影像超声在乳腺癌诊断中的应用

目的探讨超声在乳腺癌诊断中的应用效果,为提高乳腺癌临床诊断正确率提供可靠依据,使患者得到及时治疗,保障患者生活质量与生命安全。方法选取同1名具有专业知识及丰富经验的临床医学影像检验医师对37例乳腺癌患者均进行超声检查,记录超声检查阳性情况与病理结果符合率,给予分析后得出结论。结果 37例患者经超声诊断为乳腺癌比例83.78%,诊断符合率虽然较高,但与病理诊断结果仍具有一定差异,对比结果具有统计学意义(P<0.05);乳腺癌患者大多表现为浸润性导管癌、浸润性髓样癌以及导管原位癌三种类型。结论临床医师应对疑似乳腺癌患者进行综合性医学影像及实验室检查,结合患者实际临床表现,从而对其病情进行确诊,提高临床诊断正确率,使患者得到及时治疗,提高疗效及降低死亡率,值得临床推广应用。     

高频彩超诊断乳腺癌的分析

目的探讨高频彩超诊断乳腺癌的应用价值。方法选择于2010年10月~2012年10月在我院治疗的100例乳腺肿块患者,采用高频彩超进行常规检查,评估该诊断方法的准确性、操作的简便性及之后的创伤与放射情况。结果彩超诊断相符合的乳腺癌为90例,准确率为90.0%,与彩超诊断不符合的乳腺癌有10例,不符合率为10.0%,其中,诊断为乳腺炎性结节2例,诊断为乳腺纤维瘤6例,诊断为乳腺囊肿2例;检查后证实,高频彩超检查对患者无痛苦、无放射性损伤、无创伤、操作简单。结论高频彩超诊断乳腺癌无放射、无创伤、操作简单、准确率高,为临床治疗方案的制订提供有力的依据,值得推广应用。     

42例早期乳腺癌的超声表现

目的研究分析早期乳腺癌在超声检查的表现。方法选取2011年2月至2013年2月我院收治的42例乳腺癌患者的临床检查资料进行回顾性分析,并将其资料与患者的临床病理结果进行对照研究。结果 42例乳腺癌患者的超声检查中,22例超声表现类似纤维腺瘤,观其边缘毛糙,其中4例可观察到穿支血流;10例超声保险类似乳腺囊性增生,观其边缘为角征;有5例超声表现腺体局部增厚或者僵直走形、腺体结构紊乱;有4例超声观察回声不均,有减弱情况;有4例并发出现钙化情况,有泥沙样的刮花和针尖样钙化两种。结论在乳腺癌早期的临床诊断中容易与其他乳腺疾病混淆,因此在临床超声检查发现以上多种征象时应结合病例的临床症状与其他检查结果进行综合评定,避免出现误诊,提高乳腺癌的诊断率。     

磁共振与高频超声在乳腺癌诊断中的应用价值

目的探讨乳腺癌应用磁共振与高频超声的诊断价值。方法选取2013年3月至2014年3月我院诊治的乳腺癌患者132例,均分为对照组和研究组,各66例。对照组患者给予磁共振诊断,研究组患者给予高频超声诊断,记录并分析两组患者的阳性、假阳性检测率和检测肿块病变范围情况。结果两组患者阳性检测率和假阳性检测率比较差异无统计学意义(P>0.05);研究组检测病变范围明显比对照组小,差异有统计学意义(P<0.05)。结论磁共振与高频超声诊断乳腺癌各具优点和不足,应在检测过程中联合两种检查方法。     

个体化诊治时代的乳腺癌病理诊断研究

本文首先通过对乳腺癌的诊断模式、治疗方式及病理指标等进行介绍,然后详细探讨了分子分型在乳腺癌个体化治疗中的作用,希望能够进一步提高乳腺癌的病理诊断水平.     

超声弹性成像与增强磁共振成像联合应用对乳腺癌的诊断价值

目的评价超声弹性成像与增强磁共振成像(MRI)联合应用对乳腺癌早期诊断的应用价值。方法回顾性分析2011年2月至2013年10月在我院就诊并接受手术的54例同时进行过超声弹性成像和增强MRI检查的临床确诊乳腺癌的患者,以病理作为金标准,分析UE、增强MRI及UE和增强MRI联合应用对乳腺癌的诊断敏感度、假阳性率、准确度进行统计,根据结果判断各种检查方法对乳腺癌的诊断效率。结果 54例患者共73个乳腺病灶UE和增强MRI联合应用的诊断的最为准确。结论 UE和增强MRI联合应用对早期乳腺癌具有非常重要的临床诊断意义。     

核磁共振成像诊断脑梗死52例临床分析

目的探讨磁共振成像诊断脑梗死的临床结果,以此作为分析和确认脑梗死发病原因的主要诊断依据。方法随机选择2011年12月～2012年12月在我院治疗的52例脑梗死患者,将所有患者资料进行回顾性分析,并对比所有患者的治疗资料,对分析结果进行总结。结果52例患者的磁共振成像中显示,所有患者的成像中均可清晰看到T1加权像低信号,T2加权像均为高信号。脑梗死患者的病灶集中聚集在内囊、基底节区处。患者确诊时间在6～18h。52例中50例成像资料与确诊病因一致,准确率为96%。结论对疑似脑梗死病例进行磁共振成像检查是较为有效可靠的检查方法之一。     

彩色多普勒超声对甲状腺结节的良恶性诊断及病理分析

目的探讨彩色多普勒超声检查对甲状腺结节的良恶性诊断及病理学分析。方法对108例甲状腺结节患者进行术前彩色多普勒超声检查并与术后病理对照分析。结果 108例中甲状腺腺瘤52例,甲状腺腺瘤囊性变31例,结节性甲状腺肿12例,甲状腺癌13例。结论彩色多普勒超声检查对甲状腺结节良恶性的诊断有重要价值。     

提高湿法脱硫效率的措施及经济性分析

新《火电厂大气污染物排放标准》规定了严格的SO2排放限值,对脱硫机组来说较难达到该限值,本文针对石灰石湿法烟气脱硫技术,介绍了多种提高脱硫效率的措施,分析了它们适合的情况,经济性以及提升脱硫效率幅度。     

早期宫角妊娠及误诊的超声诊断分析

目的研讨超声诊断应用于早期宫角妊娠中的临床价值,并分析其误诊原因,最终使超声诊断对宫角妊娠的诊断水平得以提高。方法随机抽取2013年2月至2014年2月的早期宫角妊娠病例共计90例,该90例宫角妊娠的患者均得到手术后的病理证实,分析其超声声像图表现。结果分析证实正确率为72.1%的超声声像图表现,确诊的宫角妊娠患者共计64例,误诊为子宫肌瘤的患者为6例,误诊为纯宫内早孕的患者为8例,误诊为滋养细胞疾病的患者为7例,误诊为输卵管间质部妊娠的患者为5例。结论宫角妊娠的主要诊断手段为超声诊断,超声诊断的优点为有较高的诊断价值,缺点为误诊率较高,因此需要通过改进超声诊断的技术来提高超声诊断在宫角妊娠中的诊断水平。     

Health economics of medical devices: opportunities and challenges

Expenditure on medical devices is substantial and is expected to grow in the future. This Editorial draws attention to health economic issues surrounding medical devices. To this effect, opportunities and challenges involved in the economic analysis of the market structure of medical device sectors and in the economic evaluation of medical devices are identified.

Markets for medical devices tend to be fragmented and suffer from a lack of transparency and competition. In response to this, there is extensive government intervention in many developed countries with a view to keeping down prices, restricting public reimbursement and promoting an efficient use of medical devices. Studies are called for that evaluate and compare country approaches towards regulating medical device markets with a view to informing medical-device policies.

Whereas economic evaluation of medicines is well established, and is used to inform pricing and reimbursement decisions in many developed countries, this is less the case for medical devices. There is a need for economic evaluations of medical devices with a view to demonstrating their cost effectiveness. In addition, countries need to implement frameworks for the assessment of new and emerging medical devices with a view to taking pricing and reimbursement decisions.     

A critical review of the full economic evaluations of pharmacological treatments for colorectal cancer

Abstract

Objective: This literature review makes a critical assessment of the methodology of the full economic evaluations (FEEs) conducted on colorectal cancer (CRC) pharmacological treatments.

Method: A literature search of the international databases PubMed and EMBASE was carried out to find all the studies published in the English language on pharmacological treatments for CRC in the period 2001–2005. A checklist was adopted to analyse the 13 FEEs selected. Fourteen clinical trials were extracted from the references as sources of efficacy data and were reviewed separately according to a clinical checklist. Finally, the reliability of the 13 FEEs was assessed from the health authorities' perspective by applying a critical appraisal checklist of 16 items derived from the economic and clinical variables previously analysed.

Results: This review found that pharmacoeconomic studies on CRC showed important methodological weaknesses mainly regarding economic evaluation, whilst the sources of clinical evidence were of higher technical quality, although the clinical effectiveness of therapies was not fully sustained by their results.     

Cost-effectiveness analysis of utidelone plus capecitabine for metastatic breast cancer in China

Abstract

Objective: To estimate the cost-effectiveness of utidelone plus capecitabine therapy compared to capecitabine alone in patients with metastatic breast cancer (MBC) resistant to anthracyclines and taxanes treatment in the Chinese context and provide a reference for the marketing of utidelone in China.

Methods: A Markov model was developed based on the NCT02253459 clinical trial to simulate the clinical course of patients with metastatic breast cancer who had received taxanes and anthracycline therapy. The quality-adjusted life years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) were then analyzed to evaluate the benefits. Two-parametric Weibull distribution was conducted to fit PFS and OS curves by using R. Sensitivity analyses were performed to evaluate the stability of the model designed.

Results: The addition of utidelone increased the cost and QALYs by $13,370.25 and 0.1961, respectively, resulting in an increased ICER of $68,180.78 per QALY. The most sensitive influential parameter on ICER was the price of utidelone. At the threshold of willingness-to-pay (WTP) of $24,380 (3 per capita GDP of China), the cost of utidelone per 30?mg of less than $18.5, $33.7, and greater than $48.8 resulted in a 100%, 50%, and 0% possibility of cost-effectiveness, respectively. The addition of utidelone was not cost-effective when it was $115.4 per 30?mg—the price of its analog paclitaxel. In consideration of varied economics levels across China, cost-effectiveness could be achieved with the price of utidelone ranging from $5.2 to $35.9.

Limitations: The survival curves extended beyond the follow-up time horizon, of which data were generated not from the real analyses but from our established two-parameter Weibull survival model.

Conclusion: It is recommended that the price of utidelone would be less than $18.5 per 30?mg in order to obtain cost-effectiveness for metastatic breast cancer patients resistant to anthracyclines and taxanes treatment in China.     

A global economic model to assess the cost-effectiveness of new treatments for advanced breast cancer in Canada

Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC.

Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC.

Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2?+?MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations.

Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.     

Modelling the economic value of cross- and sustained-protection in vaccines against cervical cancer

Objective: Two human papillomavirus (HPV) vaccines are on the market. Based on expected differences in sustained- and cross-protection between the two vaccines, their long-term economic value is modelled and compared for France, Ireland and Italy.

Methods: A Markov cohort model reproducing the natural history of HPV infections, screening and vaccination, is adapted to country-specific data. Two hypothetical HPV vaccines (VA and VB) are compared. At baseline VA provides lifetime protection against HPV‐16 and 10-year protection against HPV‐18 before waning. VB is the same as VA with a 10-year protection against HPV‐6 and 11. Sustained- and cross-protection is varied over wide ranges in VA to define the levels that could make VA cost-effective or dominant compared with VB.

Results: Under baseline conditions VB dominates VA. VA becomes cost-effective when the difference in cross-protection alone reaches 13–15% (undiscounted), and 22–44% (discounted). A combination of sustained- and cross-protection is required for VA to dominate VB (discounted). The results are dependent upon country, the base-case value and the discount applied.

Conclusion: Realistic additional sustained- and cross-protection in one HPV vaccine may confer benefits that offset the economic value of protection against low-risk HPV in the other. The results are country specific.     

Budget impact analysis of everolimus for the treatment of hormone receptor positive,human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States

Abstract

Objective:

To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC).     

Costs of in-house genomic profiling and implications for economic evaluation: a case example of non-small cell lung cancer (NSCLC)

Abstract

Objectives

Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations.     

Cost-effectiveness model of abiraterone plus prednisone,cabazitaxel plus prednisone and enzalutamide for visceral metastatic castration resistant prostate cancer therapy after docetaxel therapy resistance

Abstract

Aims: Among patients diagnosed with prostate cancer, 10–20% will develop castration-resistant prostate cancer (CRPC) within 5?years; for 70%, CRPC will metastasize, mostly to the lungs and/or liver. We performed a cost-effectiveness model comparing abiraterone plus prednisone (ABI?+?PRD), cabazitaxel plus prednisone (CAB?+?PRD) and enzalutamide (ENZ) for visceral metastatic CRPC post-docetaxel therapy resistance.

Methods: A three-state (Progression-Free, Progression, Death) lifetime Markov model was constructed to compare ABI?+?PRD, CAB?+?PRD, and ENZ from a United States healthcare payer perspective (2019?US$; discount rate 3%/yr.). Effectiveness was measured in life-years (LYs) and quality-adjusted life years (QALYs). Inputs included treatment costs, grade III/IV adverse events with incidence ≥5%, physician follow-up, lab and imaging tests. Phase III trial Kaplan-Meier curves were extrapolated to estimate overall survival and Progression-Free transition probabilities. Incremental cost-effectiveness ratios (ICERs) and utility ratios (ICURs), probabilistic sensitivity analyses (PSAs) and cost-effectiveness acceptability curves at willingness-to-pay (WTP) thresholds were estimated.

Results: Models estimated 3-year overall survival rates of 1.3% for patients treated with ABI?+?PRD, 16.2% for CAB?+?PRD, and 13.2% for ENZ. Estimated Progression-Free rates at 1.5?years were 0.51% for ABI?+?PRD, 0.27% for CAB?+?PRD, and 14.47% for ENZ. LYs and QALYs were 1.20 and 0.58 respectively for ABI?+?PRD, 1.48 and 0.56 for CAB?+?PRD, and 1.58 and 0.79 for ENZ. Total treatment costs were: $115,433 for ABI?+?PRD, $85,337 for CAB?+?PRD and $109,213 for ENZ. CAB?+?PRD and ENZ dominated ABI?+?PRD due to higher LYs gained. Incremental QALYs for ENZ vs. CAB?+?PRD were larger than incremental LYs. The ICUR for ENZ was $103,674/QALY compared to CAB?+?PRD.

Conclusions: This analysis found ENZ provided greater LYs and QALYs than both ABI?+?PRD and CAB?+?PRD, at a lower cost than ABI?+?PRD, but at a higher cost compared to CAB?+?PRD. For patients with visceral mCRPC after docetaxel therapy resistance, ENZ was cost-effective 92% of the time with a WTP threshold of $100,000/QALY.     

Evaluation of the costs and resource use associated with adjuvant chemotherapy for breast cancer in France

Abstract

Objectives:

There is a paucity of recent data on breast cancer costs, particularly on the burden of chemotherapy. The present study was designed to estimate resource use and costs associated with the current standard of care for adjuvant chemotherapy for breast cancer.

Methods:

Costs and resource use were assessed by retrospective analysis of medical records at a single comprehensive cancer care center, Hôpital Tenon, Paris, France. Data were extracted from files of female patients having undergone surgical resection of breast cancer between January–July 2010. Patients were included if they received chemotherapy at the hospital and had medical records available. Patients were followed from the start of adjuvant chemotherapy (including pre-chemotherapy) to the end of treatment. Costs were collected for each resource use item from a societal perspective using standard, published sources and expressed in 2011 Euros (€). Limitations of the analysis included the single-center study design and the use of pre-defined questionnaires on resource use (which may conservatively estimate costs).

Results:

A total of 62 patients were included in the study with a mean age of ～54 years. Most patients had stage II (50.8%) or stage III (40.7%) disease. Anthracycline plus taxane-based chemotherapy regimens were most commonly prescribed (77% of patients). Mean cost of adjuvant chemotherapy was estimated to be ～€15,740 per patient from a societal perspective. The acquisition costs of chemotherapy agents were responsible for 26% of the total, with lost productivity (27%), chemotherapy administration (19%), and adverse events (16%) also contributing substantially.

Conclusions:

Evaluation of costs in patients with non-metastatic breast cancer in France has shown that the costs of adjuvant chemotherapy are substantial. The main components of total cost were the cost of chemotherapy agents, lost productivity, chemotherapy administration, and management and prevention of adverse events.     

Retrospective database analysis of the effect of zoledronic acid on skeletal-related events and mortality in women with breast cancer and bone metastasis in a managed care plan

Abstract

Background:

Bone metastases are common in patients with advanced breast cancer, and place patients at risk for skeletal-related events (SREs) including pathologic fracture, spinal cord compression, hypercalcemia of malignancy, and the need for radiotherapy and/or surgery to bone. These SREs are associated with reduced survival and quality-of-life. The nitrogen-containing bisphosphonates Zometa (zoledronic acid, ZOL) and Aredia (pamidronate disodium, PAM) reduce SRE risk in patients with bone metastases from breast cancer. This database analysis compared SRE and mortality rates in a real-life setting in women with breast cancer receiving ZOL and PAM, and assessed long-term ZOL benefit.

Methods:

A retrospective, claims-based analysis was conducted using commercial and Medicare Advantage data from >45 US managed-care plans. Eligible adult patients had diagnoses for breast cancer and bone metastasis between 01/01/01 and 12/31/06, continuous enrollment in the health plan, and no evidence of bone metastasis or intravenous bisphosphonate (IV-BP) use for 6 months before their first ZOL or PAM infusion. Patients were followed until disenrollment (including mortality) or end of the analysis period (12/31/07). Persistency was defined as absence of a >45-day gap between IV-BP treatments.

Results:

Of 8757 patients (mean age, 58.1 [SD 12.4] years), ～ 30% were treated with ZOL, 15% with PAM, and 55% with no IV-BP. Patients treated with ZOL had a moderately lower incidence of SREs (mean, 36.2 vs 40.0 SREs/100 person-years; p?=?0.0707) and significantly lower mortality (mean, 6.5 vs 11.2 deaths/100 person-years; p?<?0.001) compared with PAM-treated patients. Longer persistency with ZOL was associated with lower risk of fracture and all SREs (trend-test p?=?0.0076 and p?=?0.0200, respectively).

Limitations:

Interpretation of this claims-based analysis must be tempered by the inherent limitations of observational data, such as imbalances in patient populations and the potential for bias in treatment selection.

Conclusions:

This analysis suggests that fewer than half of breast cancer patients with bone metastases receive IV-BPs. Longer persistence with ZOL was associated with lower SRE risk, and ZOL-treated patients had longer survival and a non-significant trend toward fewer SREs compared with PAM.