Comparison of inhaled antibiotics for the treatment of chronic Pseudomonas aeruginosa lung infection in patients with cystic fibrosis: systematic literature review and network meta-analysis

PURPOSE: In Europe, 4 inhaled antibiotics (tobramycin, colistimethate sodium, aztreonam, and levofloxacin) are currently approved for the treatment of chronic Pseudomonas aeruginosa lung infection in patients with cystic fibrosis (CF). Levofloxacin inhalation solution (LIS) is the most recently approved inhaled antibiotic for adult patients with CF. A systematic literature review and Bayesian network meta-analysis (NMA) was conducted to compare the relative short-term (4 weeks) and long-term (24 weeks) outcomes of these inhaled antibiotics versus LIS. METHODS: A systematic literature search was conducted on February 16, 2016, using EMBASE and Medline via OvidSP. All randomized controlled trials comparing any of the aforementioned inhaled antibiotics with 4 or 24 weeks of follow-up were evaluated. NMA was performed for the following outcomes: relative and absolute percent changes from baseline in forced expiratory volume in 1 second (FEV1%) predicted, change in P aeruginosa sputum density, respiratory symptoms score from the CF questionnaire-revised, hospitalization, additional antibiotics use, and study withdrawal rates. RESULTS: Of the 685 articles identified, 7 unique studies were included in the 4 weeks' NMA and 9 unique studies were included in the 24 weeks' NMA. Aztreonam was predicted to result in the greatest numerically increase in FEV1% predicted at 4 weeks, whereas LIS were predicted to be numerically greater than colistimethate sodium, tobramycin inhaled solution (TIS), and tobramycin inhaled powder (TIP). However, all of the 95% credibility intervals (CrIs) of these comparisons included zero. At 24 weeks, none of the treatments was significantly more effective than LIS. The estimates for the mean change from baseline to 24 weeks in relative FEV1% versus LIS was -0.55 (95% CrI, -3.91 to 2.80) for TIS, -2.36 (95% CrI, -7.32 to 2.63) for aztreonam, -2.95 (95% CrI, -10.44 to 4.51) for TIP, and -9.66 (95% CrI, -15.01 to -4.33) for placebo. Compared with LIS, the odds ratio for hospitalization at 24 weeks was 1.92 (95% CrI, 1.01-3.30) for TIS, 2.25 (95% CrI, 1.01-4.34) for TIP, and 3.16 (95% CrI, 1.53-5.78) for placebo, all statistically worse than LIS. P aeruginosa sputum density scores, additional use of antipseudomonal antibiotics, and study withdrawal rates were comparable among all inhaled antibiotics at all times. IMPLICATIONS: Based on this NMA, the analyses for many of the outcomes did not provide significant evidence to indicate that the other approved inhaled antibiotics were more effective than LIS for the treatment of chronic P aeruginosa lung infection in patients with CF. Study withdrawal rates seemed to be comparable among these inhaled antibiotics

The cost-effectiveness of influenza vaccination for people aged 50 to 64 years: An international model

Objectives: Routine influenza vaccination is currently recommended in several countries for people aged more than 60 or 65 years or with high risk of complications. A lower age threshold of 50 years has been recommended in the United States since 1999. To help policymakers consider whether such a policy should be adopted more widely, we conducted an economic evaluation of lowering the age limit for routine influenza vaccination to 50 years in Brazil, France, Germany, and Italy.Methods: the probabilistic model was designed to compare in a single season the costs and clinical outcomes associated with two alternative vaccination policies for persons aged 50 to 64 years: reimbursement only for people at high risk of complications (current policy), and reimbursement for all individuals in this age group (proposed policy). Two perspectives were considered: third-party payer (TPP) and societal. Model inputs were obtained primarily from the published literature and validated through expert opinion. the historical distribution of annual influenza-like illness (ILI) incidence was used to simulate the uncertain incidence in any given season. We estimated gains in unadjusted and quality-adjusted life expectancy, and the cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were conducted.Results: Comparing the proposed to the current policy, the estimated mean costs per QALY gained were R$4,100, 13,200, 31,400 and 15,700 for Brazil, France, Germany, and Italy, respectively, from a TPP perspective. From the societal perspective, the age-based policy is predicted to yield net cost savings in Germany and Italy, whereas the cost per QALY decreased to R$2800 for Brazil and 8000 for France. the results were particularly sensitive to the ILI incidence rate, vaccine uptake, influenza fatality rate, and the costs of administering vaccination. Assuming a cost-effectiveness threshold ratio of 50,000 per QALY gained, the probabilities of the new policy being cost-effective were 94% and 95% for France, 72% and near 100% for Germany, and 89% and 99% for Italy, from the TPP and societal perspectives, respectively.Conclusions: Extending routine influenza vaccination to people more than 50 years of age is likely to be cost-effective in all four countries studied.I3 Innovus, Uxbridge UB8 1QG, Middx, EnglandUniv Jena, Inst Virol & Antiviral Therapy, Jena, GermanyINSERM, U444, Paris, FranceUniv Genoa, Dept Hlth Sci, Genoa, ItalyUniversidade Federal de São Paulo, Reg Influenza Surveillance Grp, São Paulo, BrazilUniv York, Ctr Hlth Econ, York YO10 5DD, N Yorkshire, EnglandI3 Innovus, Medford, MA USAHarvard Univ, Sch Publ Hlth, Boston, MA 02115 USAUniversidade Federal de São Paulo, Reg Influenza Surveillance Grp, São Paulo, BrazilWeb of Scienc

PND38 International Comparison of Huntington Disease (HD) Burden

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Update of the Swiss source model for road traffic noise

In Switzerland, the calculation method of road traffic noise is specified in the Ordonnance sur la protection contre le bruit (OPB) (Noise Protection Ordonnance (NPO)). This method is mainly based on observations that were realized in the 80s, and that are not satisfactory many situations anymore. Since the 80s, the traffic volumes have increased, new developments in car and road technologies have occurred, behaviors of users have changed. All these parame-ters contribute to lower reliability of the initial method. Even if the model is still correct in some case such as for fluid traffic, the obtained levels in different types of traffic are hardly reliable. In collaboration with the Swiss Federal Office for the Environment (FOEN), a re-search program has been setup to update the method according to those observations. The ob-jective was to give new guidelines to evaluate emission levels of roads. An important collect of data from cantons and others acoustics partners has been performed as well as measure-ments in real traffic conditions. That made it possible to gather about 7500 points of mea-surement through all Switzerland for several types of road and traffic conditions

Recent Developments of an Opto-Electronic THz Spectrometer for High-Resolution Spectroscopy

A review is provided of sources and detectors that can be employed in the THz range before the description of an opto-electronic source of monochromatic THz radiation. The realized spectrometer has been applied to gas phase spectroscopy. Air-broadening coefficients of HCN are determined and the insensitivity of this technique to aerosols is demonstrated by the analysis of cigarette smoke. A multiple pass sample cell has been used to obtain a sensitivity improvement allowing transitions of the volatile organic compounds to be observed. A solution to the frequency metrology is presented and promises to yield accurate molecular line center measurements