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This prospective cohort study aimed to characterize the sensory profile during acute herpes zoster (AHZ) and to explore sensory signs as well as physical and psychosocial health as predictors for postherpetic neuralgia (PHN). Results of quantitative sensory testing of 74 patients with AHZ at the affected site and at the distant contralateral control site were compared to a healthy control group. Pain characteristics (Neuropathic Pain and Symptom Inventory and SES), physical functioning, and psychosocial health aspects (Pain Disability Index, SF-36, and STAI) were assessed by questionnaires. Patients with PHN (n = 13) at 6-month follow-up were compared to those without PHN (n = 45). Sensory signs at the affected site were thermal and vibratory hypesthesia, dynamic mechanical allodynia (DMA), pressure hyperalgesia, and high wind-up (18%-29%), as well as paradoxical heat sensations and pinprick hypalgesia (13.5%). The unaffected control site exhibited thermal and vibratory hypesthesia, DMA, and pressure hyperalgesia. Dynamic mechanical allodynia and pinprick hypalgesia were mutually exclusive. Postherpetic neuralgia was associated with DMA (38.5% vs 6.7%; P = 0.010) and vibratory hypesthesia (38.5% vs 11.1%; P = 0.036) at the control site, with mechanical gain and/or loss combined with normal thermal detection (affected site: 69.2% vs 31.1%; P = 0.023; control site: 53.8% vs 15.5%; P = 0.009). Pain Disability Index (P = 0.036) and SES affective pain perception scores (P = 0.031) were over 50% higher, and 6 of 8 SF-36 subscores were over 50% lower (P < 0.045) in PHN. Sensory profiles in AHZ indicate deafferentation and central but not peripheral sensitization. Sensory signs at distant body sites, strong affective pain perception, as well as reduced quality of life and physical functioning in the acute phase may reflect risk factors for the transition to PHN.

The formation of patient groups within the diagnosis anorexia nervosa should be oriented towards the determined cost predictors.

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For the majority of patients, we found a trade-off between costs and health outcome, thus, it seems advisable to carefully monitor outcome parameters when applying cost containment measures.

Background: Considering clinical benefits of new combination therapies for metastatic renal-cell carcinoma (mRCC), this study aims to calculate the number needed to treat (NTT) and the cost of preventing an event (COPE) for pembrolizumab plus axitinib (P þ A), and nivolumab plus ipilimumab (N þ I) as first-line treatments, from the Brazilian private perspective. Methods: Overall survival (OS) and progression-free survival (PFS) data for intermediate-and poor-risk groups were obtained from KEYNOTE-426 and CHECKMATE-214 trials for P þ A and N þ I, respectively, versus sunitinib as mRCC first-line treatment. Results: Considering a 12-month time horizon, 6 patients should be treated with P þ A to prevent one death with sunitinib use, resulting in a COPE of 3,773,865 BRL. Using N þ I, NNT for 12-month OS rate was 13 compared to sunitinib, with a COPE of 6,357,965 BRL. Regarding PFS data, NNT was also 6 when comparing P þ A versus sunitinib, with an estimated COPE of 3,773,865 BRL. Estimated NNT was 20 comparing N þ I and sunitinib, resulting in a COPE of 10,172,744 BRL. Cost differences between two treatment options, reached more than 6 million BRL for PFS, and 2 million BRL for OS. Conclusion: At the 12-month landmark, P þ A suggests better economic scenario versus N þ I as firstline mRCC treatment option for intermediate-and poor-risk groups, through an indirect comparison using sunitinib as a common comparator.

Objectives: The surgical site infection (SSI) is the most often acquired hospital infection in Spain, about 19.4% of all nosocomial infections. The prevalence of this adverse event is 8.01%, generating high economic impact on hospital costs and undermining the quality of care. The risk of SSI has increased in recent years and infections have become more resistant to treatments. About 50% of SSIs are preventable, their costs are avoidable, and health technology can help avoiding them. The aim of this study is to analyze the economic impact that could represent the use of anti-bacterial sutures compared with conventional ones in Spanish hospitals. MethOds: An interactive Excel model was developed using data obtained through a published literature review. The rate of reduction of SSI with antibacterial suture is 30%. The incremental cost per patient with SSI is between € 9,657 and € 10,112.63. Two scenarios were designed: 100% of surgeries with normal sutures and 100% of surgeries with anti-bacterial sutures. A sensitivity analysis for the variables of greatest uncertainty was performed (cost per SSI). Results: The budget impact of the use of antibacterial sutures resulted in a 24% of cost savings related to the normal sutures. It represents savings of € 5.4M per year for an average Spanish hospital, and € 1,264M per year for the whole Spanish Health System. The results of the sensitivity analysis shows that even by changing the effectiveness of the suture and using the most unfavourable data found in the literature for the cost of an SSI, the use of the antibacterial suture still produces savings of 24% compared with the use of normal suture. cOnclusiOns: This budget impact analysis provides new evidence that reinforces the use of antibacterial sutures, because it may reduce the risk of SSI, the negative effects of its consequences and associated costs and significantly improving the quality of care for surgical patients in Spain.