Целью исследования явилась оценка динамики и характеристика абдоминального болевого синдрома у больных желчнокаменной болезнью (ЖКБ) в ходе 10-летнего наблюдения. Работа является фрагментом многолетнего проспективного наблюдения за больными ЖКБ. Больные, участвовавшие в исследовании, были разделены на 2 группы: 1-я группа (n = 113)-перенесшие холецистэктомию (ХЭ) по поводу ЖКБ; 2-я группа (сравнения) (n = 92)-больные, получавшие консервативное лечение ЖКБ, с давностью установленного диагноза не менее 10 лет. Больные обеих групп были разделены по исходному варианту течения ЖКБ: симптомное и бессимптомное. Установлено, что у больных ЖКБ после ХЭ произошло уменьшение частоты билиарных болей на 25.7 % (р < 0.001). В группе с исходно симптомным течением ЖКБ после ХЭ отмечено статистически более значимое снижение частоты билиарной боли на 31.1 % по сравнению с больными, получавшими консервативное лечение (р < 0.001). Частота билиарных болей возросла в группе консервативной терапии ЖКБ на 11.9 % (р < 0.001), в том числе у больных ЖКБ с исходно бессимптомным течением. Частота синдрома диспепсии увеличилась у пациентов после ХЭ на 33.9 % (р = 0.039), особенно значимо в группе с исходно бессимптомным течением ЖКБ. Ключевые слова: последствия холецистэктомии, постхолецистэктомический синдром, болевой синдром после оперативного лечения желчнокаменной болезни.
A number of governmental anti-HIV strategic programs are being implemented today in Russia; however, as of 2020, only 74.5% of the infected were aware of their status and only 67.4% of them were receiving the therapy. Under such conditions, it seems reasonable to assess future social and economic consequences depending on various scenarios of centralized financing of anti-HIV activities in the future. With the use of mathematic modelling, an economic analysis was performed for the “no change” scenario of maintaining costs for HIV control at the level of 2020, and a prognosis was made for 4 possible scenarios of national policy changes in relation to federal expenditures: a 25% and 50% increase in expenditures from the level of 2020, a “maximum extensive scenario” (which assumes reaching the upper limit of expenditures with approximately 60% growth while maintaining the current structure of costs), and an “intensive” scenario with an increase in nominal expenditures and shifting costs to purchasing newer third-generation antiretroviral therapy regimens. According to the modelling results, the current financial strategy (the “no change” scenario) in nominal terms will result in HIV mortality growth up to 25 thousand cases annually, the economic burden over the period of 2020–2030 will exceed RUB 4 bln and will not let achieving the national target of “90-90-90” by 2024. Under this scenario, Russia would remain the leader in HIV prevalence among the countries of Eastern Europe and Central Asia. The “no change” scenario would result in indirect economic losses of RUB 3,481.06 bln per year, with epidemiological parameters still high. The most efficient scenario turned out to be the “maximum extensive scenario” that suggests an increase in federal budget expenditures on combating HIV infection by approximately RUB 20 bln annually. This course of events would allow reducing HIV mortality to 5.4 cases per 100 thsd population by 2030, which is comparable to the current HIV mortality in Spain, Italy and Switzerland, and reducing HIV mortality by 111,9 thsd cases to a level comparable to that of the USA, Chile and New Zealand in 2019. The economic benefit from the implementation of this scenario in 2020–2030 would amount to RUB 1,663.02 bln due to decreased direct non-medical and indirect costs in the form of GDP growth and reduced payments of pensions and disability benefits.
Background. The addition of enzalutamide to standard androgen deprivation therapy (ADT) significantly increases overall survival and progression-free survival in patients with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT.Objective: to evaluate the incremental cost/effectiveness ratio (ICER) of enzalutamide use in patients with mHSPC and the ICER of enzalutamide as the first-line therapy for metastatic castration-resistant prostate cancer (mCRPC) from the Russian healthcare system perspective and to assess the contribution of enzalutamide into the reduction of mortality of mHSPC patients in the Russian Federation on the horizon until 2024.Materials and methods. Standard ADT regimens for mHSPC were used as a comparator as it is the most common treatment for mHSPC in Russia. We proposed a Markov model of mHSPC progression on enzalutamide + ADT (hereinafter enzalutamide) or ADT + 1st generation antiandrogen (hereinafter ADT) based on ENZAMET trial data. Model was used to calculate the average life-years gained (LYG) and costs of mHSPC and post-progression mCRPC treatment. Simulation period was 15 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for enzalutamide plus ADT vs ADT in the first-line therapy of mCRPC as a benchmark based on PREVAIL trial data. In both cases, the average LYG over a 15-year period was used as an efficacy criteria. To assess the contribution of the enzalutamide into the reduction of mortality rate of mHSPC patients, the potential number of patients who could be treated with enzalutamide on the horizon of 2021–2024 was taken into account.Results. According to the Markov model, the average LYG over a period of 15 years for enzalutamide was 7.59 years compared to 5.12 for ADT. The average enzalutamide therapy costs were 11,193,802 rubles per patient for 15 years, which were 8,597,131 rubles higher than when using ADT (2,596,672 rubles). ICER for enzalutamide (vs ADT) in mHSPC treatment was 3,484,362 rubles per one life-year gained. ICER for enzalutamide in the first line of mCRPC treatment (vs ADT) was 5,899,418 rubles per one life-year gained. The combination therapy with enzalutamide + ADT in Russia can be started annually by 2,410 mHSPC patients. If they all receive enzalutamide a total of 561 averted deaths among prostate cancer patients can be expected in 2021–2024.Conclusion. In the Russian healthcare system, ICER for enzalutamide in mHSPC was 3,484,362 rubles and the ICER for enzalutamide in mCRPC was 5,899,418 rubles. Enzalutamide can make a significant contribution to achieving the target cancer mortality rates by 2024.
Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.
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