Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenv...Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.展开更多
Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chi...Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.展开更多
With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role i...With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.展开更多
The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerg...The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.展开更多
Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of ...Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.展开更多
To making the decision of the developing blue prints,ideal point method was selected to estimate the life cycle cost with effectiveness of torpedo.At the same time,the concept of grey relational entropy of the grey sy...To making the decision of the developing blue prints,ideal point method was selected to estimate the life cycle cost with effectiveness of torpedo.At the same time,the concept of grey relational entropy of the grey system theory was adopted to compute the distance between each blue print and the ideal point(or negative ideal point).The blue print,nearest to the ideal point and farthest to the negative ideal point,is the best one.As an example,four blue prints of torpedo were estimated.The result indicates the practical value of this method.展开更多
Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected anim...Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.展开更多
BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to ...BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.展开更多
AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the  ...AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.展开更多
AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to comp...AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
The objective of this research is to examine the antecedents and consequences of cost management systems （CMS） design effectiveness of manufacturing businesses in Thailand. The effect of CMS design effectiveness on ...The objective of this research is to examine the antecedents and consequences of cost management systems （CMS） design effectiveness of manufacturing businesses in Thailand. The effect of CMS design effectiveness on cost information quality is investigated. Moreover, the effect of cost information quality on business success is investigated. Furthermore, executive management support and cost accountant competency are assumed to become the antecedents of CMS design effectiveness. Electronics manufacturing businesses in Thailand are samples of the research. A mail survey procedure via the questionnaire was used for data collection from accounting controllers. The results indicate that CMS design effectiveness has a positive significant effect on cost information quality. Moreover, cost information quality also has a positive significant effect on business success. Additionally, both executive management support and cost accountant competency have a positive significant effect on CMS design effectiveness.展开更多
AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separa...AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.展开更多
With difficulties in maintaining multicomponent systems of wind turbines and formulating economical and reasonable maintenance strategies,a dynamic opportunistic maintenance strategy of multicomponent systems is appli...With difficulties in maintaining multicomponent systems of wind turbines and formulating economical and reasonable maintenance strategies,a dynamic opportunistic maintenance strategy of multicomponent systems is applied in terms of economic relevance and opportunistic maintenance among various components.A preventive maintenance model based on cost-effectiveness is proposed by incorporating cost-effectiveness analysis into the multicomponent preventive maintenance strategy.The failure rate recovery degree is used to describe the effects of imperfect maintenance and replacement.When the reliability of the component reaches the threshold of preventive or opportunistic maintenance,a reasonable maintenance method is selected on the basis of the cost-effectiveness ratio of the failure rate.A case study is conducted by taking four components of a wind turbine as the research object and comparing them with the opportunistic maintenance model without considering cost-effectiveness.Results show that the total maintenance cost is reduced by 373600 yuan,indicating that the preventive opportunistic maintenance based on cost-effectiveness is more economical and can provide a theoretical basis for formulating a preventive maintenance plan.展开更多
BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC...BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.展开更多
Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticanc...Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.展开更多
As the proportion of composite materials used in aircraft continues to increase, the electromagnetic Shielding Effectiveness (SE) of these materials becomes a critical factor in the electromagnetic safety design of ai...As the proportion of composite materials used in aircraft continues to increase, the electromagnetic Shielding Effectiveness (SE) of these materials becomes a critical factor in the electromagnetic safety design of aircraft structures. The assessment of electromagnetic SE for Slotted Composite Structures(SCSs) is particularly challenging due to their complex geometries and there remains a lack of suitable models for accurately predicting the SE performance of these intricate configurations. To address this issue, this paper introduces SCS-Net, a Deep Neural Network (DNN) method designed to accurately predict the SE of SCS. This method considers the impacts of various structural parameters, material properties and incident wave parameters on the SE of SCSs. In order to better model the SCS, an improved Nicolson-Ross-Weir (NRW) method is introduced in this paper to provide an equivalent flat structure for the SCS and to calculate the electromagnetic parameters of the equivalent structure. Additionally, the prediction of SE via DNNs is limited by insufficient test data, which hinders support for large-sample training. To address the issue of limited measured data, this paper develops a Measurement-Computation Fusion (MCF) dataset construction method. The predictions based on the simulation results show that the proposed method maintains an error of less than 0.07 dB within the 8–10 GHz frequency range. Furthermore, a new loss function based on the weighted L1-norm is established to improve the prediction accuracy for these parameters. Compared with traditional loss functions, the new loss function reduces the maximum prediction error for equivalent electromagnetic parameters by 47%. This method significantly improves the prediction accuracy of SCS-Net for measured data, with a maximum improvement of 23.88%. These findings demonstrate that the proposed method enables precise SE prediction and design for composite structures while reducing the number of test samples needed.展开更多
AIM:To assess the effectiveness,safety,and costeffectiveness of the Argus II in treatment of the retinitis pigmentosa(RP)patients.METHODS:The Pro Quest,Web of Science,EMBASE,MEDLINE(via Pub Med)were searched using com...AIM:To assess the effectiveness,safety,and costeffectiveness of the Argus II in treatment of the retinitis pigmentosa(RP)patients.METHODS:The Pro Quest,Web of Science,EMBASE,MEDLINE(via Pub Med)were searched using combinations of the keywords of Argus,safety,effectiveness,bionic eye,retinal prosthesis,and RP through March 2018.The retrieved records were screened and then assessed for eligibility.RESULTS:Totally 926 records were retrieved from the searched databases and finally 12 studies included.The RP patients showed improvements in visual function after receiving the prosthesis,compared to the time before the prosthesis or the time it was off.This was measured by square localization,direction of motion,and grating visual acuity tests.No major adverse effect was reported for the Argus II prosthesis itself and/or the surgery to implement it,but the most frequently reported items were hypotony,and conjunctival dehiscence.The incremental cost-effectiveness ratio(ICER)was calculated to be€14603 per qualityadjusted life year(QALY)in UK and$207616 per QALY in Canada.CONCLUSION:The available evidence shows that the Argus II prosthesis in RP patients is effective in improvement of their visual function.Some minor adverse effects are reported for the prosthesis.The cost-effectiveness studies show that the technology is cost-effective only at high levels of willingness-to-pay.展开更多
The commercialization of perovskite solar cells(PSCs)has garnered worldwide attention and many efforts were devoted on the improvement of efficiency and stability.Here,we estimated the cost effectivities of PSCs based...The commercialization of perovskite solar cells(PSCs)has garnered worldwide attention and many efforts were devoted on the improvement of efficiency and stability.Here,we estimated the cost effectivities of PSCs based on the current industrial condition.Through the analysis of current process,the manufacturing cost and the levelized cost of electricity(LCOE)of PSCs is estimated as 0.57$W^(−1) and 18-22 US cents(kWh)^(−1),respectively,and we demonstrate the materials cost shares 70%of the total cost.Sensitivity analysis indicates that the improvement of efficiency,yield and decrease in materials cost significantly reduce the cost of the modules.Analysis of the module cost and LCOE indicates that the PSCs have the potential to outperform the silicon solar cells in the condition of over 25%efficiency and 25-year lifetime in future.To achieve this target,it is essential to further refine the fabrication processes of each layer in the module,develop stable inorganic transport materials,and precisely control material formation and processing at the microscale and nanoscale to enhance charge transport.展开更多
AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using ke...AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.展开更多
文摘Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.
基金supported by the social development project of the National Social Science Fund Project(No.17BTQ063)National Natural Science Foundation of China(72174094).
文摘Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.
文摘With the continuous application of new technologies in reconnaissance and attack, false camouflage plays a more important role in improving the survivability of targets, and the number of decoys plays a crucial role in the camouflaging effect. Based on the concept of cost-effectiveness ratio, according to the newly formulated Johnson criterion and the view of discovery and destruction, this paper proposes to take the identification probability as the probability of being destroyed and uses mathematical formulas to calculate the cost of a single use decoy. On this basis, a cost-effectiveness ratio model is established, with the product of the increase in the survival probability of the target and the cost of the target as the benefit, and the sum of the product of the probability of being destroyed and the cost of the decoy and the cost of a single use as the consumption cost. The model is calculated and analyzed, and the number of decoys that conform to the actual situation is obtained.
文摘The United States （U.S.） is facing a national opioid epidemic, and medical systems are in need of non- pharmacologic strategies that can be employed to decrease the public＇s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture＇s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, andneonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
文摘Objective:Treatment options for metastatic castration resistant prostate cancer(mCRPC)have expanded rapidly in recent years.Given the significant economic burden,we sought perform a cost-effectiveness analysis(CEA)of the contemporary treatment paradigm for mCRPC.Methods:We devised a treatment protocol consisting of sipuleucel-T,enzalutamide,abiraterone,docetaxel,radium-223,and cabazitaxel.We estimated number and length of treatments for each therapy using dosing schedules or progression free survival data from published clinical trials.We estimated treatment cost using billing data and Medicare reimbursement values and performed a CEA.Our analysis assumed US$100,000 per life year saved(LYS)as the threshold societal willingness to pay.Results:Incremental cost-effectiveness ratios(ICER)for strategies incorporating sipuleucel-T that were not eliminated by extended dominance exceeded the societal threshold willingnessto-pay of US$100,000 per LYS,the lowest of which was sipuleucel-T+enzalutamide+abiraterone+docetaxel at US$207,714 per LYS.Enzalutamide+abiraterone+docetaxel exhibited the most favorable ICER among strategies without sipuleucel-T at US$165,460 per LYS.Conclusion:Based on the available survival data and current costs of treatment,all treatment strategies greatly exceed a commonly assumed societal willingness-to-pay threshold of US$100,000 per LYS.Improvements in this regard can only comewith a reduction in pricing,better tailoring of treatment or significant enhancements in survival with clinical use of treatment combinations or sequences.
基金the Doctorate Foundation of Northwestern Polytechnical University (Grant No.CX200304)
文摘To making the decision of the developing blue prints,ideal point method was selected to estimate the life cycle cost with effectiveness of torpedo.At the same time,the concept of grey relational entropy of the grey system theory was adopted to compute the distance between each blue print and the ideal point(or negative ideal point).The blue print,nearest to the ideal point and farthest to the negative ideal point,is the best one.As an example,four blue prints of torpedo were estimated.The result indicates the practical value of this method.
文摘Anthrax is an infection caused by bacteria and it affects both human and animal populations. The disease can be categorized under zoonotic diseases and humans can contract infections through contact with infected animals, ingest contaminated dairy and animal products. In this paper, we developed a mathematical model for anthrax transmission dynamics in both human and animal populations with optimal control. The qualitative solution of the model behaviour was analyzed by determining Rhv, equilibrium points and sensitivity analysis. A vaccination class was incorporated into the model with waning immunity. Local and global stability of the model’s equilibria was found to be locally asymptotically stable whenever Rhv Rhv. It was revealed that reducing animal and human interaction rate, would decrease Rhv. We extended the model to optimal control in order to find the best control strategy in reducing anthrax infections. It showed that the effective strategy in combating the anthrax epidemics is vaccination of animals and prevention of humans.
基金Supported by Zhejiang Medical and Health Science and Technology Project,No. 2020KY608Natural Science Foundation of Zhejiang Province,No. LQ19H030013。
文摘BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.
文摘AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
基金Supported by National Natural Science Foundation of China,No.81071862
文摘AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘The objective of this research is to examine the antecedents and consequences of cost management systems （CMS） design effectiveness of manufacturing businesses in Thailand. The effect of CMS design effectiveness on cost information quality is investigated. Moreover, the effect of cost information quality on business success is investigated. Furthermore, executive management support and cost accountant competency are assumed to become the antecedents of CMS design effectiveness. Electronics manufacturing businesses in Thailand are samples of the research. A mail survey procedure via the questionnaire was used for data collection from accounting controllers. The results indicate that CMS design effectiveness has a positive significant effect on cost information quality. Moreover, cost information quality also has a positive significant effect on business success. Additionally, both executive management support and cost accountant competency have a positive significant effect on CMS design effectiveness.
基金Supported by National Institutes of Health,United States,No.R01-CA140574 and No.U01-CA152926(to Hur C)No.R21-CA156704 and No.R01-CA181275(to Anandasabapathy S)and No.K25-CA133141(to Kong CY)
文摘AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.
基金The National Key Research and Development Program of China(No.2019YFB1707300).
文摘With difficulties in maintaining multicomponent systems of wind turbines and formulating economical and reasonable maintenance strategies,a dynamic opportunistic maintenance strategy of multicomponent systems is applied in terms of economic relevance and opportunistic maintenance among various components.A preventive maintenance model based on cost-effectiveness is proposed by incorporating cost-effectiveness analysis into the multicomponent preventive maintenance strategy.The failure rate recovery degree is used to describe the effects of imperfect maintenance and replacement.When the reliability of the component reaches the threshold of preventive or opportunistic maintenance,a reasonable maintenance method is selected on the basis of the cost-effectiveness ratio of the failure rate.A case study is conducted by taking four components of a wind turbine as the research object and comparing them with the opportunistic maintenance model without considering cost-effectiveness.Results show that the total maintenance cost is reduced by 373600 yuan,indicating that the preventive opportunistic maintenance based on cost-effectiveness is more economical and can provide a theoretical basis for formulating a preventive maintenance plan.
文摘BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.
文摘Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.
基金supported by the National Natural Science Foundation of China(Nos.62101020 and 62141405)the Special Scientific Research Project of Civil Aircraft,China(No.MJZ5-2N22).
文摘As the proportion of composite materials used in aircraft continues to increase, the electromagnetic Shielding Effectiveness (SE) of these materials becomes a critical factor in the electromagnetic safety design of aircraft structures. The assessment of electromagnetic SE for Slotted Composite Structures(SCSs) is particularly challenging due to their complex geometries and there remains a lack of suitable models for accurately predicting the SE performance of these intricate configurations. To address this issue, this paper introduces SCS-Net, a Deep Neural Network (DNN) method designed to accurately predict the SE of SCS. This method considers the impacts of various structural parameters, material properties and incident wave parameters on the SE of SCSs. In order to better model the SCS, an improved Nicolson-Ross-Weir (NRW) method is introduced in this paper to provide an equivalent flat structure for the SCS and to calculate the electromagnetic parameters of the equivalent structure. Additionally, the prediction of SE via DNNs is limited by insufficient test data, which hinders support for large-sample training. To address the issue of limited measured data, this paper develops a Measurement-Computation Fusion (MCF) dataset construction method. The predictions based on the simulation results show that the proposed method maintains an error of less than 0.07 dB within the 8–10 GHz frequency range. Furthermore, a new loss function based on the weighted L1-norm is established to improve the prediction accuracy for these parameters. Compared with traditional loss functions, the new loss function reduces the maximum prediction error for equivalent electromagnetic parameters by 47%. This method significantly improves the prediction accuracy of SCS-Net for measured data, with a maximum improvement of 23.88%. These findings demonstrate that the proposed method enables precise SE prediction and design for composite structures while reducing the number of test samples needed.
基金Supported by the National Institute for Health Research(NIHR)of Iran。
文摘AIM:To assess the effectiveness,safety,and costeffectiveness of the Argus II in treatment of the retinitis pigmentosa(RP)patients.METHODS:The Pro Quest,Web of Science,EMBASE,MEDLINE(via Pub Med)were searched using combinations of the keywords of Argus,safety,effectiveness,bionic eye,retinal prosthesis,and RP through March 2018.The retrieved records were screened and then assessed for eligibility.RESULTS:Totally 926 records were retrieved from the searched databases and finally 12 studies included.The RP patients showed improvements in visual function after receiving the prosthesis,compared to the time before the prosthesis or the time it was off.This was measured by square localization,direction of motion,and grating visual acuity tests.No major adverse effect was reported for the Argus II prosthesis itself and/or the surgery to implement it,but the most frequently reported items were hypotony,and conjunctival dehiscence.The incremental cost-effectiveness ratio(ICER)was calculated to be€14603 per qualityadjusted life year(QALY)in UK and$207616 per QALY in Canada.CONCLUSION:The available evidence shows that the Argus II prosthesis in RP patients is effective in improvement of their visual function.Some minor adverse effects are reported for the prosthesis.The cost-effectiveness studies show that the technology is cost-effective only at high levels of willingness-to-pay.
基金National Key R&D Program of China(No.2021YFB3800068)the National Natural Science Foundation of China(No.U21A20171).
文摘The commercialization of perovskite solar cells(PSCs)has garnered worldwide attention and many efforts were devoted on the improvement of efficiency and stability.Here,we estimated the cost effectivities of PSCs based on the current industrial condition.Through the analysis of current process,the manufacturing cost and the levelized cost of electricity(LCOE)of PSCs is estimated as 0.57$W^(−1) and 18-22 US cents(kWh)^(−1),respectively,and we demonstrate the materials cost shares 70%of the total cost.Sensitivity analysis indicates that the improvement of efficiency,yield and decrease in materials cost significantly reduce the cost of the modules.Analysis of the module cost and LCOE indicates that the PSCs have the potential to outperform the silicon solar cells in the condition of over 25%efficiency and 25-year lifetime in future.To achieve this target,it is essential to further refine the fabrication processes of each layer in the module,develop stable inorganic transport materials,and precisely control material formation and processing at the microscale and nanoscale to enhance charge transport.
文摘AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.
