and 69, and alternative screening scenarios taking into account important country-specific factors. METHODS We used national data from Singapore in the MIcrosimulation SCreening ANalysis-Fatal diameter (MISCAN-Fadia) model to simulate 302 screening scenarios for 10 million women born between 1910 and 1969. Screening scenarios varied by starting and ending age, screening interval, and attendance. Outcome measures included life-years gained (LYG), breast cancer deaths averted, false positives, overdiagnosis, quality-adjusted life years (QALY), costs (in 2002 Singapore dollars; S$), and incremental cost-effectiveness ratios (ICER). Costs and effects were calculated and discounted with 3% using a health care provider's perspective. RESULTS Singapore's current screening program at observed attendance levels required 54,158 mammograms per 100,000 women, yielded 1,054 LYG, and averted 57 breast cancer deaths. At attendance rates ≥50%, the current program was near the efficiency frontier. Most scenarios on the efficiency frontier started screening at age 40. The ICERs of the scenarios on the efficiency frontiers ranged between S$10,186 and S$56,306/QALY, which is considered cost-effective at a willingness-to-pay threshold of S$70,000/QALY gained. CONCLUSIONS Singapore's current screening program lies near the efficiency frontier, and starting screening at age 40 or 45 is cost-effective. Furthermore, enhancing screening attendance rates would increase benefits while maintaining cost-effectiveness. IMPACT Screening all women at age 40 or 45 is cost-efficient in Singapore, and a policy change may be considered.
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Affiliation(s)
- Sarocha Chootipongchaivat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Senior Consultant, Breast and Trauma Surgery, Department of Surgery, National University Hospital, Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Director of Policy, Research and Economics Office, Ministry of Health, Singapore
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Wong XY, Lim AQJ, Shen Q, Chia JWK, Chew MH, Tan WS, Wee HL. Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment. Curr Med Res Opin 2020; 36:1677-1686. [PMID: 32609014 DOI: 10.1080/03007995.2020.1790348] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients' preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies. METHODS Discrete choice experiment (DCE) was administered to English- or Chinese-speaking Stage 2 or 3 colon cancer patients at the National Cancer Centre Singapore. DCE attributes comprise progression-free survival (PFS), severity of acne-like skin rashes, severity of bleeding, out-of-pocket cost per month and frequency of drug administration. Mixed logit model was used to calculate preference weights for all attribute levels. Subgroup analyses were conducted by interacting attribute levels with selected respondent characteristics. Relative uptake rates for various medication scenarios were studied. RESULTS 169 respondents aged 61.5 ± 10.5 years completed the survey. They placed the greatest weight on cost, followed by bleeding and skin rashes, then PFS and finally frequency of drug administration. This was similarly observed in the subgroup analyses. A scenario with shorter PFS but less severe side effects has a slightly higher relative uptake at 55%. One quarter of respondents reported that they would not take the treatment they preferred in the choice task. CONCLUSION Patients were willing to trade off some degree of efficacy to avoid certain severity of side effects. It is therefore crucial for patients and physicians to discuss patients' preferences and circumstances to understand which attributes are more important, as well as patients' views on the trade-offs between treatment benefits and risks.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Qi Jun Lim
- NUS Science Research Programme, Hwa Chong Institution (College Section), Singapore, Republic of Singapore
| | - Qianyu Shen
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - John Whay Kuang Chia
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Min Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Wah Siew Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
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Png WY, Wong XY, Kwan YH, Lin YY, Tan DSY. Perspective on CYP2C19 genotyping test among patients with acute coronary syndrome - a qualitative study. Future Cardiol 2020; 16:655-662. [PMID: 32524842 DOI: 10.2217/fca-2020-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Identify factors patients consider regarding CYP2C19 genotyping test to guide choice of antiplatelet therapy. Patients & methods: Patient's perception and attitude toward use of CYP2C19 genotyping test was gathered according to an interview guide. Thematic analysis was conducted. Results: A total of 14 patients were interviewed. The main factors found to influence uptake of CYP2C19 genotyping test are, convenience of genotyping test (n = 4), physician's recommendation (n = 11), prior explanation of genetic testing by medical personnel (n = 5) and inclination toward clopidogrel, with three sub-factors; less frequent dosing (n = 3), lower cost (n = 7) and lower risk of bleeding (n = 9). Conclusion: This study provided the information needed to develop a discrete choice experiment to empirically quantify patients' preference and willingness to pay for genetic testing and to simulate uptake.
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Affiliation(s)
- Wan Yu Png
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - Xin Yi Wong
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559
| | - Yu Heng Kwan
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857
| | - Ying Ying Lin
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - Doreen Su-Yin Tan
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
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Wee JW, Png WY, Wong XY, Kwan YH, Lin YY, Tan DSY, Wee HL. Measuring preferences for CYP2C19 genotyping in patients with acute coronary syndrome - a discrete choice experiment. Future Cardiol 2020; 16:663-674. [PMID: 32524837 DOI: 10.2217/fca-2020-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To evaluate the relative importance of CYP2C19 genotype-guided treatment attributes to patients. Patients & methods: A discrete choice experiment questionnaire was administered to 63 patients with acute coronary syndrome. Attributes examined in the discrete choice experiment questionnaire were: cost of genetic testing (S$50, S$100, S$200); cost of antiplatelet medication (S$100, S$500, S$1000); heart attack or stroke risk (5 in 100, 15 in 100, 25 in 100); bleeding risk (5 in 100, 15 in 100, 25 in 100); doctor's recommendation (yes, neutral). Mixed logit model was used for analysis. Results & conclusion: All attributes were important in patients' decision-making. Most displayed strong preference for doctor's recommendation and reduced heart attack or stroke risk. Genotyping was chosen by 63.5% of the patients.
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Affiliation(s)
- Juliana Wt Wee
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559, Singapore
| | - Wan Yu Png
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Xin Yi Wong
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Ying Ying Lin
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Doreen S-Y Tan
- Department of Pharmacy, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Hwee Lin Wee
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117559, Singapore
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Wong XY, Sena-Torralba A, Álvarez-Diduk R, Muthoosamy K, Merkoçi A. Nanomaterials for Nanotheranostics: Tuning Their Properties According to Disease Needs. ACS Nano 2020; 14:2585-2627. [PMID: 32031781 DOI: 10.1021/acsnano.9b08133] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nanotheranostics is one of the biggest scientific breakthroughs in nanomedicine. Most of the currently available diagnosis and therapies are invasive, time-consuming, and associated with severe toxic side effects. Nanotheranostics, on the other hand, has the potential to bridge this gap by harnessing the capabilities of nanotechnology and nanomaterials for combined therapeutics and diagnostics with markedly enhanced efficacy. However, nanomaterial applications in nanotheranostics are still in its infancy. This is due to the fact that each disease has a particular microenvironment with well-defined characteristics, which promotes deeper selection criteria of nanomaterials to meet the disease needs. In this review, we have outlined how nanomaterials are designed and tailored for nanotheranostics of cancer and other diseases such as neurodegenerative, autoimmune (particularly on rheumatoid arthritis), and cardiovascular diseases. The penetrability and retention of a nanomaterial in the biological system, the therapeutic strategy used, and the imaging mode selected are some of the aspects discussed for each disease. The specific properties of the nanomaterials in terms of feasibility, physicochemical challenges, progress in clinical trials, its toxicity, and their future application on translational medicine are addressed. Our review meticulously and critically examines the applications of nanotheranostics with various nanomaterials, including graphene, across several diseases, offering a broader perspective of this emerging field.
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Affiliation(s)
- Xin Yi Wong
- Nanobioelectronics and Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, and The Barcelona Institute of Science and Technology (BIST), Campus UAB, Bellaterra, 08193 Barcelona, Spain
- Department of Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor Malaysia
| | - Amadeo Sena-Torralba
- Nanobioelectronics and Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, and The Barcelona Institute of Science and Technology (BIST), Campus UAB, Bellaterra, 08193 Barcelona, Spain
| | - Ruslan Álvarez-Diduk
- Nanobioelectronics and Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, and The Barcelona Institute of Science and Technology (BIST), Campus UAB, Bellaterra, 08193 Barcelona, Spain
| | - Kasturi Muthoosamy
- Nanotechnology Research Group, Centre of Nanotechnology and Advanced Materials, University of Nottingham Malaysia, 43500 Semenyih, Selangor Malaysia
| | - Arben Merkoçi
- Nanobioelectronics and Biosensors Group, Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC, and The Barcelona Institute of Science and Technology (BIST), Campus UAB, Bellaterra, 08193 Barcelona, Spain
- ICREA, Institució Catalana de Recerca i Estudis Avançats, Pg. Lluis Companys 23, 08010 Barcelona, Spain
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Fung SM, Wong XY, Lee SX, Miao H, Hartman M, Wee HL. Performance of Single-Nucleotide Polymorphisms in Breast Cancer Risk Prediction Models: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2018; 28:506-521. [DOI: 10.1158/1055-9965.epi-18-0810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/30/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022] Open
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Chia S, Wong XY, Toon ML, Seah Y, Yap AF, Lim C, Tay HY, Fong W, Low LL, Kwan YH. Patient preferences for types of community-based cardiac rehabilitation programme. Heart Asia 2018; 10:e010976. [PMID: 29387175 DOI: 10.1136/heartasia-2017-010976] [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] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 11/03/2022]
Abstract
Introduction Cardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours constraints. Community-based CR is a possible solution. Objectives To understand the type of community-based CR preferred and identify patient characteristics associated with certain programme combinations. Methods A cross-sectional survey was administered to a randomised list of patients at risk for or with cardiovascular diseases at two community-based CR centres. Participants were presented with nine hypothetical choice sets and asked to choose only one of the two alternative programme combinations in each choice set. Attributes include support group presence, cash incentives, upfront deposit and out-of-pocket cost. The counts for each combination were tallied and corrected for repeats. Chi-square test and logistic regression were performed to understand the characteristics associated with the preferred CR combination. Results After correcting for repeats, patients most (85.2%) prefer CR programmes with new group activities, support group, cash rewards, deposit and out-of-pocket cost, and few exercise equipment with physiotherapist presence without the need for monitoring equipment. Patients with more than three bedrooms in their house are less likely (OR 0.367; CI 0.17 to 0.80; P=0.011) to choose the choice with no physiotherapist and few equipment available. Conclusion This is the first study to explore patients' preferences for different types of community CR. Higher income patients prefer physiotherapist presence and are willing to settle for less equipment. Our study serves as a guide for designing future community-based CR programmes.
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Affiliation(s)
| | - Xin Yi Wong
- Department of Pharmacy, National University of Singapore, Singapore
| | - Min Li Toon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore
| | | | - Cindy Lim
- Heart Wellness Centre, Singapore Heart Foundation, Singapore
| | - Hung Yong Tay
- Heart Wellness Centre, Singapore Heart Foundation, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
| | - Yu Heng Kwan
- Heart Wellness Centre, Singapore Heart Foundation, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Wong XY, Groothuis-Oudshoorn CG, Tan CS, van Til JA, Hartman M, Chong KJ, IJzerman MJ, Wee HL. Women's preferences, willingness-to-pay, and predicted uptake for single-nucleotide polymorphism gene testing to guide personalized breast cancer screening strategies: a discrete choice experiment. Patient Prefer Adherence 2018; 12:1837-1852. [PMID: 30271127 PMCID: PMC6154732 DOI: 10.2147/ppa.s171348] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Single-nucleotide polymorphism (SNP) gene test is a potential tool for improving the accuracy of breast cancer risk prediction. We seek to measure women's preferences and marginal willingness-to-pay (mWTP) for this new technology. MATERIALS AND METHODS We administered a discrete choice experiment (DCE) to English-speaking Singaporean women aged 40-69 years without any history of breast cancer, enrolled via door-to-door recruitment with quota sampling by age and ethnicity. DCE attributes comprise: 1) sample type (buccal swab and dried blood spot), 2) person conducting pretest discussion (specialist doctor, non-specialist doctor, and nurse educator), 3) test location (private family clinic, public primary-care clinic, and hospital), and 4) out-of-pocket cost (S$50, S$175, and S$300). Mixed logit model was used to estimate the effect of attribute levels on women's preferences and mWTP. Interactions between significant attributes and respondent characteristics were investigated. Predicted uptake rates for various gene testing scenarios were studied. RESULTS A total of 300 women aged 52.6±7.6 years completed the survey (100 Chinese, Malay, and Indian women, respectively). Sample type (P=0.046), person conducting pretest discussion, and out-of-pocket cost (P<0.001) are significantly associated with going for SNP gene testing. Women with higher income and education levels are more willing to pay higher prices for the test. Preferences in terms of mWTP across ethnic groups appear similar, but Chinese women have greater preference heterogeneity for the attributes. Predicted uptake for a feasible scenario consisting of buccal swab, pretest discussion with nurse educator at the hospital costing S$50 is 60.5%. Only 3.3% of women always opted out of the SNP gene test in real life. Reasons include high cost, poor awareness, and indifference toward test results. CONCLUSION SNP gene testing may be tailored according to individual preferences to encourage uptake. Future research should focus on outcomes and cost-effectiveness of personalized breast cancer screening using SNP gene testing.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore,
| | - Catharina Gm Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore,
| | - Janine A van Til
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore,
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Kok Joon Chong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore,
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Republic of Singapore,
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Wong XY, Chong KJ, van Til JA, Wee HL. A qualitative study on Singaporean women's views towards breast cancer screening and Single Nucleotide Polymorphisms (SNPs) gene testing to guide personalised screening strategies. BMC Cancer 2017; 17:776. [PMID: 29162038 PMCID: PMC5697412 DOI: 10.1186/s12885-017-3781-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background Breast cancer is the top cancer by incidence and mortality in Singaporean women. Mammography is by far its best screening tool, but current recommended age and interval may not yield the most benefit. Recent studies have demonstrated the potential of single nucleotide polymorphisms (SNPs) to improve discriminatory accuracy of breast cancer risk assessment models. This study was conducted to understand Singaporean women’s views towards breast cancer screening and SNPs gene testing to guide personalised screening strategies. Methods Focus group discussions were conducted among English-speaking women (n = 27) between 40 to 65 years old, both current and lapsed mammogram users. Women were divided into four groups based on age and mammogram usage. Discussions about breast cancer and screening experience, as well as perception and attitude towards SNPs gene testing were conducted by an experienced moderator. Women were also asked for factors that will influence their uptake of the test. Transcripts were analysed using thematic analysis to captured similarities and differences in views expressed. Results Barriers to repeat mammogram attendance include laziness to make appointment and painful and uncomfortable screening process. However, the underlying reason may be low perceived susceptibility to breast cancer. Facilitators to repeat mammogram attendance include ease of making appointment and timely reminders. Women were generally receptive towards SNPs gene testing, but required information on accuracy, cost, invasiveness, and side effects before they decide whether to go for it. Other factors include waiting time for results and frequency interval. On average, women gave a rating of 7.5 (range 5 to 10) when asked how likely they will go for the test. Conclusion Addressing concerns such as pain and discomfort during mammogram, providing timely reminders and debunking breast cancer myths can help to improve screening uptake. Women demonstrated a spectrum of responses towards a novel test like SNPs gene testing, but need more information to make an informed decision. Future public health education on predictive genetic testing should adequately address both benefits and risks. Findings from this study is used to inform a discrete choice experiment to empirically quantify women preferences and willingness-to-pay for SNPs gene testing. Electronic supplementary material The online version of this article (10.1186/s12885-017-3781-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore
| | - Kok Joon Chong
- Department of Planning and Development, Regional Health System Planning Office, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Janine A van Til
- Department of Health Technology & Services Research, School for Management & Governance, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Hwee Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Republic of Singapore.
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Wong XY, Hlaing RX, Liu M, Li YX, Tsang WS, Tse WJ. [Novel markers in triple-negative breast cancers]. Zhonghua Bing Li Xue Za Zhi 2017; 46:2-8. [PMID: 28072968 DOI: 10.3760/cma.j.issn.0529-5807.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Guan Z, Wong XY. [Immunologic study on pregnancy induced hypertension]. Zhonghua Fu Chan Ke Za Zhi 1994; 29:684-6. [PMID: 7712892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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