Is Initial Dasatinib-Blinatumomab Therapy for Ph-Positive ALL in Adults Cost Effective?

Adult, Philadelphia chromosome-positive, Acute Lymphoblastic Leukemia (Ph-positive ALL) had a poor prognosis, but with the use of an initial BCR/ABL tyrosine kinase inhibitor such as Dasatinib in conjunction with chemotherapy such as hyper-CVAD, the projected 24 month disease free survival is 64%. More recently Foa et al. on behalf of the GIMEMA investigators published a phase II trial of Dasatinib and Blinatumomab as initial therapy for adults with ALL. The complete remission rate was 98%, and the projected disease-free survival at 24 months is 88%. We wished to analyze the incremental cost-effectiveness ratio (ICER) of the Dasatinib and Blinatumomab therapy as compared to Dasatinib and hyper-CVAD. The comparison is based on retail costs of chemotherapy for Dasatinib, Blinatumomab and hyperCVAD and excluded hospital and outpatient charges. The cost of hyperCVAD is based on treatment of a person with a BSA I.8m2. The retail cost of therapy is shown below. Drug Dose Cost Dasatinib 100 mg $505.67 Blinatumomab 1 mg $126.81 Cyclophosphamide 1,000 mg $231.00 Mesna 1,000 mg $42.89 Vincristine 2 mg $18.52 Dexamethasone 40 mg $4.12 Cytarabine 100 mg $22.88 Leucovorin 25 mg $7.48 The ICER formula is the cost of new therapy minus (-) the cost of standard therapy/quality of adjusted life new therapy - the quality of adjusted life standard (QALY). The yearly cost of Hyper-CVAD and Dasatinib is $147,288.48 per QALY, whereas, the yearly cost of Dasatinib-Blinatumomab is $187,940.46 per QALY. The difference is $42,451.98 which is less than the 50,000-threshold using cost-effective analysis. In conclusion, the combination of Dasatinib-Blinatumomab appears to be cost effective. Disclosures No relevant conflicts of interest to declare.

Retail Internet Trade in Russia: Standing, Trends and Further Development

The article studies trends in the development of retail internet-trade in Russia based on official statistic data. The research showed that the share of internet-trade in the total retail trade turnover is very low, the target indicators of the Strategy of Trade Development in the Russian Federation up to 2025 were not attained. Only one third of the population use the Internet to buy goods and the average cost of sale per one customer in the network makes up 10 500 rubles a year. Different factors exerted various influence on the dynamics of yearly cost of internetsales per one customer: the growth in the total volume of market (trade turnover) of internet-trade had a positive impact, while a share of the population using the Internet for purchases had an adverse affect. The impact of the corona-virus pandemic, which caused a mass temporary shift to internet buying was not studied in the work. Findings of the analysis gave a chance to ground the conditions of the further development of internet-trade. Among promising conditions the article underlined a growing cover of different regions by the Internet, as this factor is an infrastructural one for building internet-trade. Another promising line in further development of internet-trade is selling goods by mobile applications, as mobile access to the Internet is prevailing for people of the country.

Daily Costs and Cost Effectiveness of Glaucoma Fixed Combinations in China

Background. The aim of this study was to compare the daily costs and cost effectiveness of fixed combination glaucoma drugs in China. Methods. This study included the following fixed combination drugs: brinzolamide 1% and timolol 0.5% (Azarga; Alcon, Inc., Fort Worth, TX, USA), travoprost 0.004% and timolol 0.5% (DuoTrav; Alcon, Inc.), bimatoprost 0.03% and timolol 0.5% (Ganfort; Allergan, Inc., Dublin, Ireland), and latanoprost 0.005% and timolol 0.5% (Xalacom; Pfizer, Inc., New York, NY, USA). Five bottles of each drug were measured. The mean actual volume, mean actual number of drops, volume per drop, daily cost, yearly cost, and per mmHg reduction cost for each drug were calculated. Results. The volumes per drop ranged from 32.61 ± 2.90 μl (DuoTrav) to 24.38 ± 0.23 μl (Ganfort). The number of usage days per bottle varied from 36 days (DuoTrav) to 61 days (Ganfort). Azarga had the lowest daily cost ($0.23) and yearly cost ($84.72), while DuoTrav had the highest daily cost ($0.79) and yearly cost ($287.02). Azarga costed $2.17–$3.30 per mmHg intraocular pressure reduction, which was lower than the other three drugs. For the prostaglandin and ß-adrenergic blocker FCs, Ganfort had the lowest daily cost ($0.35) and per mmHg reduction cost (from $3.40 to $4.04). Conclusions. The daily costs of these drugs were significantly different, with Azarga having the lowest daily cost and best cost effectiveness. For the prostaglandin and β-adrenergic blocker fixed combinations, Ganfort was the most economical choice with its lower daily cost and per mmHg reduction cost. The results of this study could provide drug selection guidance from an economic perspective, but various factors should be considered when making a decision.

Evaluation of Cost, Workflow, and Safety of Implementing a Vial Transfer Device for Ready-to-Mix Drugs at an Academic Medical Center

Objective: To evaluate the cost, workflow, and safety of implementing a vial transfer device system. Methods: In this retrospective analysis, pharmacy systems and electronic health record reports identified high-volume and high-cost medications prepared by a Vial2Bag® (V2B) system from July 2017 to June 2018. The major outcome was the extrapolated yearly cost avoidance (EYCA) from utilization of a V2B system, calculated by subtracting total costs of the V2B system from total cost of ready-to-use products and locally compounded sterile products. Secondary outcomes included a workflow and safety analysis. Results: Implementing a V2B system led to a total EYCA of $2 295 261. A total of 283 209 potential V2B units were available for dispensing from automated dispensing systems and 41 082 yearly sterile product room units were avoided. A 0.02% safety report incidence per V2B administration was calculated at our institution. Conclusion: Use of a V2B system resulted in a substantial cost avoidance compared to purchasing commercial products and preparing locally compounded sterile products. The V2B system appears to be a safe addition to further optimize workflow but may require further investigation in prospective analyses.

The economic cost of control of the invasive yellow-legged Asian hornet

Since its accidental introduction in 2003 in France, the yellow-legged Asian hornet Vespa velutina nigrithorax is rapidly spreading through France and Europe. Economic assessments regarding the costs of invasive species often reveal important costs from required control measures or damages. Despite the rapid invasion of the Asian yellow-legged hornet in Europe and potential damage to apiculture and pollination services, the costs of its invasion have not been evaluated yet. Here we aimed at studying the costs arising from the Asian yellow-legged hornet invasion by providing the first estimate of the control cost. Today, the invasion of the Asian yellow-legged hornet is mostly controlled by nest destruction. We estimated that nest destruction cost €23 million between 2006 and 2015 in France. The yearly cost is increasing as the species keeps spreading and could reach €11.9 million in France, €9.0 million in Italy and €8.6 million in the United Kingdom if the species fills its current climatically suitable distribution. Although more work will be needed to estimate the cost of the Asian yellow-legged hornet on apiculture and pollination services, they likely exceed the current costs of control with nest destruction. It could thus be worth increasing control efforts by aiming at destroying a higher percentage of nests.

Yearly Cost Saving by Using Enthalpy Heat Exchanger During Cooling and Heating

Fresh air has to be constantly supplied to the building by air handling unit, where supplied air is mixed with inside air and optimal temperature, oxygen level is adjusted and level of dust and smoke is reduced. Supply air demand of the building is determined according to number of persons in the room, room area and regulations. Necessity of ventilation rely in supplying room with oxygen, cleaning the air, adjusting temperature and moisture and reduction of odours, gases, dust, bacteria and viruses. Achieving optimal properties of supply air creates huge portion of building energy consumption. To save energy during ventilation, standard air to air sensible heat exchangers are used. They purpose is to recover sensible heat from exhaust air and at the same time avoid contamination of supply air. Drawback of these types of exchangers is limit of recovering moisture, therefore huge portion of energy in form of latent heat is lost. On top of classical plate air to air heat exchanger, enthalpy heat exchanger allows to exchange latent as well as sensible heat [1].

Immune Checkpoint Inhibitor Dosing: Can We Go Lower Without Compromising Clinical Efficacy?

In just a few years, immune checkpoint inhibitors have dramatically changed the landscape in oncology, offering durable responses and improved survival for many patients across several tumor types. With more than 3,300 new agents in the immuno-oncology pipeline plus a wide array of combinations being studied, it seems this new era is just getting started. These advances come with a significant caveat: most of the world population does not have access to their benefits, because the yearly cost of a novel anticancer medication can routinely exceed $100,000. There is a large amount of data showing that checkpoint inhibitors have significant activity at doses much lower than those currently approved. We review the evidence for reduced drug dosing as a strategy to increase the number of patients who can be treated and what would be needed to further validate this approach.

Mitigating Allocation and Hydrocarbon Accounting Uncertainty Using More Frequent Flow Test Data

Although the application of multi-phase flow meters has recently increased, the production of individual wells in many fields is still monitored by occasional flow tests using test separators. In the absence of flow measurement data during the time interval between two consecutive flow tests, the flow rates of wells are typically estimated using allocation techniques. As the flow rates, however, do not remain the same over the time between the tests, there is typically a large uncertainty associated with the allocated values. In this research, the effect of the frequency of flow tests on the estimated total production of wells, allocation, and hydrocarbon accounting has been investigated. Allocation calculations have been undertaken for three different cases using actual and simulated production data based on one to four flow tests per month. Allocation errors for each case have subsequently been obtained. The results show that for all the investigated cases, the average allocation error decreased when the number of flow tests per month increased. The sharpest error reduction has been observed when the frequency of the tests increased from one to two times per month. It reduced the allocation error for the three investigated cases by 0.43%, 0.45%, and 1.11% which are equivalent to $18.2M (million), $18.9M, and $46.8M reduction in the yearly cost of the allocation error for the respective cases. The reductions in the allocation error cost for the three cases were $27M, $29M, and $80M, respectively, when the flow tests have been undertaken weekly instead of monthly.