Cost-effectiveness of subdermal implantable buprenorphine versus sublingual buprenorphine to treat opioid use disorder

Aims: Subdermal implantable buprenorphine (BSI) was recently approved to treat opioid use disorder (OUD) in clinically-stable adults. In the pivotal clinical trial, BSI was associated with a higher proportion of completely-abstinent patients (85.7% vs 71.9%; p?=?.03) vs sublingual buprenorphine (SL-BPN). Elsewhere, relapse to illicit drug use is associated with diminished treatment outcomes and increased costs. This study evaluated the cost-effectiveness of BSI vs SL-BPN from a US societal perspective.

Methods: A Markov model simulated BSI and SL-BPN cohorts (clinically-stable adults) transiting through four mutually-exclusive health states for 12 months. Cohorts accumulated direct medical costs from drug acquisition/administration; treatment-diversion/abuse; newly-acquired hepatitis-C; emergency room, hospital, and rehabilitation services; and pediatric poisonings. Non-medical costs of criminality, lost wages/work-productivity, and out-of-pocket expenses were also included. Transition probabilities to a relapsed state were derived from the aforementioned trial. Other transition probabilities, costs, and health-state utilities were derived from observational studies and adjusted for trial characteristics. Outcomes included incremental cost per quality-adjusted-life-year (QALY) gained and incremental net-monetary-benefit (INMB). Uncertainty was assessed by univariate and probabilistic sensitivity analysis (PSA).

Results: BSI was associated with lower total costs (?$4,386), more QALYs (+0.031), and favorable INMB at all willingness-to-pay (WTP) thresholds considered. Higher drug acquisition costs for BSI (+$6,492) were outpaced, primarily by reductions in emergency room/hospital utilization (?$8,040) and criminality (?$1,212). BSI was cost-effective in 89% of PSA model replicates, and had a significantly higher NMB at $50,000/QALY ($20,783 vs $15,007; p?Conclusions: BSI was preferred over SL-BPN from a health-economic perspective for treatment of OUD in clinically-stable adults. These findings should be interpreted carefully, due to some relationships having been modeled from inputs derived from multiple sources, and would benefit from comparison with outcomes from studies that employ administrative claims data or a naturalistic comparative design.     

口腔种植导板的数字化设计与3D打印

为了提高牙齿种植位置和方向的准确性,降低手术难度,缩短手术时间,降低患者术后不适感和并发症等,对承载着种植体理想植入方位信息的种植导板进行了研究。在没有专用牙齿种植软件的情况下,利用CT图像和三维光学扫描数据重建牙颌模型,使用通用的Mimics,Geomagic和Magics等软件进行种植手术规划与导板设计,并采用FDM和SL两种3D打印工艺对导板进行制作,通过导板与牙模佩戴测试,给出了设计参数,实验结果有助于牙齿种植的数字化和精准化。提出的导板设计与制作工艺可以作为参考,以帮助医生和工程师在没有专用的种植软件的情况下,进行数字化导板的设计与制作,提高种植的精准度和成功率。     

Reoperations in intramedullary fixation of pertrochanteric hip fractures

Objective: This study evaluated the frequency of reoperation within 1 year of initial intramedullary fixation for patients with pertrochanteric hip fracture and compared 1-year healthcare resource utilization and cost burden for patients with and without reoperation.

Methods: This is a retrospective evaluation of medical claims from the US Centers for Medicare and Medicaid Standard Analytic File. Patients aged ≥65?years who underwent fixation with an intramedullary implant for a pertrochanteric fracture between 2013 and 2015 were included. Healthcare resources that were evaluated included skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmissions, and outpatient hospital visits. All-cause payments for these services comprised overall cost burden. Generalized Linear Models were used to evaluate healthcare resources and cost burden over 1-year post-surgery and to adjust for confounding between patients with and without a reoperation.

Results: A total of 6,423 Medicare patients were included in the analysis. Mean (SD) age was 82.4 (7.8) years, 76.0% were female, and 93.3% were white. A second hip surgery within 1 year after the index fixation procedure was performed in 414 patients (6.4%): 121 (29.2%) contralateral, 115 (27.8%) ipsilateral, and 178 (43.0%) without specified laterality. After adjusting for confounding factors, Medicare patients with ipsilateral reoperations had statistically significantly higher readmissions (100% vs 32.5%, p?p?=?0.018), admissions to a SNF (88.5% vs 80.4%, p?=?0.024), and admissions to an IRF (38.8% vs 22.0%, p?p?Conclusions: Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher 1-year healthcare resource utilization and 63.5% higher costs than patients without reoperation.     

Buyer–seller relationships of the dental devices industry in Taiwan: perspective of relationship

Purpose: While research in marketing and management has addressed characteristics associated with buyer and seller, relatively little research has been reported on the marketing of relationship benefits and relationship bonding tactics, particularly involving their relationships with customers. Given a dyadic perspective, it can be surmised that gaps in buyer and seller perceptions may well dampen relationships, and will inevitably occur, since a perfect match is highly unlikely between two exchange parties. To enhance relationships, major gaps need therefore to be identified and eliminated. Therefore, the purpose of this study is developing matrices of customer relationship benefits and relationship bonding tactics separately from buyer’s and seller’s perspectives, together with the insights of interrelated propositions.

Methodology: This research subjects chosen for this study consist of those distributors of dental devices, procurement in hospitals, and dentists. Using the grounded theory, four stages of coding analysis are conducted.

Findings: The results indicated that buyers and sellers differed in their perceptions in all field interviews due to their different attitudes toward different benefits. While buyers’ perceived benefits were based on the consideration of confidence and trust in the practical use of purchased medical devices, sellers primarily considered specialized issues of provided services and technologies. Based on this, buyer and seller perspectives were distinguished.

Research Implications: As a self-enclosed system, the medical device industry is difficult to enter for new manufacturers. Therefore, from the perspective of product providers, academic support can increase their product visibility, improve their company’s image, and provide more opportunities to contact new clients. From the perspective of medical institutions, the participation of hospitals and clinics in relationship marketing activities and seminars can raise their prestige and provide more opportunities for gaining new information.

Originality/Value/Contribution: Theoretical contribution of this study is in building matrices of customer relationship benefits and relationship bonding tactics separately from buyer’s and seller’s perspectives, together with the insights of six propositions. These insights shall expose the undisclosed systems of the dental devices industry.     

齿音介音归属问题初探

对于介音问题,目前学术界普遍认同的是一二等无介音,三等字必有介音。但对于介音的归属问题,还存在争议。一般认为介音是韵母的一个构成成分,也称作韵头。但有的学者认为介音是属于声母的,或独立的。本文通过分析齿音的反切来观察介音与声母、韵母的关系,运用统计法初步探究介音的归属问题。     

Goodness-of-fit techniques for count data models: an application to the demand for dental care in Spain

This paper compares the practical performance of alternative goodness-of-fit techniques for count data models in the context of a study of the determinants of demand for dental care in Spain. We apply alternative goodness-of-fit techniques to different specifications. In particular, we implement recently proposed specification tests which are consistent in the direction of general nonparametric alternatives. The analysis suggests that a negative binomial model is an appropriate specification for dental care demand. Dental health and income are identified as important predictors of individuals' behavior. First version received: April 2000/Final version received: March 2001     

关于完善综合性医院口腔科实习教学体系的思考

临床实习是培养合格医学生的关键时期,是医学生们将书本所学理论付诸于实践和培养良好临床思维的重要阶段,同时是对医学生进行综合训练的重要环节,而高水平的临床教学质量则是医学生在临床实习过程中发生蜕变的保证。临床实习教学体系是理论学习体系的延伸,两者相辅相成、互相包容、相互渗透,所以实习教学应该像理论课一样,对其制订完整的实习教学计划和大纲。目前综合性医院口腔科实习教学过程中的"教"与"学"仍存在诸多问题,严重滞缓了口腔科实习生向合格临床医生转变的过程,因此进一步思考完善综合性医院中口腔科临床实习教学体系至关重要。