Objectives: To assess the cost-effectiveness of Abiraterone Acetate plus Prednisone (A-P) compared with Cabazitaxel plus Prednisone (C-P) in Dominican Republic, in patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC) that have failed to chemotherapy with Docetaxel. MethOds: A three-health state cohort simulation Markov Model (progression-free, post-progression and death) was developed based on overall and progression free survival data. The time frame was 10 years. The perspective was that of the Public System of Health of Dominican Republic. The health outcomes of interest were Quality Adjusted Life Years (QALYs) and Life Years (LYs). Efficacy data was taken from clinical trials (COU-AA-301 for A-P and TROPIC for C-P). Utilities for health states and negative utilities for adverse events were estimated based on quality of life endpoints of the COU-AA-301 trial. The base year was 2012. All costs are presented in Dominican currency (Dominican Pesos -RD$). Costs and outcomes were discounted at 5%. Probabilistic sensitivity (PSA) analysis was performed to evaluate uncertainty surrounding the parameters. Results: A-P resulted in 0.79 QALYs and 1.35 LYs, per patient, respectively. C-P resulted in 0.71 QALYs and 1.28 LYs, per patient, respectively. Mean total costs per patient were: RD$ 2.204.289 for A-P and RD$ 2.732.365 for C-P. The results of the probabilistic sensitivity analysis showed that, when compared with C-Z, A-P was found dominant (associated with reduced costs and increased QALYs) in the majority of the iterations. A-P had a 75% probability of being cost effective, independent of the willingness to pay, when compared to C-P. cOnclusiOns: A-P can be considered cost-saving (dominant), when compared with C-P, in patients with Metastatic Castration-Resistant Prostate Cancer that have failed to chemotherapy with Docetaxel, from the perspective of the Public System of Health of Dominican Republic.

A 3 4 7 -A 7 6 6 A403 drugs); monitoring costs (from screening to pregnancy determination, in accordance with the ESTHER protocol); procedure costs (including oocyte retrieval, fertilisation, embryo freezing, and embryo transfer), as well as costs related to ovarian hyperstimulation syndrome (OHSS) and OHSS preventive measures. Results: The total average cost per IVF cycle ranges from £5,797 to £5,818 for Follitropin-delta and from £5,809 to £5,836 for Follitropin-alfa with a mean absolute total cost difference from £2 to £26. The cost benefits associated to Follitropin-delta are mainly due to its reduction in the proportion of women needing OHSS prevention (2.36% versus 4.67%) and in its reduction of OHSS incidence (3.46% versus 4.84%). ConClusions: This CMA and the sensitivity analyses performed demonstrate that Follitropin-delta is a cost neutral alternative versus Follitropin-alfa in women undergoing a first fresh IVF cycle in the UK.

Миофасциальная боль является актуальной междисциплинарной медицинской проблемой. Она выявляется более чем у половины пациентов молодого и среднего возраста, точных данных о ее распространенности среди пожилых людей нет. В настоящее время отсутствует систематизированный подход к терминологии и нозологической принадлежности миофасциальной боли. Авторами приводятся и оцениваются значимые факторы возникновения миофасциальной боли и диагностические критерии миофасциального болевого синдрома. В алгоритме лечения делается акцент на общих принципах терапии, механизмах действия и показаниях для обоснованного применения наружных форм НПВП, в частности препарата Вольтарен Эмульгель 12 часов, в качестве как самостоятельного метода лечения при слабой и умеренной боли, так и дополнения к основной терапии, направленной на подавление боли.

CASP checklists. The success characteristics were extracted from the eligible articles. Results: The search returned with 1833 articles with 944 excluded for duplicates, non-relevance, study design and endpoints, and publication types after initial review. Preliminary result showed that diabetes, cardiology and obesity were the most common target disease areas for digital technology implementation. The most used digital technology were mobile applications, wearables, and web-based intervention, with artificial intelligence is increasingly studied. Publications on industry-sponsored trials, digital technology in clinical trials and as specific treatment companion are limited. The endpoints for outcome measurement and result of digital technology in improving patients' quality of care vary. The success factors for digital technology implementation are quality of care achievement (effective, efficient, accessible/ coverage, and standardized) and positive user experience (usability, acceptability, non-interference and reliability). Conclusions: Digital technology is increasingly used in healthcare settings and showed promising benefits to measure and improve patient outcome. Patients' insights, system standardization and validation are crucial for the success of digital solution. A standardized and robust study design is required to demonstrate the impact of digital technology on patients' quality of care.

rived from the 3 phase III clinical trials of tapentadol PR in osteoarthritis and lower back pain and published literature. Switch rates to 2nd line therapies and comedication costs were provided by the National Centre of Pharmacoeconomics based on the GMS database analysis. Costs of physician visits were obtained by applying local costs to the number of physician visits in each therapy line obtained from a retrospective analysis of the UK THIN database of GP patient records. Oneway deterministic and probabilistic sensitivity analyses were undertaken to assess the impact of parameter uncertainty. RESULTS: Mean annual total costs per patient from GMS Scheme perspective amount to 4,367€ for tapentadol vs. 4,381€ for oxycodone. Tapentadol generates 0.6316 QALYs compared to 0.6122 QALYs for oxycodone, resulting in tapentadol being a dominant treatment. For DP/LTI Scheme, tapentadol had an ICER of 1,662 €/QALY gained. Results were robust in a broad range of sensitivity analyses. Probability that tapentadol is cost-effective vs. oxycodone at threshold of 20,000 €/QALY gained exceeded 95%. CONCLUSIONS: Compared to oxycodone CR, the most commonly used oral drug for chronic severe non-cancer pain in Ireland, tapentadol PR appears to be a highly cost-effective treatment option. OBJECTIVES:To assess the cost-effectiveness of tapentadol PR compared to opioids (morphine, oxycodone, transdermal buprenorphine [TDB] and transdermal fentanyl [TDF]) for the treatment of severe chronic non-cancer pain from the societal perspective in Portugal. METHODS: A one year Markov transition state model with monthly cycles was built. Four health states were defined: 'no withdrawal and no adverse events treated', 'occurrence of adverse events (AEs) with need for medical treatment', 'withdrawal due to AEs', and 'withdrawal due to lack of efficacy'. If patients did not adequately respond to treatment or withdraw, switching to alternative second line opioid (morphine, hydromorphone, TDB or TDF) was considered. Third line therapy was the absorption state. Data regarding efficacy, tolerability and utility values (EQ-5D) were derived from clinical trials and published literature. Switch rates to subsequent opioid therapies and resource consumption were estimated by clinical experts. Costs were calculated from the societal perspective. Direct costs were calculated based on official Portuguese prices/tariffs, indirect costs derived from the National Health Survey. One-way and probabilistic sensitivity analyses were conducted. RESULTS: Mean annual total costs per patient amounted to 3793 € for morphine, 3,804€ for TDF, 3891 € for TDB, 3964 € for oxycodone, and 4117 € for tapentadol. Total QALYs generated were 0.6102 (morphine), 0.6062 (TDF), 0.6026 (TDB), 0.6096 (oxycodone), and 0.6287 (tapentadol). The resulting ICERs (€/QALY gained) for tapentadol yield 7,995 versus oxycodone, 8,685 versus TDB, 13,943 versus TDF, and 17,547 versus morphine. Varying costs, probabilities, and utilities by Ϯ50%, Ϯ10%, and Ϯ10%, respectively, resulted in an ICER range fr...

months of AICC infused prophylaxis (PX) with 6 months of on-demand (OD) therapy, separated by a 3-month washout period during which patients used on-demand therapy. HRQoL was summarized in two continuous variables: Physical Component Score (PCS-36) and Mental Component Score . The difference between two study periods for 6-month change from baseline in PCS-/MCS-36 are compared using Wilcoxon signed-rank test to measure the difference between two groups regardless of the sequence of medications. To investigate the effect of random sequence in the change of HRQoL, the difference between two study periods for 6-month change from baseline in PCS-/MCS-36 is compared by random sequence using Wilcoxon-Mann-Whitney U test with exact statement. RESULTS: Twenty-six patients completed both study periods. 17 of them were Ͼ14 years old and thus completed QoL questionnaires and are included in this analysis. The difference between PX and OD in 6-month change from baseline was 2.83 for PCS-36 (pϭ0.378) and 1.29 for MCS-36 (pϭ0.890), favored PX on both measures. Regardless of random sequence of medication, HRQoL showed a moderate improvement with PX. When comparing the difference of 6-month change by treatment sequence, patients who initiated with PX then switched to OD had a greater improvement compared to the opposite sequence (PX-ϾOD: 6.59, OD-ϾPX: 0.19 for PCS-36 (pϭ0.475); PX¡OD: 2.66, OD¡PX: 0.33 for MCS-36 (pϭ0.601)). CONCLUSIONS: A cross-over effect, albeit statistically non-significant, was observed when the difference of 6-month change was compared by treatment sequence. Patients who started with more favorable medication tended to show a greater improvement, whereas patients in opposite sequence showed a slight improvement.

OBJECTIVES:A daily assessment of the speed of action and effectiveness of treatment of a combination of paracetamol and codeine in patients suffering from intense pain, which has progressed since less than 7 days. METHODS: A multicentre longitudinal observational prospective study carried out in metropolitan France using data collected by general practitioners who agreed to participate. RESULTS: A total of 574 patients treated by a paracetamol-codeine combination (600mg/50mg and 400mg/20mg) were included. The severity of pain measured at inclusion using a visual numeric scale was 7Ϯ1.28. The severity of pain measured after half a day of treatment was 5.61Ϯ1.87 and 5.28 Ϯ 1.86 at the end of the first 24 hours of treatment. A significant improvement in pain was observed from the first half-day (pϽ0.001). The severity of pain on the 2nd, 4th and 7th evenings was respectively 4.08Ϯ1.85; 2.76Ϯ1.76 and 1.79 Ϯ1.69 On D1, 69.7% declared treatment to be effective, 61.04% were satisfied with their treatment and 79.26% did not observe any side effects to the treatment. On D7, 96.15% (D3, 91.3% ) declared treatment to be effective, 87.10% were satisfied with their treatment and 88.96% did not observe any side effects to the treatment. 8 out of 10 patients did not complain about side effects related to the treatment. CONCLUSIONS: A reduction in pain within the first 12 hours showed the pertinence of treatment using a paracetamol-codeine combination. This pertinence was confirmed by two-thirds patients who declared the treatment to be effective from the 1st day, and 91% of them declared this on the 3rd day

treated was 2,575 for fondaparinux and 2,688 for enoxaparin. Over 65% of total costs were attributed to the invasive treatment (PCI and revascularization). Drug costs (in-hospital therapies) accounted for 10% (fondaparinux) and 12% (enoxaparin) of total costs. The estimated rates of cardiovascular events were 7.3% and 9.0% for fondaparinux and enoxaparin, respectively. Results kept unchanged on days 30 and 180 post-NSTE-ACS. Sensitivity analysis confirmed base-case results. CONCLUSIONS: Fondaparinux was dominant over enoxaparin (lower costs, better long-term benefits). The budget impact after 5 years of anticoagulant substitution (at 20% constant adoption rate per year) could reach 90 million BRL in savings for the Brazilian MoH and healthcare system. OBJECTIVES:The objective of this analysis was to estimate the cost effectiveness of commonly used antiarrhythmic agents for the treatment of supraventricular tachycardia (SVT) and intraoperative/ postoperative tachycardia and hypertension. METHODS: A decision tree model was built to examine the cost effectiveness of esmolol, metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative and postoperative tachycardia and hypertension from a hospital perspective. The default pharmacy costs in the model were based on publicly available wholesale acquisition costs (WAC). Literature based values were used for the rates and medical costs of adverse cardiac events including myocardial infarction, stroke, hypotension, bradycardia, and ischemia. The primary efficacy parameter, rate of successful heart rate control, was based on literature values. The outcome was the cost per successful heart rate control with incremental cost effectiveness ratios (ICERs) calculated. No discounting was applied due to the short time frame of the analysis. For the probabilistic sensitivity analysis, a Monte Carlo simulation consisting of 1,000 simulations was conducted to test the joint uncertainty of all modeling parameters simultaneously. RESULTS: The total cost of therapy was $1,250.82, $2,630.19, $2,280.21, and $1,555.14 for esmolol, metoprolol, diltiazem and amiodarone, respectively. The rate of successful heart rate control was 90% (esmolol), 64% (metoprolol), 90% (diltiazem) and 74% (amiodarone). The cost per successful heart rate control was $1,389.80 (esmolol), $4,109.67 (metoprolol), $2,533.57 (diltiazem), and $2,101.54 (amiodarone). The ICER of esmolol dominated metoprolol, diltiazem and amiodarone. In the probabilistic sensitivity analysis, esmolol was the most cost-effective antiarrhythmic in 99.6% of simulations. One-way sensitivity analyses showed the model was most sensitive to the cost of hypotension and bradycardia. CONCLUSIONS: In this model, esmolol was the least costly and most effective antiarrhythmic. Esmolol is cost-effective in comparison with metoprolol, diltiazem and amiodarone for the treatment of SVT and intraoperative/ postoperative tachycardia and hypertension.