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Cost-effectiveness of entecavir versus adefovir for the treatment of chronic hepatitis B in patients with decompensated cirrhosis from a third-party US payer perspective
Tsai N,Jeffers L,Cragin L,Sorensen S
ClinicoEconomics and Outcomes Research , 2012,
Abstract: Naoky Tsai,1 Lennox Jeffers,2 Lael Cragin,3 Sonja Sorensen,3 Wenqing Su,3 Lisa Rosenblatt,4 Hong Tang,4 Tony Hebden,4 Timothy Juday41John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA; 2University of Miami School of Medicine, Miami, FL, USA; 3United BioSource Corporation, Bethesda, MD, USA; 4Bristol-Myers Squibb Company, Plainsboro, NJ, USABackground: Decompensated cirrhosis is a serious clinical complication of chronic hepatitis B (CHB) that places a large economic burden on the US health care system. Although entecavir has been shown to improve health outcomes in a cost-effective manner in mixed populations of CHB patients, the cost-effectiveness of entecavir has not been evaluated in CHB patients with decompensated cirrhosis.Methods: This study assessed the cost-effectiveness of entecavir versus adefovir, from a US payer perspective, in CHB patients with decompensated cirrhosis, using a health-state transition Markov model with four health states: hepatocellular carcinoma (HCC), HCC-free survival, post-liver transplant, and death. The model considered a hypothetical patient population similar to that included in a randomized controlled trial in the target population (ETV-048): predominantly male (74%), Asian (54%), mean age 52 years, hepatic decompensation (Child–Pugh score ≥ seven), hepatitis B e antigen-positive or -negative, treatment-na ve or lamivudine-experienced, and no liver transplant history. Clinical inputs were based on cumulative safety results for ETV-048 and published literature. Costs were obtained from published literature. Costs and outcomes were discounted at 3% per annum.Results: For 1000 patients over a 3-year time horizon, predicted overall survival and HCC-free survival were longer with entecavir than with adefovir (2.35 versus 2.30 years and 2.11 versus 2.03 years, respectively). Predicted total health care costs were $889 lower with entecavir than with adefovir ($91,878 versus $92,768). For incremental cost/life-year gained and incremental cost/HCC-free-year gained, entecavir was less costly and more effective than adefovir. Sensitivity analyses found the results to be robust to plausible variations in health-state costs and discount rate.Conclusion: This analysis suggests that entecavir improves survival outcomes in a cost-saving manner compared with adefovir in CHB patients with hepatic decompensation.Keywords: hepatocellular carcinoma, antiviral, survival, health economics, incremental net benefit
Cost-effectiveness of entecavir versus adefovir for the treatment of chronic hepatitis B in patients with decompensated cirrhosis from a third-party US payer perspective
Tsai N, Jeffers L, Cragin L, Sorensen S, Su W, Rosenblatt L, Tang H, Hebden T, Juday T
ClinicoEconomics and Outcomes Research , 2012, DOI: http://dx.doi.org/10.2147/CEOR.S31784
Abstract: st-effectiveness of entecavir versus adefovir for the treatment of chronic hepatitis B in patients with decompensated cirrhosis from a third-party US payer perspective Original Research (1618) Total Article Views Authors: Tsai N, Jeffers L, Cragin L, Sorensen S, Su W, Rosenblatt L, Tang H, Hebden T, Juday T Published Date August 2012 Volume 2012:4 Pages 227 - 235 DOI: http://dx.doi.org/10.2147/CEOR.S31784 Received: 14 March 2012 Accepted: 19 June 2012 Published: 23 August 2012 Naoky Tsai,1 Lennox Jeffers,2 Lael Cragin,3 Sonja Sorensen,3 Wenqing Su,3 Lisa Rosenblatt,4 Hong Tang,4 Tony Hebden,4 Timothy Juday4 1John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA; 2University of Miami School of Medicine, Miami, FL, USA; 3United BioSource Corporation, Bethesda, MD, USA; 4Bristol-Myers Squibb Company, Plainsboro, NJ, USA Background: Decompensated cirrhosis is a serious clinical complication of chronic hepatitis B (CHB) that places a large economic burden on the US health care system. Although entecavir has been shown to improve health outcomes in a cost-effective manner in mixed populations of CHB patients, the cost-effectiveness of entecavir has not been evaluated in CHB patients with decompensated cirrhosis. Methods: This study assessed the cost-effectiveness of entecavir versus adefovir, from a US payer perspective, in CHB patients with decompensated cirrhosis, using a health-state transition Markov model with four health states: hepatocellular carcinoma (HCC), HCC-free survival, post-liver transplant, and death. The model considered a hypothetical patient population similar to that included in a randomized controlled trial in the target population (ETV-048): predominantly male (74%), Asian (54%), mean age 52 years, hepatic decompensation (Child–Pugh score ≥ seven), hepatitis B e antigen-positive or -negative, treatment-na ve or lamivudine-experienced, and no liver transplant history. Clinical inputs were based on cumulative safety results for ETV-048 and published literature. Costs were obtained from published literature. Costs and outcomes were discounted at 3% per annum. Results: For 1000 patients over a 3-year time horizon, predicted overall survival and HCC-free survival were longer with entecavir than with adefovir (2.35 versus 2.30 years and 2.11 versus 2.03 years, respectively). Predicted total health care costs were $889 lower with entecavir than with adefovir ($91,878 versus $92,768). For incremental cost/life-year gained and incremental cost/HCC-free-year gained, entecavir was less costly and more effective than adefovir. Sensitivity analyses found the results to be robust to plausible variations in health-state costs and discount rate. Conclusion: This analysis suggests that entecavir improves survival outcomes in a cost-saving manner compared with adefovir in CHB patients with hepatic decompensation.
Adverse Event Burden, Resource Use, and Costs Associated with Immunosuppressant Medications for the Treatment of Systemic Lupus Erythematosus: A Systematic Literature Review
A. Oglesby,A. J. Shaul,T. Pokora,C. Paramore,L. Cragin,G. Dennis,S. Narayanan,A. Weinstein
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/347520
Abstract: This paper assessed the burden of adverse events (AEs) associated with azathioprine (AZA), cyclophosphamide (CYC), mycophenolate mofetil (MMF), methotrexate (MTX), and cyclosporine (CsA) in patients with systemic lupus erythematosus (SLE). Thirty-eight publications were included. Incidence of AEs ranged from 42.8% to 97.3%. Common AEs included infections (2.4–77%), gastrointestinal AEs (3.2–66.7%), and amenorrhea and/or ovarian complications (0–71%). More hematological cytopenias were associated with AZA (14 episodes) than MMF (2 episodes). CYC was associated with more infections than MMF (40–77% versus 12.5–32%, resp.) or AZA (17–77% versus 11–29%, resp.). Rates of hospitalized infections were similar between MMF and AZA patients, but higher for those taking CYC. There were more gynecological toxicities with CYC than MMF (32–36% versus 3.6–6%, resp.) or AZA (32–71% versus 8–18%, resp.). Discontinuation rates due to AEs were 0–44.4% across these medications. In summary, the incidence of AEs associated with SLE immunosuppressants was consistently high as reported in the literature; discontinuations due to these AEs were similar across treatments. Studies on the economic impact of these AEs were sparse and warrant further study. This paper highlights the need for more treatment options with better safety profiles. 1. Introduction Systemic lupus erythematosus (SLE) is a chronic systemic inflammatory autoimmune disease that can affect almost any organ and can present with musculoskeletal, neuropsychiatric, renal, cutaneous, and hematologic manifestations alone or in combination [1–3]. The treatment plan used to manage SLE is dependent upon the severity of the disease and organ systems involved. Antimalarials, nonsteroidal anti-inflammatory drugs (NSAIDs), and low-dose corticosteroids are used to treat mild-to-moderate disease, whereas higher doses of steroids are often used when symptoms remain uncontrolled [4]. Although not approved by the Food and Drug Administration for use in patients with SLE, immunosuppressants (e.g., azathioprine (AZA), cyclophosphamide (CYC), mycophenolate mofetil [MMF], methotrexate (MTX), or cyclosporine (CsA)) are prescribed to patients with moderate-to-severe symptoms to reduce steroid exposure in some patients [4–6]. Based on a clinical trial conducted in North America and Europe, it is estimated that more than half of patients with active SLE receive immunosuppressants as part of standard therapy [7]. However, immunosuppressant drugs are associated with significant short- and long-term side effects and require monitoring to
Image Analysis for Cosmology: Shape Measurement Challenge Review & Results from the Mapping Dark Matter Challenge
T. D. Kitching,J. Rhodes,C. Heymans,R. Massey,Q. Liu,M. Cobzarenco,B. L. Cragin,A. Hassaine,D. Kirkby,E. Jin Lok,D. Margala,J. Moser,M. O'Leary,A. M. Pires,S. Yurgenson
Physics , 2012,
Abstract: In this paper we present results from the Mapping Dark Matter competition that expressed the weak lensing shape measurement task in its simplest form and as a result attracted over 700 submissions in 2 months and a factor of 3 improvement in shape measurement accuracy on high signal to noise galaxies, over previously published results, and a factor 10 improvement over methods tested on constant shear blind simulations. We also review weak lensing shape measurement challenges, including the Shear TEsting Programmes (STEP1 and STEP2) and the GRavitational lEnsing Accuracy Testing competitions (GREAT08 and GREAT10).
The sweet taste quality is linked to a cluster of taste fibers in primates: lactisole diminishes preference and responses to sweet in S fibers (sweet best) chorda tympani fibers of M. fascicularis monkey
Yiwen Wang, Vicktoria Danilova, Tiffany Cragin, Thomas W Roberts, Alexey Koposov, G？ran Hellekant
BMC Physiology , 2009, DOI: 10.1186/1472-6793-9-1
Abstract: We first ascertained that lactisole exerted similar suppression of sweetness in M. fascicularis, as reported in humans, by recording their preference of sweeteners and non- sweeteners with and without lactisole in two-bottle tests. The addition of lactisole significantly diminished the preference for all sweeteners but had no effect on the intake of non-sweet compounds or the intake of water. We then recorded the response to the same taste stimuli in 40 single chorda tympani nerve fibers. Comparison between single fiber nerve responses to stimuli with and without lactisole showed that lactisole only suppressed the responses to sweeteners in S fibers. It had no effect on the responses to any other stimuli in all other taste fibers.In M. fascicularis, lactisole diminishes the attractiveness of compounds, which taste sweet to humans. This behavior is linked to activity of fibers in the S-cluster. Assuming that lactisole blocks the T1R3 monomer of the sweet taste receptor T1R2/R3, these results present further support for the hypothesis that S fibers convey taste from T1R2/R3 receptors, while the impulse activity in non-S fibers originates from other kinds of receptors. The absence of the effect of lactisole on the faint responses in some S fibers to other stimuli as well as the responses to sweet and non-sweet stimuli in non-S fibers suggest that these responses originate from other taste receptors.A series of elegant studies in genetically modified mice show that sweet and umami tastes are dependent on T1R-receptors, that bitter taste is caused by stimulation of T2R receptors, that these two receptors never are found in the same taste receptor cell (TRC) and that the TRC determines the behavioral response [1-7]. One study, for example, showed "that mice engineered to express a bitter taste receptor in 'sweet cells' become strongly attracted to its cognate bitter tastants, whereas expression of the same receptor (or even a novel GPCR) in T2R-expressing cells resulted i
Effect of Potassium Concentration on Some Agrophysiological Parameters of Pineapple Plants (Ananas comosus L. cv. Smooth Cayenne and MD2) Grown in C？te d'Ivoire
L.
- , 2018, DOI: 10.9734/JEAI/2018/45079
Abstract: (1) Dr. Slawomir Borek, Professor, Department of Plant Physiology, Adam Mickiewicz University, Poland.
Computing Reachable Sets as Capture-Viability Kernels in Reverse Time  [PDF]
No？l Bonneuil
Applied Mathematics (AM) , 2012, DOI: 10.4236/am.2012.311219
Abstract: The set SF(x0;T) of states y reachable from a given state x0 at time T under a set-valued dynamic x’(t)∈F(x (t)) and under constraints x(t)∈K where K is a closed set, is also the capture-viability kernel of x0 at T in reverse time of the target {x0} while remaining in K. In dimension up to three, Saint-Pierre’s viability algorithm is well-adapted; for higher dimensions, Bonneuil’s viability algorithm is better suited. It is used on a large-dimensional example.
Three Dimensional Evolution of SN 1987A in a Self-Gravitating Disk  [PDF]
L. Zaninetti
International Journal of Astronomy and Astrophysics (IJAA) , 2013, DOI: 10.4236/ijaa.2013.32010
Abstract:

The introduction of an exponential or power law gradient in the interstellar medium (ISM) allows to produce an asymmetric evolution of the supernova remnant (SNR) when the framework of the thin layer approximation is adopted. Unfortunately both the exponential and power law gradients for the ISM do not have a well defined physical meaning. The physics conversely is well represented by an isothermal self-gravitating disk of particles whose velocity is everywhere Maxwellian. We derived a law of motion in the framework of the thin layer approximation with a control parameter of the swept mass. The photon’s losses, which are often neglected in the thin layer approximation, are modeled trough velocity dependence. The developed framework is applied to SNR 1987A and the three observed rings are simulated.

The Luminosity Function of Galaxies as Modeled by a Left Truncated Beta Distribution  [PDF]
L. Zaninetti
International Journal of Astronomy and Astrophysics (IJAA) , 2014, DOI: 10.4236/ijaa.2014.41013
Abstract: A first new luminosity function of galaxies can be built starting from a left truncated beta probability density function, which is characterized by four parameters. In the astrophysical conversion, the number of parameters increases by one, due to the addition of the overall density of galaxies. A second new galaxy luminosity function is built starting from a left truncated beta probability for the mass of galaxies once a simple nonlinear relationship between mass and luminosity is assumed; in this case the number of parameters is six because the overall density of galaxies and a parameter that regulates mass and luminosity are added. The two new galaxy luminosity functions with finite boundaries were tested on the Sloan Digital Sky Survey (SDSS) in five different bands; the results produce a “better fit” than the Schechter luminosity function in two of the five bands considered. A modified Schechter luminosity function with four parameters has been also analyzed.
Evolution in Diagnosis and Classification of Diabetes  [PDF]
L. Sreenivasamurthy
Journal of Diabetes Mellitus (JDM) , 2021, DOI: 10.4236/jdm.2021.115017
Abstract: Diabetes, has been known to mankind for centuries, often described by its unique nature of sweet tasting urine or by the symptoms of excessive urination and thirst. Several renowned scientists have attempted to describe the symptoms, pathophysiology, diagnosis and various experimental treatment options with varying degrees of success. The current widely accepted classification focuses on etiology and pathogenesis to guide treatment and is very successful and adapted across the world. Diagnostic criteria underwent multiple changes to define glycemic targets which were more and more guided by better understanding of the disease pathogenesis. Recent research focuses on a more individualized approach to managing diabetes, better understanding and identifying individuals who are at an increased risk of complications at diagnosis itself to offer more personalized management to prevent long term complications. Early differentiation of individual based on multiple factors rather than a single parameter is the path being paved currently. BMI, Waist circumference, age at diagnosis, HbA1c, triglycerides, HDL cholesterol, GAD Antibodies, Homeostasis model assessment of Insulin Resistance (HOMA-2 IR), beta-cell dysfunction (HOMA2-Beta), and fasting and stimulated C-peptide, are core parameters in the current rationalized approach towards better long term outcomes for people with diabetes. Cluster based identification and focused treatment with individualistic targets is the way forward in Diabetes management.
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