In a lifetime horizon, which should be used when comparing technologies with different impacts on mortality, cost-effectiveness evaluation resulted in more favourable economic outcomes for ticagrelor than for generic clopidogrel, with the cost per QALY well below the recommended willingness to pay threshold in Poland (24,965 PLN vs. 111,381 PLN).
Introduction: The combination of immunotherapy and targeted therapy is currently marking a new era in the treatment of renal cancer. The latest clinical guidelines recommend the use of drug combinations for the first-line treatment of advanced renal cancer. The aim of this review is to compare the efficacy of combined cabozantinib + nivolumab therapy with other immune checkpoint inhibitors combined with tyrosine kinase inhibitors or monoclonal antibodies blocking the CTLA-4 (cytotoxic T cell antigen 4) in the first-line treatment of metastatic clear-cell renal cell carcinoma (RCC).Methodology: A systematic literature search was carried out in the PubMed and EMBASE databases. Randomized controlled trials (RCTs) on therapies recommended by the latest EAU and ESMO guidelines for treatment-naïve metastatic RCC (i.e., lenvatinib + pembrolizumab, axitinib + pembrolizumab and nivolumab + ipilimumab) were searched. A network meta-analysis (NMA) was performed for data synthesis. The methodology of included RCTs was assessed using the Cochrane RoB two tool. The data were analyzed in the overall population as well as in risk subgroups defined according to the International Metastatic Database Consortium (IMDC) i.e., patients with a favorable and intermediate or poor prognoses. The most recent cut-off dates from included studies were analyzed.Results: Four RCTs (CheckMate 9 ER, KEYNOTE-426, CLEAR and CheckMate 214) were included in the review. No studies directly comparing cabozantinib + nivolumab with any of the drug combinations included in this review were available. NMA showed that cabozantinib + nivolumab was superior compared to axitinib + pembrolizumab and nivolumab + ipilimumab in all analyzed comparisons (overall population and IMDC risk subgroups), both in terms of overall survival and progression-free survival (PFS). The advantage of cabozantinib + nivolumab was statistically significant only for PFS when compared to nivolumab + ipilimumab in the overall population. The results for the comparison of cabozantinib + nivolumab with lenvatinib + pembrolizumab showed numerical superiority of lenvatinib + pembrolizumab combination in terms of overall survival, but none of the results were statistically significant. The advantage of lenvatinib + pembrolizumab over cabozantinib + nivolumab in terms of PFS was statistically significant in the overall and favorable prognosis population.Conclusion: Inclusion of the most recent cut-off data from CheckMate 9 ER did not affect the role of the cabozantinib + nivolumab combination for treatment-naïve metastatic RCC. Cabozantinib + nivolumab is an effective therapeutic option for the first-line treatment of advanced renal cancer that is recommended both in the latest European and American guidelines for all IMDC risk groups.
objeCtives: Marfan syndrome is a rare systemic connective tissue disorder caused by mutations in the gene encoding fibrillin-1 (FBN1). Marfan Syndrome has an estimated prevalence of 1 in 5,000-10,000. Disease manifestations include, but are not limited to, cardiovascular (CV) and pulmonary disorders. Among Marfan patients > 26 years we compared health outcomes, costs and clinical factors. Comparisons were made between CV and pulmonary-related hospital discharges and those not primarily associated with CV or pulmonary manifestations. Methods: We used data from the 2012 Nationwide Inpatient Sample (NIS) to complete the study. Marfan Syndrome patients > 26 years were identified using ICD-9 code 759.82. Patients were stratified by primary diagnosis; CV (CCS:096,097,100,101,103-113,115-118) or pulmonary-related (CCS:128-131,133,134) conditions. Descriptive and inferential statistics were used to compare demographics [race, Charlson Comorbidity Index (CCI), region, and payer information] and healthcare outcomes and charges [length of stay (LOS), mortality, and total charges]. Chi-square and t-tests were used for statistical analysis. The reference group for all analyses included hospital discharges that were not CV or pulmonary-related. Results: 954 Marfan syndrome patients were identified, of which 284 (29.7%) were CV, 38 (3.9%) pulmonary, and 632 (66.2%) for the reference group. Mean CCI scores, LOS, and total charges among CV patients
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.