Reimbursement for Supportive Cancer Medications Through Private Insurance in Saskatchewan

ABSTRACT Background: As demand for cancer treatment grows, and newer, more expensive drugs become available, public payers in Canada are finding it increasingly difficult to fund the full range of available cancer drugs.Objective: To determine the extent of private drug coverage for supportive cancer treatments in Saskatchewan, preparatory to exploring the potential for cost-sharing. Methods: Patients who presented for chemotherapy and who provided informed consent for participation were surveyed regarding their access to private insurance. Insurers were contacted to verify patients’ level of coverage for supportive cancer medications. Groups with specified types of insurance were compared statistically in terms of age, income bracket, time required to assess insurance status, and amount of deductible. Logistic regression was used to determine the effect of patients’ age and income on the probability of having insurance.Results: Of 169 patients approached to participate, 156 provided consent and completed the survey. Their mean age was 58.5 years. About two-fifths of all patients (64 or 41%) were in the lowest income bracket (up to $30 000). Sixty-three (40$50 000 was a significant predictor of access to drug insurance (p = 0.003), but age was not significantly related to insurance status. Conclusions: A substantial proportion of cancer patients in this study had access to private insurance for supportive cancer drugs for which reimbursement is currently provided by the Saskatchewan Cancer Agency. Cost-sharing and optimal utilization of the multipayer environment might offer a greater opportunity for public payers to cover future innovative and supportive therapies for cancer, but further study is required to determine whether a cost-sharing program would be cost-effective and in the best interest of patients.RÉSUMÉ Contexte : Avec la demande croissante pour les traitements anticancéreux, et l’arrivée de nouveaux médicaments plus coûteux, les payeurs publics canadiens ont de plus en plus de difficultés à rembourser toute la gamme de médicaments anticancéreux maintenant offerts.Objectif : Déterminer dans quelle proportion les médicaments adjuvants des anticancéreux sont remboursés par les régimes privés d’assurance médicaments en Saskatchewan, avant d’évaluer la possibilité du partage des coûts.Méthodes : Les patients qui se sont présentés à une séance de chimiothérapie et qui ont donné leur consentement éclairé à participer au sondage ont répondu à un questionnaire sur leur couverture d’assurance médicaments privée. Un suivi auprès des assureurs de chaque patient a permis de vérifier la couverture offerte pour les médicaments adjuvants des anticancéreux. Les groupes de patients ayant chacun un type défini d’assurance ont été comparés pour ce qui est des critères suivants : âge, tranche de revenu, délai d’évaluation de la couverture d’assurance et montant de la franchise. Un modèle de régression logistique a servi à déterminer l’effet de l’âge et du revenu des patients sur la probabilité d’avoir une assurance.Résultats : Des 169 patients sollicités pour participer au sondage, 156 ont donné leur consentement et répondu au sondage. L’âge moyen était de 58,5 ans. Environ deux cinquièmes des patients (64 ou 41 %) se situaient dans la tranche de revenu le plus faible (jusqu’à 30 000 $). Soixante-trois (40$ était un facteur prédictif significatif d’accès à une assurance médicaments (p = 0,003), mais pas l’âge.Conclusions : Une proportion considérable de patients atteints de cancer dans cette étude avaient accès à un régime privé d’assurance couvrant les médicaments adjuvants des anticancéreux qui étaient actuellement remboursés par la Saskatchewan Cancer Agency. Le partage des coûts et l’utilisation optimale du contexte de payeurs multiples permettraient aux payeurs de rembourser publics de futurs traitements novateurs et adjuvants du cancer, mais d’autres études sont nécessaires pour déterminer si un programme de partage des coûts serait rentable et dans le meilleur intérêt des patients

Visual and Vestibular Components of Motion Sickness

Background: The relative importance of visual and vestibular information in the etiology of motion sickness (MS) is not well understood, but these factors can be manipulated by inducing Coriolis and pseudo-Coriolis effects in experimental subjects. Hypothesis: We hypothesized that visual and vestibular information are equivalent in producing MS. The experiments reported here aim, in part, to examine the relative influence of Coriolis and pseudo-Coriolis effects in inducing MS. Methods: We induced MS symptoms by combinations of whole body rotation and tilt, and environment rotation and tilt, in 22 volunteer subjects. Subjects participated in all of the experiments with at least 2 d between each experiment to dissipate after-effects. We recorded MS signs and symptoms when only visual stimulation was applied, when only vestibular stimulation was applied, and when both visual and vestibular stimulation were applied under specific conditions of whole body and environmental tilt. Results: Visual stimuli produced more symptoms of MS than vestibular stimuli when only visual or vestibular stimuli were used (ANOVA: F = 7.94, df = 1, 21 p =0.01), but there was no significant difference in MS production when combined visual and vestibular stimulation were used to produce the Coriolis effect or pseudo-Coriolis effect (ANOVA: F = 0.40, df = 1, 21 p = 0.53). This was further confirmed by examination of the order in which the symptoms occurred and the lack of a correlation between previous experience and visually induced MS. Conclusions: Visual information is ore important than vestibular input in causing MS when these stimuli are presented in isolation. In conditions where both visual and vestibular information are present, cross-coupling appears to occur between the pseudo-Coriolis effect and the Coriolis effect, as these two conditions are not significantly different in producing MS symptoms

AIDA DART asteroid deflection test: Planetary defense and science objectives

International audienc

Effects of denosumab on pain and analgesic use in giant cell tumor of bone: Interim results from a phase II study

Background. Giant cell tumor of bone (GCTB) is an aggressive primary osteolytic tumor. GCTB often involves the epiphysis, usually causing substantial pain and functional disability. Denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor. kappa beta ligand (RANKL), is an effective treatment option for patients with advanced GCTB. This analysis of data from an ongoing, open-label study describes denosumab's effects on pain and analgesic use in patients with GCTB. Material and methods. Patients with unresectable disease (e. g. sacral or spinal GCTB, or multiple lesions including pulmonary metastases) were enrolled into Cohort 1 (N = 170), and patients with resectable disease whose planned surgery was associated with severe morbidity (e. g. joint resection, limb amputation, or hemipelvectomy) were enrolled into Cohort 2 (N = 101). Patients received denosumab (120 mg) subcutaneously every four weeks, with additional doses on study days 8 and 15. Patients assessed worst pain severity with the Brief Pain Inventory - Short Form (BPI-SF) at baseline, at each visit for the first six months, and every three months thereafter. Results. Clinically relevant pain improvement was reported by 29% of patients in Cohort 1 and 35% in Cohort 2 during week 1 and by >= 50% of patients in each cohort at each study visit from months 2-30. Median time to clinically relevant improvement was 30 (95% CI 16, 57) days in Cohort 1 and 15 (95% CI 15, 29) days in Cohort 2. Results in patients with moderate/severe pain at baseline were similar. Fewer than 30% of patients in Cohort 1 and 10% in Cohort 2 experienced clinically relevant pain worsening at any visit through 27 months. Most patients had no/low analgesic use during the study. Conclusion. Most patients treated with denosumab experienced clinically relevant decreases in pain within two months

The Double Asteroid Redirection Test (DART): Planetary Defense Investigations and Requirements

International audienceThe Double Asteroid Redirection Test (DART) is a Planetary Defense mission, designed to demonstrate the kinetic impactor technique on (65803) Didymos I Dimorphos, the secondary of the (65803) Didymos system. DART has four level 1 requirements to meet in order to declare mission success: (1) impact Dimorphos between 2022 September 25 and October 2, (2) cause at least a 73 s change in its binary orbit period via the impact, (3) measure the change in binary period to an uncertainty of 7.3 s or less, and (4) measure the momentum transfer efficiency (β) of the impact and characterize the resulting effects of the impact. The data necessary to achieve these requirements will be obtained and analyzed by the DART Investigation Team. We discuss the rationales for the data to be gathered, the analyses to be undertaken, and how mission success will be achieved