An exclusive human milk diet for very low birth weight newborns—A cost-effectiveness and EVPI study for Germany

Scholz S, Greiner W. An exclusive human milk diet for very low birth weight newborns—A cost-effectiveness and EVPI study for Germany. PLOS ONE. 2019;14(12): e0226496.Objectives Human milk-based fortifiers have shown a protective effect on major complications for very low birth weight newborns. The current study aimed to estimate the cost-effectiveness of an exclusive human milk diet (EHMD) compared to the current approach using cow’s milk-based fortifiers in very low birth weight newborns. Methods A decision tree model using the health states of necrotising enterocolitis (NEC), sepsis, NEC + sepsis and no complication was used to calculate the cost-effectiveness of an EHMD. For each health state, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (RoP) and neurodevelopmental problems were included as possible complications; additionally, short-bowel syndrome (SBS) was included as a complication for surgical treatment of NEC. The model was stratified into birth weight categories. Costs for inpatient treatment and long-term consequences were considered from a third party payer perspective for the reference year 2017. Deterministic and probabilistic sensitivity analyses were performed, including a societal perspective, discounting rate and all input parameter-values. Results In the base case, the EHMD was estimated to be cost-effective compared to the current nutrition for very low birth weight newborns with an incremental cost-effectiveness ratio (ICER) of €28,325 per Life-Year-Gained (LYG). From a societal perspective, the ICER is €27,494/LYG using a friction cost approach and €16,112/LYG using a human capital approach. Deterministic sensitivity analyses demonstrated that the estimate was robust against changes in the input parameters and probabilistic sensitivity analysis suggested that the probability EHMD was cost-effective at a threshold of €45,790/LYG was 94.8 percent. Conclusion Adopting EHMD as the standard approach to nutrition is a cost-effective intervention for very low birth weight newborns in Germany

Correction to: Health economic evaluation of an internet intervention for depression (deprexis), a randomized controlled trial.

Gräfe V, Moritz S, Greiner W. Correction to: Health economic evaluation of an internet intervention for depression (deprexis), a randomized controlled trial. Health economics review. 2020;10(1): 24.An amendment to this paper has been published and can be accessed via the original article

Discovery of the high-field polar RX J1724.0+4114

We report the discovery of a new AM Herculis binary (polar) as the optical counterpart of the soft X-ray source RX J1724.0+4114 detected during the ROSAT all-sky survey. The magnetic nature of this V~17 mag object is confirmed by low-resolution spectroscopy showing strong Balmer and HeII emission lines superimposed on a blue continuum which is deeply modulated by cyclotron humps. The inferred magnetic field strength is 50+/-4 MG (or possibly even ~70 MG). Photometric observations spanning ~3 years reveal a period of 119.9 min, right below the period gap. The morphology of the optical and X-ray light curves which do not show eclipses by the secondary star, suggests a self-eclipsing geometry. We derive a lower limit of d~250 pc.Comment: 6 pages, LATEX with mn.sty, incl 4 Figs., to appear in MNRAS; [email protected]

Multifragmentation near the threshold

We investigate the onset of multifragmentation employing an improved version of the N-body ‘‘quantum’’ molecular-dynamics approach. We study in detail the reaction 18O+197Au at 84 MeV/nucleon and find good agreement between the calculated results and the data for the double-differential proton cross section, the mass yield, the multiplicity, the kinetic energy of the fragments, and even for the kinematic correlations between intermediate mass fragments (IMF’s), which have been measured in this experiment for the first time. We observe a strong correlation between the impact parameter and both the size of the target remnant as well as the average proton multiplicity. Hence both observables can be used to determine the impact parameter experimentally. The IMF’s come from the most central collisions. The calculations confirm the experimental result that they are not emitted from an equilibrated system. Although the inclusive energy spectra look thermal, we cannot identify an impact parameter-independent isotropically emitting source. Even in central collisions global equilibrium is not observed. We find that multifragment emission at this bombarding energy is caused by a process very similar to that proposed in the macroscopic cold multifragmentation model. Thus it has a different origin than at beam energies around 1 GeV/nucleon, although the mass yield has an almost identical slope

The costs of schizophrenia and predictors of hospitalisation from the statutory health insurance perspective

BACKGROUND: The aim of the study was to determine the costs of treating schizophrenia from the perspective of the statutory health insurance, as well as the identification of predictors of hospitalisation of formerly stable schizophrenia patients. METHODS: Claims data for the years 2004–2006 were analysed. Patients who did not have to be treated in a hospital as a result of an ICD diagnosis F20 both in the year 2005 as well as also in 2006 were defined as stable patients. In contrast, those patients who had to be treated in a hospital in 2006 because of a diagnosis of schizophrenia were defined as unstable. In addition to the overall healthcare costs, the costs specific to schizophrenia were also analysed. Also, based on binary logistic regression analysis, predictors for hospital treatment were determined. RESULTS: 8497 stable and 1449 unstable patients were identified. The schizophrenia specific costs for stable patients were € 1605 and the overall costs were € 4029 in 2006, respectively. Unstable patients had indication-specific costs amounting to € 12864 and overall health care costs of € 16824. For unstable patients, the costs of hospital treatment were identified as being a substantial cost area. Predictors for a higher probability of hospital treatment were: female patients, at least one rehabilitation measure, at least one stay in hospital in 2004, and being co-morbid with substance abuse. In contrast, older patients, who were treated with concomitant medications, and if they received a continuous drug therapy in all quarters of a year had a lower probability of hospitalisation. In addition, an increased number of visits to a doctor reduced the probability of hospitalisation. The variable ‘depot medication’ were close to significance and the variable ‘inability to work lasting more than six weeks’ had, in contrast, no significant influence. CONCLUSIONS: The schizophrenia specific and overall health care costs of unstable patients were clearly higher than was the case with stable patients and mainly determined by inpatient hospital treatment. A range of potential predicting factors which can be extracted from routine claims data have a positive or negative influence on the probability of treatment in hospital

Search for GRB X-ray Afterglows in the ROSAT All-sky Survey

We report on the status of our search for X-ray afterglows of gamma-ray burts (GRBs) using ROSAT all-sky survey (RASS) date. The number of potential X-ray afterglow candidates with respect to the expected number of bearmed GRBs allows to constrain the relative beaming angles of GRB emission and afterglow emission at about 1-5 hrs after the GRB

Anatomical Variation of Human Bone Bioapatite Crystallography

This systematic investigation of bioapatite, the mineral component of human bone, aims to characterize its crystallographic state, including lattice parameters and average crystallite size, and correlate these values with respect to anatomical position (bone function), physicality, and bone chemical composition. In sample sets of buried bone from three different human adult skeletons, anatomical variation of crystallographic parameters and correlation to chemical composition were indeed observed. In general, the observed bioapatite a unit-cell edge-length among all analyzed human bones in this study was larger by 0.1-0.2% compared to that of stoichiometric hydroxylapatite (HAp), and substantially larger than that of fluorapatite (FAp). Across all analyzed samples, the a (=b) lattice parameter (unit cell edge-length) varies more than does the c lattice parameter. Average crystallite size (average coherent diffracting domain size) in the c-direction was equal to approximately 25 nm, ranging among the analyzed 18 bone samples from about 20-32 nm, and varying more than crystallite size in the a,b-direction (similar to 8-10 nm). Neither lattice parameters nor average bioapatite crystallite sizes appeared to be correlated with bone mechanical function. The relative chemical composition of the bone material, however, was shown to correlate with the a (=b) lattice parameter. To our knowledge, this research provides, for the first time, the systematic study of the crystallographic parameters of human bone bioapatite in the context of anatomical position, physical constitution, and bone chemical composition using X-ray powder diffraction (XRPD) and Fourier transform infrared spectroscopy (FTIR)

Klein-Gordon lower bound to the semirelativistic ground-state energy

For the class of attractive potentials V(r) <= 0 which vanish at infinity, we prove that the ground-state energy E of the semirelativistic Hamiltonian H = \sqrt{m^2 + p^2} + V(r) is bounded below by the ground-state energy e of the corresponding Klein--Gordon problem (p^2 + m^2)\phi = (V(r) -e)^2\phi. Detailed results are presented for the exponential and Woods--Saxon potentials.Comment: 7 pages, 4 figure

Need for nursing care support in cancer patients: Registry-linkage study in Germany

Aim:&nbsp;In Germany, very little is known about the need for assistance and nursing care support among cancer patients after hospitalization. The aim of this study was to describe nursing care support for cancer patients and to analyse whether these patients need more care assistance than other persons in need for care. Methods:&nbsp;This was a registry linkage study conducted in 2011. Cases were identified from the population-based cancer registry for the Muenster District in north-western Germany and in factually anonymised form linked by a semi-automatic probabilistic procedure (the standard procedure of the cancer registry) with medical examination records of patients applying for assistance and nursing care support from the regional statutory health insurance. The application records of 4,029 patients with colon, breast and prostate cancer were compared to a reference group of 13,104 non-cancer patients. Results:&nbsp;In only 41.7% of colon, 45.8% of breast and 37.4% of prostate cancer patients was the malignancy the main underlying diagnostic cause for the application of assistance and nursing care. These patients were on average younger (mean age 71.1 vs. 76.8 years) than the non-cancer reference group, required higher levels of support (79.5 vs. 58.1% “considerable” or higher level care need) and their applications were less likely to be rejected (odds ratios [ORs] 0.26, 0.28, and 0.31, respectively). By contrast, the proportion of successful applications and the level of support granted did not differ between multimorbid cancer patients with other main diagnoses as compared to non-cancer applicants. Conclusion:&nbsp;Patients with colon, breast or prostate cancer do not need per se more nursing care than non-cancer patients. Only if cancer is the main underlying diagnosis for nursing care support, higher levels of support are needed

Platelet aggregation inhibitors in primary and secondary prevention of ischemic stroke

Background The ischaemic stroke (IS) is one of the most frequent cause of death in Germany. Besides of non-drug many drug-based interventions are used in primary or secondary prevention of IS, among them the thrombocyte aggregation inhibitors (TAI). Objectives The evaluation addresses the questions on medical efficacy and cost-effectiveness of the TAI administration in the prevention of IS as compared to the management of risk factors alone as well as to the use of anticoagulant drugs. Methods The literature search for articles published after 1997 was conducted in December 2003 in the most important medical and economic databases. The medical analysis was performed on the basis of the most up-to date meta-analyses of randomised controlled trials (RCT) as well as of new published RCT. The data from the studies for stroke, bleeding complications as well as for the combined endpoint "severe vascular events" (SVE: death or stroke or myocardial infarction) were summarised in meta-analyses. In order to include grey literature contact has been taken up with the pharmaceutical manufacturers of TAI. Results are presented in a descriptive way. Results The medical analysis included data from 184 RCT (vs. placebo) and from 22 RCT (vs. anticoagulant drugs). The absolute reduction of IS (4.8% vs. 6.6%; p<0,00001) and SVE (10.0% vs. 12.4%; p<0,00001) were definitely higher than the absolute increase of bleeding complications (1.6% vs. 0.9%; p<0,00001), but relatively similar to this absolute increase in a subpopulation with a low risk for SVE. With regard to the stroke prevention, evidence of efficacy could be yielded for acetylsalicil acid (ASA), dipyridamole, cilostazol, ridogrel and the combination ASA with dipyridamole. ASA is less effective than anticoagulants in the prevention of ischaemic stroke in atrial fibrillation, however, it causes fewer bleeding complications. Low dosed ASA can be considered cost-effective in secondary prevention of ischemic stroke, which is not the case for clopridogrel. Dipyridamole/ASA being more effective compared with ASA alone is connected with higher acquisition costs. Discussion The exclusive consideration of stroke prevention is limited, as well as physicians by allocation to TAI expect to avoid all thrombotic events. Since no pharmacoeconomic studies exist for the German context, the economic assessment had to be based on international evidence. Conclusions From the medical point of view, TAI may be recommended for primary and secondary prevention of IS in patients with a high risk of severe vascular events and with low risk for bleeding complications. ASA may be also administered in patients with atrial fibrillation in case of contraindication to anticoagulation drugs. From the health economic point of view a systematic primary prophylaxis of IS with ASA cannot be recommended, whereas in secondary prophylaxis savings can be made. Neither the use of Dipyridamole/ASS nor Clopidogrel is advisable for a systematic secondary prophylaxis of IS.Wissenschaftlicher Hintergrund Der ischämische Schlaganfall (IS) ist eine der häufigsten Todesursachen in Deutschland. Außer nicht-medikamentösen werden auch verschiedene medikamentöse Maßnahmen zur Primär- bzw. Sekundärprävention des IS eingesetzt, darunter die Anwendung von Thrombozytenaggregationshemmern (TAH). Forschungsfragen Es sollen die medizinische Effektivität und der Kosteneffektivität des Einsatzes von TAH in der Prävention des IS im Vergleich zum alleinigen Management von Risikofaktoren sowie im Vergleich zu Antikoagulantien bewertet werden. Methodik Die Literaturrecherche fand im Dezember 2003 in den wichtigsten medizinischen und gesundheitsökonomischen Datenbanken mit Referenzzeitraum ab 1997 statt. In die medizinische Bewertung wurden Übersichtspublikationen zum aktuellsten Wissensstand sowie neu publizierte RCT eingeschlossen. Daten für Schlaganfälle, Blutungskomplikationen sowie für den kombinierten Endpunkt "schwere vaskuläre Ereignisse" (SVE) wurden in Metaanalysen ausgewertet. Im Rahmen der gesundheitsökonomischen Analyse wurde außerdem Kontakt mit den TAH-Herstellern zur Identifikation unpublizierter Studien aufgenommen. Die Ergebnisdarstellung erfolgt deskriptiv. Ergebnisse Es wurden insgesamt Daten aus 184 RCT (vs. Placebo) und aus 22 RCT (vs. Antikoagulantien) in die medizinische Bewertung einbezogen. Die absolute Reduktion IS (4,8% vs. 6,6%; p<0,00001) und SVE (10,0% vs. 12,4%; p<0,00001) war deutlich größer als die absolute Zunahme an Blutungskomplikationen (1,6% vs. 0,9%; p<0,00001), nur in einer Subpopulation mit niedrigem SVE-Risiko dagegen annährend gleich. Hinsichtlich der Schlaganfällprävention konnte ein Wirksamkeitsnachweis für Acetylsalicylsäure (ASS), Dipyridamol, Cilostazol, Ridogrel und der Kombination von ASS mit Dipyridamol erbracht werden. ASS ist weniger wirksam als Antikoagulantien bei Vorhofflimmern, allerdings mit weniger Blutungskomplikationen. Aus gesundheitsökonomischer Sicht ist niedrig dosiertes ASS im Rahmen der IS-Sekundärprophylaxe nicht nur kosteneffektiv, sondern es lassen sich auch Kosten einsparen. Beides trifft für Clopidogrel nicht zu. Die Kombination ASS/Dipyridamol ist bei besserer klinischer Wirksamkeit mit höheren Kosten verbunden, so dass über Art und Umfang der Anwendung die gesellschaftliche Zahlungsbereitschaft entscheidet. Diskussion Die exklusive Betrachtung der Schlaganfallprävention ist nur eingeschränkt hilfreich, da Ärzte bei der TAH-Verordnung von einer Vermeidung aller thrombotischen Ereignisse ausgehen. Auch die gesundheitsökonomische Bewertung wurde durch die vergleichsweise enge Themenstellung methodisch erschwert. Zudem ist zu berücksichtigen, dass keine gesundheitsökonomischen Studien für das deutsche Gesundheitssystem vorliegen, sodass die Bewertung auf ausländischen Quellen beruhen musste. Schlussfolgerung Aus medizinischer Sicht können TAH zur Primär- und Sekundärprävention des IS bei Patienten mit hohem Risiko für SVE und ohne erhöhtes Risiko für Blutungskomplikationen empfohlen werden, für Patienten mit Vorhofflimmern bei Kontraindikationen für Antikoagulation. Eine systematische medikamentöse Primärprophylaxe des IS erscheint aus gesundheitsökonomischer Sicht nicht angezeigt. Durch die Verwendung von ASS im Rahmen der IS-Sekundärprävention können Kosten eingespart werden. Für die übrigen TAH hingegen ist von einer Verwendung bei der systematischen IS-Sekundärprophylaxe Abstand zu nehmen. Insbesondere bei Risikopatienten ist erheblicher gesundheitsökonomischer Forschungsbedarf zu konstatieren