The presence of O-CSA does not preclude an adequate response to CPAP. Adherence rate to PAP was poor in both the O-CSA and I-CSA groups. Further studies are needed to define optimal adherence rate and long-term benefits of PAP in CSA.
In hospitalized patients with HCAP, GCAT did not show survival benefit compared to non-GCAT. However, our results are limited by the cohort design of the selected studies and the degree of heterogeneity among them. Future trials are needed to identify risk factors for multidrug-resistant pathogens in HCAP patients who may benefit from broad-spectrum antimicrobial regimens.
Introduction: Cancer care costs escalated with the introduction of novel therapies. Therefore, cancer-related Cost Utility Analyses (CUAs) are used to guide policy makers. Since numerous methods (criteria) exist to evaluate CUAs, we compared these criteria between CUAs of solid tumors and those of hematological malignancies. Methods:A systemic MEDLINE search of English-language publications between 2001 and 2012 was performed. Strict inclusion criteria were limited to CUAs examining one single intervention and one single study comparator. Standard data of 66 variables, based on the Drummond criteria, were collected to review each CUA for clarity, completeness, and health economic methodological quality.Results: Among 8,515 screened papers on Pubmed, 177 cancer-related CUAs (2%) were eligible. Solid tumors and hematological malignancies CUAs constituted 161(91%) and 16(9%). Among the standardized methods for evaluating CUAs, those of solid tumors reported more frequently the presentation of cost-effectiveness acceptability curve (p=0.02) and the use of threshold value to interpret study results (p=0.024) than those of hematological malignancies. Further, CUAs of solid tumors were more frequently multicenter-based (p=0.014); however, CUAs of hematological malignancies listed differential quality adjusted life year separately more frequently (p=0.02). Outcomes of CUAs of solid tumors were more frequently reported as significant (p=0.014). Conclusions:CUAs of solid tumors abided more frequently with the standardized methods (criteria) than those of hematological malignancies, which may be due in part to their multiple study sites. CUAs of hematological malignancies may warrant more methodological standardization and incorporate more study sites. MethodsA systemic MEDLINE search by the keywords: CUAs and cancer of English-language manuscripts published between 2001 and 2012 was performed. Eligibility criteria consisted of including only CUAs that examined one single intervention and one single study comparator. For example, adding rituximab to fludarabine and cyclophosphamide for the treatment of previously untreated chronic lymphocytic leukemia [15]. Exclusion criteria included CUAs that examined more than one intervention, more than one comparator or more than one study population or type of malignancy. The study population was not limited by age; therefore, CUAs examining children, adult or geriatric populations were included.
Introduction Decitabine (Dec) is not approved in the United States (US) for acute myeloid leukemia (AML) because it did not improve overall survival compared with standard conventional induction treatment. We asked what would be the cost effectiveness of Dec versus conventional induction therapy in AML patients (pts) older than 60 years of age. Methods The standard conventional induction including cytarabine, and daunorubicin, (AD) (N Engl J Med. 2009 361:1235-48) was compared with Dec (Haematologica. 2012 97:393-401) using a semi-Markov model compiling survival and cost data. Survival probabilities were retrieved from the literature. Data accounted for re-induction therapy with IDA-FLAG (idarubicin, fludarabine, cytarabine and granulocyte colony-stimulating factor) and consolidation therapy with high-dose cytarabine (HiDAC) but not for stem cell transplantation. The assumption-based model considered a maximum of 4 cycles of HiDAC and continuing Dec until loss of benefit. Drug costs were derived from the 2012 US market. Hospital costs accrued were evaluated in a diagnosis-related group (DRG) system. Drug dosage was estimated based on a body surface area of 1.85 m2. The quality of life (QoL) was assumed as 1 for healthy individuals; 0 for death; 0.524 for active disease; 0.91 for AML in remission on AD; 0.71 and 0.524 for AML being actively treated with Dec or AD, and 0.81 for AML in remission treated with Dec or HIDAC. QoL data were based on the literature except for pts on consolidation therapy. The latter was the mean of QoL of AML in remission and AML actively being treated. Results Assuming 1,000 pts for each treatment arm in a semi-Markov model over 1 year time horizon, the quality-adjusted life year (QALY) for AD vs. Dec was 0.1754 and 0.5982. The percentage survival for AD and Dec was 45.2% and 50.5%. Their costs were $127,867 and $55,777. The incremental cost-effectiveness ratio (ICER) was -$72,090/0.4228 = -$170,506/year. By sensitivity analysis, Dec was superior to AD to all parameters (Table 1). Conclusion Dec is a more cost-effective therapy for pts older than 60 years of age than conventional induction therapy. Given the economic pressures in the US Health System, one should consider approving Dec for newly diagnosed AML pts older than 60 years of age. Disclosures: No relevant conflicts of interest to declare.
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