Economic evaluation of linaclotide for the treatment of adult patients with irritable bowel syndrome with constipation in the United States

Abstract

Objectives:

To use techniques of decision-analytic modeling to evaluate the effectiveness and costs of linaclotide vs lubiprostone in the treatment of adult patients with irritable bowel syndrome with constipation (IBS-C).

Methods:

Using model inputs derived from published literature, linaclotide Phase III trial data and a physician survey, a decision-tree model was constructed. Response to therapy was defined as (1) a ≥14-point increase from baseline in IBS-Quality-of-Life (IBS-QoL) questionnaire overall score at week 12 or (2) one of the top two responses (moderately/significantly relieved) on a 7-point IBS symptom relief question in ≥2 of 3 months. Patients who do not respond to therapy are assumed to fail therapy and accrue costs associated with a treatment failure. Model time horizon is aligned with clinical trial duration of 12 weeks. Model outputs include number of responders, quality-adjusted life-years (QALYs), and total costs (including direct and indirect). Both one-way and probabilistic sensitivity analyses were conducted.

Results:

Treatment for IBS-C with linaclotide produced more responders than lubiprostone for both response definitions (19.3% vs 13.0% and 61.8% vs 57.2% for IBS-QoL and symptom relief, respectively), lower per-patient costs ($803 vs $911 and $977 vs $1056), and higher QALYs (0.1921 vs 0.1917 and 0.1909 vs 0.1894) over the 12-week time horizon. Results were similar for most one-way sensitivity analyses. In probabilistic sensitivity analyses, the majority of simulations resulted in linaclotide having higher treatment response rates and lower per-patient costs.

Limitations:

There are no available head-to-head trials that compare linaclotide with lubiprostone; therefore, placebo-adjusted estimates of relative efficacy were derived for model inputs. The time horizon for this model is relatively short, as it was limited to the duration of available clinical trial data.

Conclusions:

Linaclotide was found to be a less costly option vs lubiprostone for the treatment of adult patients with IBS-C.     

获得性免疫缺陷综合征并发动眼神经麻痹的临床特征

目的观察就诊于眼科的获得性免疫缺陷综合征并发单侧动眼神经麻痹的眼部表现、系统特征和治疗情况。方法回顾分析4例4眼艾滋病并发单侧动眼神经麻痹患者的眼部表现、视敏度、色觉检查、上睑下垂程度、瞳孔及眼外肌受累、复视情况;CD4+T淋巴细胞计数,给予口服高效抗逆转录病毒药物治疗联合抗病毒药物治疗,随诊观察2～6个月。结果初诊时检查,视敏度2眼为6/9,1眼为6/18,1眼为6/36;色觉检查均正常;上睑下垂3例为重度,1例为中度;瞳孔扩大固定,直径为5～7mm;水平性复视,眼球处于外转位,外转正常、不能向上、下、内转动,CD4+T淋巴细胞计数1例为200个/ul,3例介于100～200个/ul之间;经高效抗逆转录病毒药物治疗后CD4+T淋巴细胞计数上升到≥300个/ul。结论排除颅内、眶内占位,其他因素所致脑梗塞,对不明原因的单眼动眼神经麻痹患者,建议作血清人类免疫缺陷病毒(Human immunodeficiency virus,HIV)抗体检测,避免漏诊误诊。     

Comparison of healthcare resource utilization and costs in patients hospitalized for acute coronary syndrome managed with percutaneous coronary intervention and receiving prasugrel or ticagrelor

Abstract

Objective:

To compare healthcare resource utilization (HCRU) and healthcare costs in patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with prasugrel or ticagrelor.     

A cost-effectiveness analysis of subcutaneous interferon beta-1a 44mcg 3-times a week vs no treatment for patients with clinically isolated syndrome in Sweden

Abstract

Objective:

To assess the cost-effectiveness of subcutaneous interferon (sc IFN) beta-1a 44?mcg 3-times weekly (tiw) vs no treatment at reducing the risk of conversion to multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS) in Sweden.

Methods:

A Markov model was constructed to simulate the clinical course of patients with CIS treated with sc IFN beta-1a 44?mcg tiw or no treatment over a 40-year time horizon. Costs were estimated from a societal perspective in 2012 Swedish kronor (SEK). Treatment efficacy data were derived from the REFLEX trial; resource use and quality-of-life (QoL) data were obtained from the literature. Costs and outcomes were discounted at 3%. Sensitivity analyses explored whether results were robust to changes in input values and use of Poser criteria.

Results:

Using McDonald criteria sc IFN beta-1a was cost-saving and more effective (i.e., dominant) vs no treatment. Gains in progression free life years (PFLYs) and quality-adjusted life-years (QALYs) were 1.63 and 0.53, respectively. Projected cost savings were 270,263 SEK. For Poser criteria cost savings of 823,459 SEK were estimated, with PFLY and QALY gains of 4.12 and 1.38, respectively. Subcutaneous IFN beta-1a remained dominant from a payer perspective. Results were insensitive to key input variation. Probabilistic sensitivity analysis estimated a 99.9% likelihood of cost-effectiveness at a willingness-to-pay threshold of 500,000 SEK/QALY.

Conclusion:

Subcutaneous IFN beta-1a is a cost-effective option for the treatment of patients at high risk of MS conversion. It is associated with lower costs, greater QALY gains, and more time free of MS.

Limitations:

The risk of conversion from CIS to MS was extrapolated from 2-year trial data. Treatment benefit was assumed to persist over the model duration, although long-term data to support this are unavailable. Cost and QoL data from MS patients were assumed applicable to CIS patients.     

Hidden Overhang of Domestic Debt and Its Role in the This-Time-Is-Different Syndrome: An Empirical Contingent Liabilities Model

The recent studies in public finance literature open an exciting research area on hidden overhang of domestic public debt and creative accounting. In this study, I identify hidden public debts in Turkey. I then develop a dynamical model that takes as given the stock of contingent liabilities generated by lending/borrowing relationships among public entities and looks for the debt (in)tolerance of government to liquidate it in finite periods. Last, I introduce a general empirical methodology to analyze the role of overborrowing in the this-time-is-different syndrome and test model outcome against data for hidden debts in Turkey's postliberalization period (1989-2010).     

阴阳周天灸联合培元固本大膏药治疗寒湿型腰椎间盘突出症患者的临床护理效果

目的：探讨阴阳周天灸联合培元固本大膏药治疗寒湿型腰椎间盘突出症的临床护理效果。方法选取2013年3月至2014年6月在河南省中医研究院附属医院疼痛科住院的寒湿型腰痛患者120例,随机将其分为两组,对照组患者给予阴阳周天灸疗法及常规护理,治疗组患者给予阴阳周天灸联合培元固本大膏药药烫及综合护理干预。比较两组患者的临床效果及疼痛视觉模拟量表（VAS）、数字评分法（NRS）以及腰椎功能评定情况。结果治疗组患者总有效率为90.0%,对照组患者总有效率为81.7%,差异有统计学意义（P＜0.05）;治疗前后两组患者的VAS、NRS评分比较,差异有统计学意义,治疗后,治疗组的NRS、VAS评分明显低于对照组,差异有统计学意义（P＜0.05）;治疗后,治疗组患者的疼痛程度较冶疗前均得到改善,屈曲伸直比明显减小,中位频率斜率明显增大;腰椎功能评定指标比较,治疗组均明显优于对照组,差异有统计学意义（P＜0.05）。结论阴阳周天灸联合培元固本大膏药治疗寒湿型腰椎间盘突出症临床护理效果明显。     

An innovative regime switching model to forecast Taiwan tourism demand

The tourism industry has become a major part of economic development for many countries. These countries have greatly invested in tourism to attract more tourist arrivals. Hence, the need for more accurate forecasts of tourism demand is important. Various approaches have been applied to forecast tourism demand of different countries. However, tourism demands tend to be imprecise and their trends nonlinear. In addition, there may be drastic changes in the tourism demand time series. To properly handle these problems, this study proposes an innovative forecasting model to detect the regime switching properly and to apply fuzzy time-series model to forecast. The monthly tourist arrivals to Taiwan will be used as forecasting target. The analysis by the proposed model will be validated by the major events as well as previous studies.     

小儿原发性肾病综合症复发相关因素分析及其护理对策

探讨小儿原发性肾病综合症复发相关因素，为预防和护理对策提供相应的依据。选择原发性肾病综合症患儿52例，对其可能引起复发的相关因素及预防护理对策进行了分析。引起原发性肾病综合症复发的因素复杂，除服药周期未达到足够的疗程外，还与肾病本身和治疗用药导致的抵抗力下降、并发感染等有关。探讨引起肾病综合症复发的相关因素，从护理角度预防及减少其复发是很有必要的。     

跨国公司综合症诊断、分析与对策

跨国公司在经营管理中不可避免地会遇到由不同文化所产生的困惑或沟通障碍甚至冲突,这就是跨国公司综合症的具体表现。如何正确诊断跨国公司综合症,分析其实质,并探索其对策是跨国公司在多元文化中实现跨国经营管理,实现发展的值得重视的课题。本文旨在就如何诊断跨国公司综合症、如何分析其性质、最终提出解决问题的对策作一些探讨。     

一种联合星座和伴随式信息的迭代译码算法

针对构造性的大数逻辑可译低密度奇偶校验（LDPC）码,联合信号星座和伴随式信息,提出一种基于可靠度的迭代大数逻辑译码算法。在校验节点,直接使用伴随式信息进行传递和处理;在变量节点,结合信源端的星座映射和伴随式进行译码信息收集和处理。理论分析和仿真实验结果表明,所提出的算法在保持优良译码性能的同时,具有更低的译码复杂度。