Health and economic impact of PHiD-CV in Canada and the UK: a Markov modelling exercise

Abstract

Objective:

The spectrum of diseases caused by Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) represents a large burden on healthcare systems around the world. Meningitis, bacteraemia, community-acquired pneumonia (CAP), and acute otitis media (AOM) are vaccine-preventable infectious diseases that can have severe consequences. The health economic model presented here is intended to estimate the clinical and economic impact of vaccinating birth cohorts in Canada and the UK with the 10-valent, pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared with the newly licensed 13-valent pneumococcal conjugate vaccine (PCV-13).

Methods:

The model described herein is a Markov cohort model built to simulate the epidemiological burden of pneumococcal- and NTHi-related diseases within birth cohorts in the UK and Canada. Base-case assumptions include estimates of vaccine efficacy and NTHi infection rates that are based on published literature.

Results:

The model predicts that the two vaccines will provide a broadly similar impact on all-cause invasive disease and CAP under base-case assumptions. However, PHiD-CV is expected to provide a substantially greater reduction in AOM compared with PCV-13, offering additional savings of Canadian $9.0 million and £4.9 million in discounted direct medical costs in Canada and the UK, respectively.

Limitations:

The main limitations of the study are the difficulties in modelling indirect vaccine effects (herd effect and serotype replacement), the absence of PHiD-CV- and PCV-13-specific efficacy data and a lack of comprehensive NTHi surveillance data. Additional limitations relate to the fact that the transmission dynamics of pneumococcal serotypes have not been modelled, nor has antibiotic resistance been accounted for in this paper.

Conclusion:

This cost-effectiveness analysis suggests that, in Canada and the UK, PHiD-CV’s potential to protect against NTHi infections could provide a greater impact on overall disease burden than the additional serotypes contained in PCV-13.     

The cost-effectiveness of OM-85 in managing respiratory tract infections in China

Abstract

Objectives:

To demonstrate the health economic impact of OM-85, a bacterial lysates based immunostimulant, for its approved indications in China.

Methods:

A cost-effectiveness decision tree model was constructed comparing OM-85 with the best supportive care/placebo therapy for managing the acute exacerbation of chronic bronchitis and rhinosinusitis in the Chinese population. Clinical efficacy and adverse events (AE) data were included in the model based on a thorough literature review. All localized direct treatment costs, including drug cost, AE costs, and medical treatment costs for underlining diseases were included from a Chinese third party payer perspective. A Key Opinion Leaders (KOL) survey was conducted with 20 senior physicians specialized in respiratory, ENT, allergy, and immunology fields from tertiary hospitals in Beijing, Shanghai, Guangzhou, Hangzhou, Shenyang, and Wuhan to validate the local treatment costs. Incremental cost-effectiveness ratio (ICER) was calculated based on the above efficacy and cost information.

Results:

OM-85 is a cost-effective therapy when compared with placebo (standard care). OM-85 can treat/prevent one additional full episode exacerbation of chronic bronchitis and one additional full episode exacerbation of rhinosinusitis with only additional costs of RMB 653 and RMB 1182.84, respectively. In comparison, each acute exacerbation of chronic bronchitis will cost RMB 4510.10, and each acute exacerbation of rhinosinuisitis will cost RMB 1807.21 in a Chinese clinical management setting. One-way sensitivity analyses were performed and the ICER result was demonstrated to be consistent.

>Conclusions:

OM 85 reduces acute exacerbations among patients with chronic bronchitis and chronic rhinosinusitis when compared with Placebo (standard care). From a Chinese payer perspective, OM 85 is a cost-effective therapy in the clinical management of both chronic bronchitis and rhinosinusitis in the adult population.     

Cost and effectiveness of ciprofloxacin + hydrocortisone versus neomycin + polymyxin B + hydrocortisone in France for the treatment of acute otitis externa

Summary

The cost-effectiveness of two topical otic combinations, ciprofloxacin + hydrocortisone and polymyxin B — neomycin — hydrocortisone (PNH), was assessed in the treatment of acute otitis externa (AOE). Two randomised controlled double-masked trials compared their clinical and bacteriological efficacy and safety after 7 to 10 days of qid treatment. The treatment failure cost was established from a panel of ENT specialists and GPs. A decision-tree analysis was constructed to reproduce the results of empirical treatment. The most often encountered species were Pseudomonas aeruginosa (82.4%) and Staphylococcus aureus (9.7%). Patients documented with P aeruginosa had a better ciprofloxacin + hydrocortisone bacterial and clinical efficacy. The cost of AOE first-line failure was EUR 94.44 (Societal) and EUR 57.24 (Sécurité Sociale). The savings associated with ciprofloxacin + hydrocortisone (Cipro HC ®) were respectively EUR 3.87 and EUR 2.85. This model shows that topical ciprofloxacin + hydrocortisone could be a cost saving alternative in the treatment of AOE, provided its public price does not exceed EUR 10.60.

Cipro HC® is a registered trademark of Alcon, France.     

胸腹部穿刺辅助控制装置

胸腹部脏器疾病,比如肝癌等在临床上常见的恶性肿瘤,影像学检查一般能发现病灶,有时却难以明确定性,对进一步确定治疗方案带来困难。CT导引下经皮肝脏穿刺可获得病理学诊断,对指导临床选择治疗方案、随访及预测预后等均有重要意义,近年来在肝部疾病的鉴别诊断和治疗中应用越来越广泛。然而在实际的穿刺过程中,常常由于病人的呼吸导致胸腹部内脏的活动,致使穿刺失败或者是重复穿刺加重病人的痛苦。本设计针对这一问题,以呼吸活动为切入点,寻求解决方案。呼吸活动的外在表现是胸腹部压力的变化,本设计的主要思想是利用STC89C52单片机为核心制作一个装置,第一步利用一个气体压力传感器MPS2108通过包裹在病人腹部的气囊采集压力信号,第二步将该信号在LM324放大器上进行放大,第三步再送到ADC0804进行A/D转换后变为数字信号,最终在数码管上显示出来,定位时在数码管上取一个值,等到穿刺时让病人有意识的呼吸,直到压力传感器感受相同的压力,数码管显示相同的值时,由于内脏的位置大体相似,这时再穿刺时可以提高穿刺的成功率,减少重复穿刺现象的发生,减轻病人的痛苦。     

Are employees more committed and willing to accept critical assignments during a crisis? A study of organizational commitment,professional commitment and willingness to care during the SARS outbreak in Taiwan

Few researches were involved in investigating the factors of commitment affecting employees' willingness to take critical assignment during a crisis. The severe acute respiratory syndrome (SARS) event provided as a good arena for crisis research. The study focused on the impact of crisis on the employees' willingness to accept critical assignments and the influencing factors of their willingness. This empirical study of willingness is captured by comparing the nurses' willingness to take care of SARS patients during and after 2 years of SARS outbreak and investigating organizational commitment (OC) and professional commitment (PC) as the determinants of their willingness to care under SARS outbreak. Registered nurses were surveyed during (2003) and after (2005) the SARS outbreak. The results showed that crisis does not affect a change on employees' willingness to accept critical assigned jobs. However, the nurses had higher level of desire to stay at the job and lower level of professional identification during the SARS crisis. The determinants of the nurses' willingness to care for SARS patients with pooling data were organizational identification, and particularly willingness to work in extra efforts. To enhance employees' willingness to accept critical assignments during a crisis, improving their level of OC and PC is a direction for the management to work on.     

Resource use in patients hospitalized with complicated skin and soft tissue infections in Europe and analysis of vulnerable groups: the REACH study

Background:

Hospitalized patients with complicated skin and soft tissue infections (cSSTI) present a substantial economic burden, and resource use can vary according to the presence of comorbidities, choice of antibiotic agent, and the requirement for initial treatment modification. REACH (NCT01293435) was a retrospective, observational study aimed at collecting empirical data on current (year 2010–2011) management strategies of cSSTI in 10 European countries.

Methods:

Patients (n?=?1995) were aged ≥18 years, hospitalized with a cSSTI and receiving intravenous antibiotics. Data, collected via electronic Case Report Forms, detailed patient characteristics, medical history, disease characteristics, microbiological diagnosis, disease course and outcomes, treatments before and during hospitalization, and health resource consumption.

Results:

For the analysis population, mean length of hospital stay (including duration of hospitalizations for patients with recurrences) was 18.5 days (median 12.0). Increased length of hospital stay was found for patients with comorbidities vs those without (mean?=?19.9; [median?=?14.0] days vs 13.3 [median?=?8.0] days), for patients with methicillin-resistant Staphylococcus aureus compared with patients with methicillin-sensitive S. aureus (mean?=?27.7 [median?=?19.5] days vs 18.4 [median?=?13.0] days) and for patients requiring surgery (mean?=?24.4 [median?=?16.0] days vs 15.0 [median?=?11.0] days). Patients requiring modification of their initial antibiotic treatment had an associated increase in mean length of hospital stay of 10.9 days (median?=?6.5) and additional associated hospital resource use. A multivariate analysis confirmed the association of nosocomial infections, comorbidities, directed treatment, recurrent infections, diabetes, recent surgery, and older age (≥65 years), with longer hospital stay.

Conclusions:

This study provides real-life data on factors that are expected to impact length of hospital stay, to guide clinical decision-making to improve outcomes, and reduce resource use in patients with cSSTI.     

血必净注射液治疗重症急性胰腺炎的Meta分析

目的评价血必净注射液对重症急性胰腺炎（SAP）患者的影响,从而了解血必净用于辅助治疗重症急性胰腺炎的临床疗效。方法选择符合纳入标准的随机或临床对照试验（CRT、CCT）文献,对数据进行Meta分析。结果5项研究纳入421例患者,Meta分析显示,血必净＋乌司他丁＋基础治疗组与乌司他丁＋基础治疗组比较,腹痛缓解时间（WMD=-1.86,95%CI：-2.27～-1.45,P=0.00001）、血淀粉酶恢复正常时间（WMD=-1.80,95%CI：-2.68～-0.93,P〈0.0001）、尿淀粉酶恢复正常时间（WMD=-1.96,95%CI：-2.42～-1.50,P〈0.00001）、白细胞计数恢复正常时间（WMD=-2.49,95%CI：-3.56～-1.41,P〈0.00001）以及总有效率（RR=1.16,95%CI：1.07～1.25,P=0.0002）的差异有统计学意义。结论应用血必净的治疗组能明显缩短重症急性胰腺炎患者腹痛缓解时间、血（尿）淀粉酶以及白细胞计数恢复正常时间,且治疗组的总有效率明显高于对照组。     

米卡芬净药物经济学研究进展

侵袭性真菌感染发病率正在逐年上升，且死亡率高，花费大。米卡芬净是新一代的棘白菌素类抗真菌药物，对念珠菌和曲霉菌具有广谱的抗菌活性。药物经济学分析显示米卡芬净比氟康唑、两性霉素B脂质体和卡泊芬净在预防和治疗侵袭性真菌感染时具有更好的成本一效果，从而在一定程度上给临床用药以指导。     

健康冲击对农户民间借贷参与的影响——来自于CHARLS数据的经验证据

基于中国健康与养老追踪调查(CHARLS)2013年全国25个省份6220个农户家庭层面的样本,并运用Logit模型实证分析健康冲击对农户参与民间借贷的影响。实证结果表明:第一,不同类型的健康冲击对农户参与民间借贷的影响不同。慢性健康冲击变量对农户民间借贷参与的影响不显著,而急性健康冲击变量对农户参与民间借贷有着显著的正向影响。第二,不同健康冲击对农户民间借贷参与的影响存在年龄与婚姻状况差异。在年龄差异方面,慢性健康冲击对老年农户与中年农户参与民间借贷的影响均不显著,而急性健康冲击对中年农户参与民间借贷有着显著的正向影响,但对老年农户的影响不显著。在婚姻状况差异方面,慢性健康冲击对非婚状况与已婚状况的农户参与民间借贷的影响都不显著,而急性健康冲击对非婚状况的农户参与民间借贷没有显著影响,对已婚状况的农户参与民间借贷有着显著的正向影响。     

药食两用的中药复合组合物对即时解酒保肝的作用研究

目的:探讨一种药食两用原料组合物产品——甘氧片,对小鼠的解酒作用及对醉酒小鼠肝脏功能的影响.方法:采用小鼠50％酒精灌胃,建立急性酒精中毒模型,观察醉酒行为学指标、摘眼球取血,分离血清测定肝功能、取肝脏测定肝脏中乙醇脱氢酶活性.结果:样品组为人体10倍和20倍剂量,与模型对照组相比较,在醉酒诱导时间和醒酒时间上都具...