Background: Several studies have evaluated the cost-effectiveness of treatment for advanced hepatocellular carcinoma (HCC), but the economics of atezolizumab plus bevacizumab (Ate plus Beva) remains unclear. Method: A three-state Markov model was established to simulate the life-time cost and effectiveness of advanced liver cancer, which included costs and health outcomes. Medical costs were sourced from Red Book, Healthcare Cost and Utilization Project (HCUP) and literatures. Also, the utility values of health state were deprived from references. The primary outcomes were measured by life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-benefit ratio (ICER) and incremental net-health benefit (INHB). The robustness of the model was verified by one-way and probabilistic sensitivity analysis.Results: Ate plus Beva generated a gain of 0.84 QALYs (1.17 LYs ), an additional incremental cost of $242,447.40 per patient as compared with sorafenib, which resulted in the ICER of $288,663.09/QALY ($206,906.76/LY) at the willingness-to-pay (WTP) threshold of $150,000/QALY, and the INHB was -0.78/QALY. The sensitivity analysis demonstrated that the ICER was most affected by the price of atezolizumab.Conclusion: From the U.S. health care payer perspective, compare with sorafenib, Ate plus Beva regimen seems unlikely to be cost-effective in advanced HCC patients at a WTP threshold of 150,000 /QALY. If the price of atezolizumab was reduced by 75%, the probability of atezolizumab being cost-effective was over 50% at the WTP threshold.
Purpose: To investigate the influence of chloroprocaine combined with morphine on the analgesic effects, adverse reactions and inflammation factors in patients receiving transurethral resection of the prostate (TURP).Methods: A total of 80 patients with benign prostatic hyperplasia (BPH) in the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China, were divided into morphine group and combination-therapy group (morphine combined with chloroprocaine). Pain index, changes in inflammatory factors and incidence of adverse reactions in the two groups of patients were assessed.Results: The morphine group and combination-therapy group showed basic profile prior to the treatments. Visual Analogue Scale (VAS) scores before operation and 6 h after operation in the morphine group were similar to those in the combination-therapy group, but the scores at 12, 24 and 48 h after operation in the combination-therapy group were significantly lower than those in the morphine group. Similarly, the combination-therapy group showed lower levels of substance P (SP) and bradykinin (BK) at 12, 24 and 48 h after operation than the morphine group (p < 0.05). Both groups exhibited similar levels of serum inflammatory factors before the operation, but the levels decreased in the combination-therapy group when compared with those in the morphine group after operation (p < 0.05). The combination-therapy group also showed a lower incidence of adverse reactions than the morphine group.Conclusion: Chloroprocaine combined with morphine effectively ameliorates postoperative pain, lowers secretion of tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10), and decreases the incidence of postoperative adverse reactions, thus affording a high level of safety after operation.
ObjectiveRecently, the significant improvement of atezolizumab and pembrolizumab over chemotherapy for treatment-naïve stage IV non-small cell lung cancer (NSCLC) has been demonstrated, but the cost-effectiveness of these regimens remains unknown.MethodsA Markov model was adapted from the US healthcare perspective to assess the cost-effectiveness of atezolizumab, pembrolizumab, and chemotherapy in treatment-naïve NSCLC. Pseudo-individual patient data were generated from digitized Kaplan–Meier curves. Direct medical costs and utility values were sourced from the database and literature. Quality-adjusted life-years (QALYs), total costs, and incremental cost-effectiveness ratios (ICERs) were computed. Sensitivity analyses and budgetary impact analyses were calculated.ResultsIn any and high programmed cell death 1-ligand 1 (PD-L1) expression populations, with chemotherapy, atezolizumab provided ICERs of $234,990 and $130,804 per QALY, while pembrolizumab yielded ICERs of $424,797 and $140,873 per QALY. The ICER of atezolizumab vs. pembrolizumab was $56,635 and $115,511.82 in any and high PD-L1 expression population, respectively. The critical drivers of ICERs included the cost of atezolizumab and pembrolizumab. The accumulated incremental budgetary impact of atezolizumab vs. chemotherapy increased to approximately $39.1 million in high PD-L1 expression patients over 5 years.ConclusionsIn the high PD-L1 expression population, both atezolizumab and pembrolizumab were cost-effective for stage IV NSCLC compared to chemotherapy, which is contrary to that in any PD-L1 expression population. Atezolizumab shows a higher acceptability in both populations. Treating with immune checkpoint inhibitors (ICIs) has a substantial budgetary impact on the medical burden. The PD-L1 expression level has the potential to be a predictor for the economics of ICIs.
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