Comprehensive assessment of patients with irritable bowel syndrome with constipation and chronic idiopathic constipation using deterministically linked administrative claims and patient-reported data: the Chronic Constipation and IBS-C Treatment and Outcomes Real-World Research Platform (CONTOR)

Abstract

Aims

To characterize a US population of patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) using CONTOR, a real-world longitudinal research platform that deterministically linked administrative claims data with patient-reported outcomes data among patients with these conditions.     

CEO环境不确定性感知与企业创新模式选择关系研究

基于高阶理论与调节焦点理论,通过中国373家企业问卷调查数据,探讨CEO环境不确定性感知对企业创新模式选择的影响机制。结果表明：CEO环境不确定性感知对企业渐进性创新与突破性创新均具有显著正向影响;高管团队行为整合在CEO环境不确定性感知与企业创新间发挥部分中介作用;CEO特质调节焦点正向调节CEO环境不确定性感知与高管团队行为整合之间的关系,同时正向调节上述中介机制。     

Cost-effectiveness of dipeptidyl peptidase-4 inhibitor monotherapy versus sulfonylurea monotherapy for people with type 2 diabetes and chronic kidney disease in Thailand

Objective: With a high prevalence of chronic kidney disease (CKD) in type 2 diabetes (T2DM) in Thailand, the appropriate treatment for the patients has become a major concern. This study aimed to evaluate long-term cost-effective of dipeptidyl peptidase-4 (DPP-4) inhibitor monothearpy vs sulfonylurea (SFU) monotherapy in people with T2DM and CKD.

Methods: A validated IMS CORE Diabetes Model was used to estimate the long-term costs and outcomes. The efficacy parameters were identified and synthesized using a systematic review and meta-analysis. Baseline characteristics and cost parameters were obtained from published studies and hospital databases in Thailand. Costs were expressed in 2014?US Dollars. Outcomes were presented as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.

Results: From a societal perspective, treatment with DPP-4 inhibitors yielded more quality-adjusted life years (QALYs) (0.024) at a higher cost (>66,000 Thai baht (THB) or >1,829.27 USD) per person than SFU, resulting in the ICER of >2.7 million THB/QALY (>74,833.70 USD/QALY). The cost-effectiveness results were mainly driven by differences in HbA1c reduction, hypoglycemic events, and drug acquisition cost of DPP-4 inhibitors. At the ceiling ratio of 160,000 THB/QALY (4,434.59 USD/QALY), the probability that DPP-4 inhibitors are cost-effective compared to SFU was less than 10%.

Conclusions: Compared to SFU, DPP-4 inhibitor monotherapy is not a cost-effective treatment for people with T2DM and CKD in Thailand.     

Patterns of care and burden of chronic idiopathic thrombocytopenic purpura in Brazil

Aims: Although several therapeutic options are available for chronic immune thrombocytopenic purpura (cITP), little is known about the treatment of cITP in Brazil.

Materials and methods: A multi-center, retrospective chart review, observational study was designed to describe the treatment patterns, clinical burden, resources use, and associated costs for adult patients diagnosed with cITP and treated in public and private institutions in Brazil. Patient charts were screened in reverse chronological order based on their last visit post January 1, 2012. (All costs were calculated using 1.00 USD?=?3.9571 BRL, from February 2016.)

Results: Of 340 patient charts screened, 50 patients were eligible for inclusion in the study. Single-drug therapy (prednisone, dexamethasone, or dapsone) was the most commonly used treatment, followed by combination therapies (azathioprine?+?prednisone, azathioprine?+?prednisone?+?danazol, and prednisone?+?dapsone). Splenectomy was performed in 22% of patients after at least first-line treatment. Platelet count and number of bleeding episodes at diagnosis were 31,561.1/mm³ (SD?=?±26,396.1) and 40 episodes, respectively; in first-line, 92,631.1/mm³ (SD?=?±79,955.3) and 19 episodes, respectively; in second-line, 96,950.0/mm³ (SD?=?±76,476.4) and 17 episodes, respectively. Private system patients had a higher median cost compared to public system patients (USD 17.49/month, range?=?0–2,020.77 vs USD 9.51/month, range?=?0–192.64, respectively).

Limitations: This study does not allow conclusions for causal explanations due to the cohort study design, and treatment patterns represent only the practices of physicians who have agreed to participate in the study.

Conclusions: The data indicate that available therapeutic strategies for second- and third-line therapies appear to be limited.     

Superhighway patrolman

This fictional prototype explores two of the future's major societal challenges: the delivery of healthcare to an increasingly ageing society; and the policing of a society, in which digital surveillance may predominate. It contrasts the author's vision of what life could be like in the United Kingdom in a decade's time (just as he contemplates retirement) with the simpler values of the 1980s, when he began his postgraduate career. The lyrics of the poignant 1982 Bruce Springsteen song, “Highway Patrolman” are used to bridge the epochs¹. The prototype relocates the two main ‘middle-America’ characters, brothers Joe and Frank Roberts, in London in the year 2025. Much has already changed politically and socially in ‘Western societies’ in the intervening period up to 2012, driven by the inexorable advances of technology. As further scientific advances drive us to an anticipated paradigm change,² one can only speculate on how society will advance, posing serious ethical dilemmas. Many of the changes will be positive. However, the story explores the potential negative consequences to the ageing population, in what appears to be a successful economy. Although somewhat pessimistic in outlook, a hopeful conclusion is that the ‘ties that bind’ will still predominate.     

Stress and consumer behavior

Although stress research has received increased attention in the behavioral and social sciences, it has been virtually ignored by marketing researchers. This paper attempts to advance the stress perspective as a useful framework in consumer research. First, the author presents theoretical and conceptual foundations of stress research. Second, the author develops a general conceptual model of the causes and consequences of stress on the basis of theory and research. The model serves as a blueprint for presenting theory and research on stress, organizing and interpreting findings of consumer studies in the context of stress theory, and developing propositions for needed research. Finally, the author provides a research agenda to guide future studies in this area.     

Shopping enjoyment and store shopping modes: The moderating influence of chronic time pressure

The objectives of this study were to investigate: (a) whether shopping enjoyment has a differential influence on two key store shopping modes (browsing vs. bargain hunting); (b) whether the level of chronic time pressure moderates the influence of shopping enjoyment on each shopping mode; and (c) whether each of the shopping modes has a differential influence on hedonic shopping value. Data were collected from a sample of US store shoppers (n=1009). Results revealed that the influence of shopping enjoyment was much stronger on the browsing mode than on the bargain hunting mode. In turn, the browsing mode exerted a stronger influence on hedonic shopping value. Also, this study confirmed that the level of chronic time pressure significantly moderated the influence of shopping enjoyment on the browsing mode. Implications for brick-and-mortar retailers were discussed with suggestions for future research.     

盐酸非索非那定联合雷尼替丁治疗慢性荨麻疹的临床疗效

目的探讨盐酸非索非那定联合雷尼替丁治疗慢性荨麻疹的临床疗效。方法选取门诊慢性荨麻疹患者70例,随机分为两组,观察组患者给予盐酸非索非那定片,并加服雷尼替丁胶囊;对照组患者仅服用盐酸非索非那定片。两组患者均连续服药4周后比较临床疗效。结果观察组患者治疗临床总有效率为91.4%,明显高于对照组的65.7%,差异有统计学意义(P<0.05)。结论盐酸非索非那定联合雷尼替丁治疗慢性荨麻疹效果良好。     

Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in treatment-experienced chronic hepatitis C genotype 1 patients

Background:

Telaprevir (TVR,T) and boceprevir (BOC,B) are direct-acting antivirals (DAAs) used for the treatment of chronic genotype 1 hepatitis C virus (HCV) infection. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV) compared with Peg-IFN alfa-2a and RBV (PR) alone or BOC plus Peg-IFN alfa-2b and RBV in treatment-experienced patients.

Methods:

A Markov cohort model of chronic genotype 1 HCV disease progression reflected the pathway of experienced patients retreated with DAA therapy. The population was stratified by previous response to treatment (i.e., previous relapsers, partial responders, and null responders). Sustained virologic response (SVR) rates were derived from a mixed-treatment comparison that included results from separate Phase III trials of TVR and BOC. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the NHS perspective. Costs and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were carried out by interleukin (IL)-28B genotype.

Results:

Higher costs and improved outcomes were associated with T/PR relative to PR alone for all experienced patients (ICER of £6079). T/PR was cost-effective for each sub-group population with high SVR advantage in relapsers (ICER of £2658 vs £7593 and £20,875 for partial and null responders). T/PR remained cost-effective regardless of IL-28B sub-type. Compared to B/PR, T/PR prolonged QALYs by 0.57 and reduced lifetime costs by £13,960 for relapsers. For partial responders T/PR was less costly but less efficacious than B/PR, equating to an ICER of £128,117 per QALY gained.

Limitations:

No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.

Conclusion:

T/PR is cost-effective compared with PR alone in experienced patients regardless of treatment history and IL-28B genotype. Compared to B/PR, T/PR is always cost-saving but only more effective in relapsers.