Immunosurveillance of childhood ALL: polymorphic interferon-γ alleles are associated with age at diagnosis and clinical risk groups

AbstractChildhood neuroblastoma has a remarkable variability in outcome. Age at diagnosis is one of the most important prognostic factors, with children less than 1 year old having favorable outcomes. Here we study single-cell and single-nuclei transcriptomes of neuroblastoma with different clinical risk groups and stages, including healthy adrenal gland. We compare tumor cell populations with embryonic mouse sympatho-adrenal derivatives, and post-natal human adrenal gland. We provide evidence that low and high-risk neuroblastoma have different cell identities, representing two disease entities. Low-risk neuroblastoma presents a transcriptome that resembles sympatho- and chromaffin cells, whereas malignant cells enriched in high-risk neuroblastoma resembles a subtype of TRKB+ cholinergic progenitor population identified in human post-natal gland. Analyses of these populations reveal different gene expression programs for worst and better survival in correlation with age at diagnosis. Our findings reveal two cellular identities and a composition of human neuroblastoma tumors reflecting clinical heterogeneity and outcome.

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Gasto farmacéutico en diabetes mellitus en una región de España según el Clinical Risk Group, 2012

Gerencia y Políticas de Salud ◽

10.11144/javeriana.rgyps15-30.gfdm ◽

2016 ◽

Vol 15 (30) ◽

Author(s):

Luis Alvis Estrada ◽

David Vivas-Consuelo ◽

Vicent Caballer-Tarazona ◽

Ruth Usó-Talamantes ◽

Carla Sancho-Mestre ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Group ◽

Risk Groups ◽

Clinical Risk ◽

Clinical Risk Groups

<p>Se pretende estimar la multimorbilidad asociada con diabetes mellitus tipo 2 y su relación con el gasto farmacéutico, para lo cual se realizó un estudio de corte transversal durante el año 2012. Se identificó a 350 015 individuos diabéticos, a través de códigos clínicos, usando la Clasificación Internacional de Enfermedades y el software 3M Clinical Risk Groups. Todos los pacientes fueron clasificados en cuatro grupos de morbilidad. El primer grupo corresponde al estadio inicial, el segundo grupo incluye el núcleo de multimorbilidad de pacientes en fases intermedia y avanzada, el tercer grupo incluye pacientes con diabetes y enfermedades malignas, y el último grupo es de pacientes en estado catastrófico, principalmente enfermos renales crónicos. La prevalencia bruta de diabetes fue de 6,7 %. El gasto promedio total fue de € 1257,1. La diabetes se caracteriza por una fuerte presencia de otras condiciones crónicas y tiene un gran impacto en el gasto farmacéutico.</p>

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Cost-effectiveness of paediatric influenza vaccination in the Netherlands

10.1101/2020.03.02.20029124 ◽

2020 ◽

Author(s):

Pieter T. de Boer ◽

Franklin C.K. Dolk ◽

Lisa Nagy ◽

Jan C. Wilschut ◽

Richard Pitman ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Influenza Vaccination ◽

Vaccination Programme ◽

Risk Groups ◽

Inactivated Vaccine ◽

Vaccination Strategies ◽

Clinical Risk ◽

Vaccine Type ◽

Clinical Risk Groups

AbstractBackgroundThis study evaluates the cost-effectiveness of extending the Dutch influenza vaccination programme for elderly and clinical risk groups to include paediatric influenza vaccination, taking indirect protection into account.MethodsAn age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over four seasons (2010/11 to 2013/14). The clinical and economic impact of different paediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children and the vaccine type for elderly and clinical risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life years (QALYs), incremental cost-effectiveness ratios, and net health benefits (NHBs), using a willingness-to-pay threshold of €20,000 per QALY gained.ResultsAt an assumed coverage of 50%, adding vaccination of 2- to 17-year-olds with quadrivalent-live-attenuated influenza vaccine (Q-LAIV) to the current influenza vaccination programme was estimated to avert on average 406,270 symptomatic cases and 83 deaths per season compared to vaccination of elderly and risk groups with trivalent inactivated vaccine (TIV), and was cost-saving (cumulative 20-year savings of 36,396 QALYs and €1,680 million; NHB: 120,411 QALYs). This strategy dominated paediatric vaccination strategies targeting 2- to 6-year-olds or 2- to 12-year-olds, or paediatric vaccination strategies with TIV. The highest NHB was obtained when 2- to 17-year-olds were vaccinated with Q-LAIV and existing target groups switched from TIV to quadrivalent inactivated vaccine (NHB: 132,907 QALYs).ConclusionModelling indicates that paediatric influenza vaccination reduces the disease burden of influenza substantially and is cost-saving.

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