The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada

Background The Global Initiative for Asthma recommends the use of as-needed low-dose inhaled corticosteroid (ICS)-formoterol as a preferred controller therapy for patients with mild asthma. These recommendations were based, in part, on evidence from the SYGMA 1 and 2 studies of as-needed budesonide-formoterol. This analysis aimed to compare the cost-effectiveness of as-needed budesonide-formoterol to low-dose maintenance ICS plus as-needed short-acting β2-agonist (SABA) in patients with mild asthma. Methods A Markov cohort model was designed that included three possible health states (non-exacerbation, severe exacerbation, and death) to compare as-needed budesonide-formoterol 200–6 μg to twice-daily budesonide 200 μg maintenance therapy (low-dose ICS) plus as-needed terbutaline 0.5 mg (SABA). The deterministic base-case analysis used severe exacerbation, adverse event (AE), and healthcare resource use data from SYGMA 2, and was conducted from a Canadian public payer perspective with a 50-year time horizon, and a discount rate of 1.5% per annum. Moderate exacerbation was modelled on data from SYGMA 1 in sensitivity analyses. Utility values were derived from SYGMA 2 quality of life data. All-cause- and asthma-related mortality rates and costs (reported in 2019 Canadian dollars) were based on published data, using Canada-specific values where available. One-way deterministic sensitivity, probabilistic sensitivity, and eight scenario analyses were conducted to examine the robustness of the results. Results As-needed budesonide-formoterol was the dominant treatment option in the base-case analysis, providing incremental cost savings of $9882 per patient and quality-adjusted life year (QALY) gains of 0.002 versus low-dose maintenance ICS plus as-needed SABA over a 50-year time horizon. Using a willingness-to-pay threshold of $50,000/QALY ($100,000/QALY), as-needed budesonide-formoterol had a 94% (95%) probability of being cost-effective compared with maintenance ICS plus as-needed SABA. Cost-saving was mostly driven by lower overall medication and AE-related costs. As-needed budesonide-formoterol remained the dominant treatment in sensitivity and scenario analyses. Conclusions As-needed budesonide-formoterol is a cost-saving option for the treatment of mild asthma from the perspective of the Canadian public payer compared with low-dose maintenance ICS plus as-needed SABA.

Optimal treatment strategies for stage I non-small cell lung cancer in veterans with pulmonary and cardiac comorbidities

Background Veterans are at increased risk of lung cancer and many have comorbidities such as chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). We used simulation modeling to assess projected outcomes associated with different management strategies of Veterans with stage I non-small cell lung cancer (NSCLC) with COPD and/or CAD. Patients and methods Using data from a cohort of 14,029 Veterans (years 2000–2015) with NSCLC we extended a well-validated mathematical model of lung cancer to represent the management and outcomes of Veterans with stage I NSCLC with COPD, with or without comorbid CAD. We simulated multiple randomized trials to compare treatment with lobectomy, limited resection, or stereotactic body radiation therapy (SBRT). Model output estimated expected quality adjusted life years (QALY) of Veterans with stage I NSCLC according to age, tumor size, histologic subtype, COPD severity and CAD diagnosis. Results For Veterans <70 years old lobectomy was associated with greater projected quality-adjusted life expectancy regardless of comorbidity status. For most combinations of tumors and comorbidity profiles there was no dominant treatment for Veterans ≥80 years of age, but less invasive treatments were often superior to lobectomy. Dominant treatment choices differed by CAD status for older patients in a third of scenarios, but not for patients <70 years old. Conclusions The harm/benefit ratio of treatments for stage I NSCLC among Veterans may vary according to COPD severity and the presence of CAD. This information can be used to direct future research study design for Veterans with stage I lung cancer and COPD and/or CAD.

Transnational Social Movements and Peaceful Change

The chapter discusses the relationship between social movements and peaceful change. First, it reviews the way this relationship has been elaborated in IR constructivist and critical analyses, as part of transnational activist networks, global civil society, and transnational social movements, while considering the blind sides left by the dominant treatment of these entities as positive moral actors. Second, the chapter reviews insights from the revolution and political violence literature, a literature usually sidelined in IR debates about civil society, in order to cast a wider relational perspective on how social movements participate in, and are affected by, interactive dynamic processes that may escalate into violent outcomes at both local and international levels.

Insulin treatment for diabetes

The first use of insulin in 1922 began a new era in the management and survival of patients with type 1 diabetes. Before 1922, patients with this condition were placed on a starvation diet and survived only a few months. Nearly a century later, insulin remains the dominant treatment for type 1 diabetes, is used in gestational diabetes and increasingly in type 2 diabetes. This article focuses on insulin treatment for adult diabetic patients in general practice. It will explore the effect of insulin and the role it has in diabetes, the preparations available, recommended regimens and some challenges with insulin treatment.

Not just nuisance: spatialising social statistics

Outside of the specialist community of quantitative spatial researchers’ statistical analyses in the social sciences see geography merely as simple units of analysis or else as nuisance risks to the satisfaction of underlying statistical assumptions, if indeed it sees geography at all. In step-by-step discussion and visualisations this chapter upends that dominant treatment by illustrating the range of rich and frequently untapped spatial insights that a clearer understanding and grasp of specialist but (relatively) straightforward spatial methodologies can bring substantively to social policy analysis and practice.

Cost-Effectiveness of Venetoclax and Rituximab Combination Therapy in Relapsed/Refractory Chronic Lymphocytic Leukemia (CLL) in Argentina

OBJETIVE: To estimate the cost- effectiveness of Venetoclax + Rituximab (VEN + R) versus ibrutinib in the treatment of Relapsed/Refractory (R/R) Chronic Lymphocytic Leukaemia (CLL), in Argentina from the Social Security perspective." METHODS: A three-state partitioned survival model (including pre-progression, post-progression and death) developed in accordance with the NICE Guide to the Methods of Technology Appraisal and the ISPOR decision modelling guidelines was adapted to Argentina setting. Population inputs are derived from the MURANO trial. Efficacy and safety data for treatments in R/R CLL were obtained from the literature. The cost of medication was based on country level drug prices. Costs of resources used for routine medical attention and the management of adverse events were based on tariffs from social security system of Argentina. Costs were expressed in US dollars ($) (exchange rate 1$ = 37.10 AR$, November 2018). A 30-year time horizon and the Social Security's payer's perspective were assumed. Costs and health outcomes were discounted at 5%. Deterministic and probabilistic sensitivity analyses (PAS) were performed. RESULTS: Over a 30-year time horizon, VEN + R regimen generates a significantly lower total treatment cost in comparison to Ibrutinib (- US dollars ($) 312.679,37). In QALYs the result is higher in VEN + R related to the comparator (5.83 vs. 4.18). These show that VEN + R is a dominant treatment strategy over Ibutrinib in patients with R/R CLL. The univariate sensitivity and scenario analysis confirm the robustness of this result. Likewise, the probabilistic sensitivity analysis shows that there is a 100% probability that VEN + R is a cost-effective strategy against Ibrutinib. CONCLUSIONS: This study shows that in Argentina, VEN+R would be dominant treatment option (better results and lower costs) compared with ibrutinib in R/R CLL patients. Disclosures Elgart: 3eff: Consultancy. Glancszpigel:3eff: Employment. Kanevsky:Abbvie: Employment. Godar:Abbvie: Employment. Touliet:Abbvie: Employment. Albaytero:3eff: Employment.

“This is a Controlled Invasion”: The Czech President Miloš Zeman’s Populist Perception of Islam and Immigration as Security Threats

This paper is a contribution to the academic debate on populism and Islamophobia in contemporary Europe. Its goal is to analyze Czech President Miloš Zeman’s strategy in using the term “security” in his first term of office. Methodologically speaking, the text is established as a computer-assisted qualitative data analysis (CAQDAS) of a data set created from all of Zeman’s speeches, interviews, statements, and so on, which were processed using MAXQDA11+. This paper shows that the dominant treatment of the phenomenon of security expressed by the President is primarily linked to the creation of the vision of Islam and immigration as the absolute largest threat to contemporary Europe. Another important finding lies in the fact that Zeman instrumentally utilizes rhetoric such as “not Russia, but Islam”, which stems from Zeman’s relationship to Putin’s authoritarian regime. Zeman’s conceptualization of Islam and migration follows the typical principles of contemporary right-wing populism in Europe.

Treatment trends and Medicare reimbursements for localized prostate cancer in elderly patients

Introduction: The absolute and proportional numbers of elderly patients diagnosed with localized prostate cancer (PCa) are on the rise. We examined treatment trends and reimbursement figures in localized PCa patients aged ≥80 years.Methods: Between 2000 and 2008, we identified 30 217 localized PCa patients aged ≥80 years in Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Alternative treatment modalities consisted of conservative management (CM), radiation therapy (RT), radical prostatectomy (RP), and primary androgendeprivation therapy (PADT). For all four modalities, utilization and reimbursements were examined.Results: PADT was the most frequently used treatment modality between 2000 and 2005. CM became the dominant treatment modality from 2006‒2008. RP rates were marginal. RT ranked third, and its annual rate increased from 20.77% in 2000 to 29.13% in 2008. Median individual reimbursement of RT was highest and ranged from $29 343 in 2000 to $31 090 in 2008, followed by RP (from $20 560 in 2000 to $19 580 in 2008), PADT (from $18 901 in 2000 to $8000 in 2008), and CM (from $1824 in 2000 to $1938 in 2008). RT contributed to most of the cumulative annual reimbursements from 2003 (49.24%) to 2008 (72.97%). PADT ranked first from 2000 (54.56%) to 2002 (50.49%), but decreased by 19.40% in 2008. CM’s contribution increased from 4.42% in 2000 to 6.96% in 2008. RP’s share of reimbursements was stable during the study period.Conclusions: Our results, focusing on localized PCa treatment in patients aged ≥80 years, showed an important increase in rates, median cost, and proportion of cumulative cost related to RT.

TINJAUAN HUKUM ISLAM TERHADAP PEREMPUAN MELAHIRKAN PADA DOKTER KANDUNGAN LAKI-LAKI

In the examination of the patient, the doctor would see the nakedness of the patient to be examined and not only see the nakedness of the patientbut also touch and feel him. Whereas in Islam that same-sex genitaliathere are limits that should be seen and touched, especially the oppositesex. This study aims to determine the views of Islamic law againstpregnant women who had treatment and gave birth to the maleobstetrician. Which at the fact that pregnant women patients either anultrasound or bore little handled by a male doctor. and even most of thepregnant women are more dominant treatment in gynecologist mencompared with a specialist female, This happens mainly because theprofession obstetrician is dominated by men and also because manymothers assume that specialists content of more competent men(because physically stronger males), clever and more objective. It iscertain pregnant women who had treatment and gave birth to the maleobstetrician will reveal his private parts, genitalia fact is something thatwe must cover both men and women in order to maintain the honor inthe eyes of the beholder. So close the genitals was advocated by thereligious exception in certain circumstances and conditions whichallowed open genitalia.