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https://www.readbyqxmd.com/read/28212954/evaluation-of-copd-treatments-a-multicriteria-decision-analysis-of-aclidinium-and-tiotropium-in-the-united-states
#1
Kevin Marsh, Erica Zaiser, Panagiotis Orfanos, Suzanne Salverda, Teresa Wilcox, Shawn Sun, Shailja Dixit
BACKGROUND: Comparisons of the use of aclidinium bromide and tiotropium bromide for the treatment of chronic obstructive pulmonary disease often concentrate on key end points (exacerbations) at the expense of other benefits and risks. Multicriteria decision analysis (MCDA) can help overcome this by using stakeholder preferences to combine multiple end points into an overall value estimate. OBJECTIVES: To evaluate the use of aclidinium bromide twice daily via Pressair™ (AstraZeneca Pharmaceuticals LP, Wilmington, DE) and of tiotropium once daily via HandiHaler(®) (Boehringer Ingelheim Pharmaceuticals, Inc...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28210989/net-clinical-benefit-of-dabigatran-vs-warfarin-in-venous-thromboembolism-analyses-from-re-cover-%C3%A2-re-cover%C3%A2-ii-and-re-medy%C3%A2
#2
Martin Feuring, Sam Schulman, Henry Eriksson, Ajay J Kakkar, Sebastian Schellong, Stefan Hantel, Elke Schueler, Jörg Kreuzer, Samuel Z Goldhaber
The direct oral anticoagulants, e.g., dabigatran etexilate (DE), are effective and well tolerated treatments for venous thromboembolism (VTE). Net clinical benefit (NCB) is a useful concept in weighing potential benefits against potential harm of comparator drugs. The NCB of DE vs. warfarin in VTE treatment was compared. Post-hoc analyses were performed on pooled data from the 6-month RE-COVER® and RE-COVER™ II trials, and data from the RE-MEDY™ trial (up to 36 months), to compare the NCB of DE (150 mg twice daily) and warfarin [target international normalized ratio (INR) 2...
February 16, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28209373/cost-utility-of-first-line-disease-modifying-treatments-for-relapsing-remitting-multiple-sclerosis
#3
Erkki Soini, Jaana Joutseno, Marja-Liisa Sumelahti
PURPOSE: This study evaluated the cost-effectiveness of first-line treatments of relapsing-remitting multiple sclerosis (RRMS) (dimethyl fumarate [DMF] 240 mg PO BID, teriflunomide 14 mg once daily, glatiramer acetate 20 mg SC once daily, interferon [IFN]-β1a 44 µg TIW, IFN-β1b 250 µg EOD, and IFN-β1a 30 µg IM QW) and best supportive care (BSC) in the health care payer setting in Finland. METHODS: The primary outcome was the modeled incremental cost-effectiveness ratio (ICER; €/quality-adjusted life-year [QALY] gained, 3%/y discounting)...
February 13, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28203120/international-lessons-in-new-methods-for-grading-and-integrating-cost-effectiveness-evidence-into-clinical-practice-guidelines
#4
REVIEW
Kathryn M Antioch, Michael F Drummond, Louis W Niessen, Hindrik Vondeling
Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor...
2017: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/28198091/impact-of-chronic-kidney-disease-on-2-year-clinical-outcomes-in-patients-treated-with-6-month-or-24-month-dapt-duration-an-analysis-from-the-prodigy-trial
#5
Giuseppe Gargiulo, Andrea Santucci, Raffaele Piccolo, Anna Franzone, Sara Ariotti, Andrea Baldo, Giovanni Esposito, Aris Moschovitis, Stephan Windecker, Marco Valgimigli
OBJECTIVES: To assess whether moderate-to-severe CKD is a treatment modifier for benefit or harm in patients randomly allocated to 24-month versus 6-month DAPT. BACKGROUND: It is still unclear whether chronic kidney disease CKD should impact on the decision-making on optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). METHODS AND RESULTS: PRODIGY trial randomized 1970 all-comer patients at 24-month versus 6-month DAPT after PCI...
February 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28182774/benefits-and-unintended-consequences-of-antimicrobial-de-escalation-implications-for-stewardship-programs
#6
Josie Hughes, Xi Huo, Lindsey Falk, Amy Hurford, Kunquan Lan, Bryan Coburn, Andrew Morris, Jianhong Wu
Sequential antimicrobial de-escalation aims to minimize resistance to high-value broad-spectrum empiric antimicrobials by switching to alternative drugs when testing confirms susceptibility. Though widely practiced, the effects de-escalation are not well understood. Definitions of interventions and outcomes differ among studies. We use mathematical models of the transmission and evolution of Pseudomonas aeruginosa in an intensive care unit to assess the effect of de-escalation on a broad range of outcomes, and clarify expectations...
2017: PloS One
https://www.readbyqxmd.com/read/28180977/a-methodological-framework-for-assessing-agreement-between-cost-effectiveness-outcomes-estimated-using-alternative-sources-of-data-on-treatment-costs-and-effects-for-trial-based-economic-evaluations
#7
Felix Achana, Stavros Petrou, Kamran Khan, Amadou Gaye, Neena Modi
A new methodological framework for assessing agreement between cost-effectiveness endpoints generated using alternative sources of data on treatment costs and effects for trial-based economic evaluations is proposed. The framework can be used to validate cost-effectiveness endpoints generated from routine data sources when comparable data is available directly from trial case report forms or from another source. We illustrate application of the framework using data from a recent trial-based economic evaluation of the probiotic Bifidobacterium breve strain BBG administered to babies less than 31 weeks of gestation...
February 9, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/28156598/disparities-in-access-to-palliative-care-services-among-cancer-patients-in-south-texas
#8
Susanne Schmidt, Ifeoma Aduba, Jessica Jones, Laura LaNiel Tenner
: 130 Background: Palliative medicine is dedicated to improving quality of life for patients throughout their disease course. The integration of palliative medicine in oncology practice has increased due to growing evidence of benefits for patient. While the collaboration of palliative and oncology care is beneficial, access to palliative services remains an issue for cancer patients. The aim of this project is to evaluate how insurance status impacts palliative care access for cancer patients in South Texas...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152737/financial-risk-sharing-agreements-using-options-to-make-marginal-benefits-cost-effective
#9
(no author information available yet)
: 41 Background: New cancer treatments have become increasingly costly. Although new drugs may be sufficiently cost-efficiency for a primary indication (i1) to receive funding, subsequent indications (ia) may not prove cost-effective. A financial risk-sharing agreement to increase access is proposed. A potential 2012 real-world implementation in Canada for pazopanib use in metastatic renal cell carcinoma (mRCC) as i1, and soft-tissue sarcoma (STS) as ia is presented. METHODS: The market value of an indication can be approximated by its net-present-value (NPV) of expected cash flows...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151772/combined-use-of-short-term-and-long-term-cardiovascular-risk-scores-in-primary-prevention-an-assessment-of-clinical-utility
#10
Giovanni Veronesi, Simona Giampaoli, Diego Vanuzzo, Francesco Gianfagna, Luigi Palmieri, Guido Grassi, Giancarlo Cesana, Marco M Ferrario
AIMS: To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting. METHODS: CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE ≤ 1%), 'intermediate' (SCORE 1-4%) and 'moderate/high' short-term CVD risk (SCORE ≥ 4% or diabetes)...
February 1, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28146601/stepping-down-the-dose-of-inhaled-corticosteroids-for-adults-with-asthma
#11
REVIEW
Iain Crossingham, David Jw Evans, Nathan R Halcovitch, Paul A Marsden
BACKGROUND: Asthma is a condition of the airways affecting more than 300 million adults and children worldwide. National and international guidelines recommend titrating up the dose of inhaled corticosteroids (ICS) to gain symptom control at the lowest possible dose because long-term use of higher doses of ICS carries a risk of systemic adverse events. For patients whose asthma symptoms are controlled on moderate or higher doses of ICS, it may be possible to reduce the dose of ICS without compromising symptom control...
February 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28139412/value-analysis-of-digital-breast-tomosynthesis-for-breast-cancer-screening-in-a-us-medicaid-population
#12
Jeffrey D Miller, Machaon M Bonafede, Sally D Herschorn, Scott K Pohlman, Kathleen A Troeger, Laurie L Fajardo
PURPOSE: Better understanding regarding the clinical-economic value of digital breast tomosynthesis (DBT) for breast cancer screening for Medicaid enrollees is needed to help inform sound, value-based decision making. The objective of this study was to conduct a clinical-economic value analysis of DBT for breast cancer screening among women enrolled in Medicaid to assess the potential clinical benefits, associated expenditures, and net budget impact of DBT. METHODS: Two annual screening mammography scenarios were evaluated with an economic model: (1) full-field digital mammography and (2) combined full-field digital mammography and DBT...
January 26, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28134282/does-von-willebrand-factor-improve-the-predictive-ability-of-current-risk-stratification-scores-in-patients-with-atrial-fibrillation
#13
Amaya García-Fernández, Vanessa Roldán, José Miguel Rivera-Caravaca, Diana Hernández-Romero, Mariano Valdés, Vicente Vicente, Gregory Y H Lip, Francisco Marín
Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA)...
January 30, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28125363/evaluation-of-the-asco-value-framework-for-anticancer-drugs-at-an-academic-medical-center
#14
Leslie Wilson, Tracy Lin, Ling Wang, Tanuja Patel, Denise Tran, Sarah Kim, Katie Dacey, Courtney Yuen, Lisa Kroon, Bret Brodowy, Kevin Rodondi
BACKGROUND: Anticancer drug prices have increased by an average of 12% each year from 1996 to 2014. A major concern is that the increasing cost and responsibility of evaluating treatment options are being shifted to patients. This research compared 2 value-based pricing models that were being considered for use at the University of California, San Francisco (UCSF) Medical Center to address the growing burden of high-cost cancer drugs while improving patient-centered care. PROGRAM DESCRIPTION: The Medication Outcomes Center (MOC) in the Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy focuses on assessing the value of medication-related health care interventions and disseminating findings to the UCSF Medical Center...
February 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28123727/systemic-chemotherapy-with-folfox-in-metastatic-grade-1-2-neuroendocrine-cancer
#15
Marjorie Faure, Patricia Niccoli, Aurelie Autret, Gerard Cavaglione, Laurent Mineur, Jean-Luc Raoul
Neuroendocrine tumors (NETs) comprise a heterogeneous group of malignancies with various clinical presentations and evolution. NETs are often diagnosed at a late stage, when they are already metastatic. Treatment is currently based on traditional chemotherapies, such as streptozocin, with serious side effects. The favorable toxicity profile of the combination of 5-fluorouracil with oxaliplatin, together with its significant antitumor activity in several gastrointestinal malignancies, led to the evaluation of its efficacy and tolerability in patients with advanced grade 1/2 (G1/G2) NETs...
January 2017: Molecular and Clinical Oncology
https://www.readbyqxmd.com/read/28123191/characterization-of-venous-thromboembolism-risk-in-medical-inpatients-using-different-clinical-risk-assessment-models
#16
Reza Rafizadeh, Ricky D Turgeon, Josh Batterink, Victoria Su, Anthony Lau
BACKGROUND: Symptomatic venous thromboembolism (VTE) occurs in about 1% of patients within 3 months after admission to a medical unit. Recent evidence for thromboprophylaxis in an unselected medical inpatient population has suggested only a modest net benefit. Consequently, guidelines recommend careful risk stratification to guide thromboprophylaxis. OBJECTIVES: To compare candidacy for thromboprophylaxis according to 4 risk stratification models: a regional preprinted order (PPO) set used in the study institution, the Padua Prediction Score, and the IMPROVE predictive and associative risk assessment models...
November 2016: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/28120297/personalizing-bridging-anticoagulation-in-patients-with-nonvalvular-atrial-fibrillation-a-microsimulation-analysis
#17
Matthew A Pappas, Geoffrey D Barnes, Sandeep Vijan
BACKGROUND: Bridging anticoagulation is commonly prescribed to patients with atrial fibrillation who are initiating warfarin or require interruption of anticoagulation. Current guidelines recommend bridging for patients at high risk of stroke. Among patients with atrial fibrillation and one or more risk factors for ischemic stroke, the recently published BRIDGE trial found forgoing bridging during interruption to be, on average, noninferior to bridging with respect to ischemic complications, with significantly fewer hemorrhagic complications...
January 24, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28110562/lipid-and-other-management-to-improve-arterial-disease-and-survival-in-end-stage-renal-disease
#18
Simon B Dimmitt, Jennifer H Martin
Arterial disease is common in advancing renal failure, culminating in myocardial infarction with cardiac failure, strokes and peripheral and renal artery disease. Attention to cardiac and arterial disease may slow deterioration of renal function. Management of risk factors can reduce these sequelae. Areas covered: Modifiable risk factors for arterial disease and relevant pharmacotherapies. Expert opinion: Cardiovascular disease is the biggest killer in renal failure. Statins are viewed as essential in symptomatic coronary disease and have been shown in non-renal patients to improve survival after myocardial infarction...
February 6, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28109024/computer-assisted-technologies-used-in-oral-rehabilitation-and-the-clinical-documentation-of-alleged-advantages-a-systematic-review
#19
REVIEW
Asbjørn Jokstad
The objective of this systematic review is to identify current computer-assisted technologies used for managing patients with a need to re-establish craniofacial appearance, subjective discomfort and stomatognathic function, and the extent of their clinical documentation. Electronic search strategies were used for locating clinical studies in MEDLINE through PubMed and in the Cochrane library, and in the grey literature through searches on Google Scholar. The searches for commercial digital products for use in oral rehabilitation resulted in identifying 225 products per November 2016, used for patient diagnostics, communication and therapy purposes, and for other computer-assisted applications in context with oral rehabilitation...
January 21, 2017: Journal of Oral Rehabilitation
https://www.readbyqxmd.com/read/28106343/net-clinical-benefit-of-hospitalization-versus-outpatient-management-of-patients-with-acute-pulmonary-embolism
#20
P-M Roy, D J Corsi, M Carrier, A Theogene, C de Wit, C Dennie, G Le Gal, A Delluc, T Moumneh, M Rodger, P Wells, E Gandara
BACKGROUND: The decision to hospitalize or not patients with acute pulmonary embolism (PE) is controversial. Despite the advantages of close monitoring, hospitalization by itself may lead to in-hospital complications and potentially worsen the prognosis of PE patients. OBJECTIVES: To determine the net clinical benefit of hospitalization versus outpatient management of normotensive patients with acute pulmonary embolism (PE). METHODS: Retrospective cohort propensity score analysis (radius marching with replacement)...
January 20, 2017: Journal of Thrombosis and Haemostasis: JTH
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