Cost-effectiveness analysis of ramucirumab treatment for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations of at least 400 ng/ml

Abstract

Objective: This study aimed to compare the cost-effectiveness of ramucirumab versus placebo for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations (AFP) of at least 400?ng/ml in the United States.

Methods: A Markov model was constructed to assess the cost-effectiveness of ramucirumab. Health outcomes were measured as quality-adjusted life years (QALYs). With TreeAge software, the disease process was modeled as three health states: progression-free survival (PFS), progressive disease (PD), and death. Costs were extracted from the REACH-2 trial, and utility was derived from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare ramucirumab with placebo. Probabilistic sensitivity analyses were developed to examine the robustness of the results.

Results: In the base case analysis, ramucirumab therapy had a cost of $55,508.41 and generated 0.54 QALYs, while placebo therapy had a cost of $761.09 and generated 0.47 QALYs, leading to an additional $54,747.32 in costs and 0.07 QALYs. The ICER was $782,104.57 per QALY, which was much higher than the willingness-to-pay threshold of $100,000 per QALY. According to sensitivity analyses, the utility of PD in the two groups was the dominant parameter influencing the ICER.

Conclusion: Although ramucirumab was associated with prolonged survival for patients with advanced hepatocellular carcinoma who progressed on sorafenib treatment with an AFP of at least 400?ng/ml, it is not a cost-effective treatment from a United States payer perspective.     

旅游的时空穿越结构机制研究

本文首先通过语义内涵解读、现象考察和比较分析构建了穿越认知逻辑分析框架,然后从语义学视角应用发生学方法、心理距离理论,通过逻辑分析构建旅游时空穿越回环结构、旅游穿越过程结构机制模型,并对旅游穿越结构进行过程机制分析。研究结论认为:旅游的时空转换结构是一种穿越结构,旅游穿越表现出完整的时空穿越特征,具有人类穿越式对话的典型性;旅游结构的本质是时空穿越;旅游穿越就是通过物理时空转换建立心理距离,最终达成心灵对话之目标。因此,旅游运行的核心矛盾就是解决由物理空间转换带来的交通需要和由穿越式对话带来的旅游实景营造需要,从而实现心理时空穿越。本文通过对旅游结构本质的追问,将"穿越"这一日常化语言抽象为学术语言,形成旅游学内生性概念和范畴,为旅游体验活动提供了一种新型的解释话语,并为不同类型穿越结构、穿越感问题的研究拓展了探讨空间。     

电力系统二次设备检修技术探讨

随着计算机技术与通信技术的高速发展,电力系统二次设备的安全性和可靠性都有所提高,这样也有利于增强状态检修的可能性。但是因为大部分检修技术都是针对系统一次设备,所以很容易忽视对电力系统二次设备的状态检修。因此,文章在介绍电力系统二次设备检修的基础上,对电力系统二次设备的检修技术进行深入的分析探讨,希望能够让更多的人重视电力系统二次设备的检修,以确保电力系统的稳定性和安全性。     

中小银行过快扩张风险问题探析

近年来，中小银行（本文所指中小银行，如无特别说明，均指全国性股份制商业银行和城市商业银行）过快扩张，一旦内部风险管理和控制无法跟上扩张的步伐，就容易出现问题，甚至形成风险。本文基于货币政策趋紧和监管政策趋严的背景，对中小银行过快扩张导致的风险问题与隐患进行了分析，并提出了合理建议，以期对其稳健发展有所裨益。     

Managing security risks for inter-organisational information systems: a multiagent collaborative model

Information sharing across organisations is critical to effectively managing the security risks of inter-organisational information systems. Nevertheless, few previous studies on information systems security have focused on inter-organisational information sharing, and none have studied the sharing of inferred beliefs versus factual observations. In this article, a multiagent collaborative model (MACM) is proposed as a practical solution to assess the risk level of each allied organisation’s information system and support proactive security treatment by sharing beliefs on event probabilities as well as factual observations. In MACM, for each allied organisation’s information system, we design four types of agents: inspection agent, analysis agent, control agent, and communication agent. By sharing soft findings (beliefs) in addition to hard findings (factual observations) among the organisations, each organisation’s analysis agent is capable of dynamically predicting its security risk level using a Bayesian network. A real-world implementation illustrates how our model can be used to manage security risks in distributed information systems and that sharing soft findings leads to lower expected loss from security risks.     

开征地热资源税的可行性研究——以山东省为例

我国地热资源储量丰富、分布广泛,而地热资源具有经济价值高、开发潜能广等特征。合理利用地热资源是缓解资源约束、优化能源结构的重要途径。将地热资源纳入资源税征收管理、充分发挥资源税对地热资源的使用调节作用,既是实现地热资源有效利用的必然要求,也有利于深化资源税改革。文章基于我国及山东省地热资源禀赋和开发利用现状,分析将地热纳入资源税征收管理范围的可行性及法律依据;对开征地热资源税所面临的现实问题,从征管体制、税源管理、税费关系等角度提出政策建议,以期实现地热资源的合理开发利用,缓解地方财政压力,促进经济可持续发展。     

生态消费模式合作案例研究——以樱慈有机生活体验馆为例

生态消费模式是人们为满足消费需求并实现生态平衡过程所做的一种新型探索。生态消费模式中的合作案例较多,具体可以体现为:倡导节约性消费理念、选择简捷性消费方式、明确安全化消费目标、完善和谐化消费制度等。樱慈有机生活体验馆正是以新媒体传播方式、新交流合作平台、新代际立体反馈、新消费链条构建的真实案例展现。     

井冈蜜柚取汁工艺优化

井冈蜜柚果汁饮料有一定的市场前景,其深加工有待发展。对柚子果汁饮料生产工艺中的关键技术问题,即提高柚子出汁率问题进行研究。结果表明:100 g果肉直接榨汁后按1 000 U/100 g添加量加入果胶酶,200 U/100 g添加量加入纤维素酶,在45℃下处理3 h,出汁量达到86.3 g/100 g果肉,比未加酶处理时提高了近1倍。     

基于Pro/E的家用多功能躺椅的设计

利用Pro/E软件设计了一款多功能躺椅,实现坐、躺和攀爬相结合的功能。该装置采用整体设计、关键部位设计和细节设计的设计思路,利用Pro/E的骨架建模结合多功能躺椅自身结构的特点进行运动和受力分析。结果表明:该设计思路可以有效实现设计的一致性,设计的多功能躺椅既可以当椅子用,也可以转换为躺椅用来休息,同时又可以折叠成梯子来使用,从而达到一物三用的目的。     

地方财政行为是否驱动了中国贸易 收支的动态调整*——基于异质性动态调整模型的分析

本文利用1997-2013年中国省际层面的面板数据，借助异质性动态调整模型从动态视角考察了地方财政行为对中国贸易收支调整速度的影响。研究结果显示：（1）平均而言，在地方财政行为的驱动下，中国实际贸易收支向最优水平动态调整的速度约为0045。总体表明，地方财政行为对中国贸易收支的驱动性影响较弱，引致实际贸易收支向最优水平调整的速度也较为缓慢。（2）财政支出分权的强化会制约贸易收支的调整速度，贸易收支调整呈现“相对惰性”。财政收入分权的提高和预算内财政支出的扩张能够加快实际贸易收支向最优贸易收支调整的速度，助力贸易收支实现平滑调整。预算外财政支出和财政收入的变化对调整速度则不会产生显著性影响。（3）贸易收支的调整速度呈现显著的区域异质性。本文的结论表明，现阶段中国要实现贸易收支的平衡调整路径，中央及地方政府必须把握好财政行为与贸易收支的动态联动关系。