Der Einfluss des Karpaltunnelsyndroms auf autonome Oberflächenpotentiale

Da die meisten der autonomen Nervenfasern des Armes mit dem Nervus medianus verlaufen vermuteten wir, dass ein Karpaltunnelsyndrom (KTS) auch zu Veränderungen der sympathischen Hautantwort (SSR) führt. Wir untersuchten 28 Patienten (11 männlich, 17 weiblich) im Alter von 30 bis 84 Jahren mit einem klinisch manifesten einseitigen KTS. Die Kontrollgruppe bestand aus 11 klinisch Gesunden im Alter von 25 bis 50 Jahren. Neben der üblichen neurographischen Diagnostik wurde die SSR jeweils beiderseits von der Handfläche abgeleitet. Die neurographischen Messungen zeigen deutliche Veränderung des SSR in Latenz und Amplitude durch das KTS. Dies weist darauf hin, dass beim KTS eine Beziehung zwischen somatosensorischen sensiblen Fasern und sudomotorischen sympathischen Fasern besteht, es kommt unseren Messungen nach zu einer Beeinträchtigung des afferenten und efferenten Reflexweges mit Veränderungen der SSR Eigenschaften

The impact of structural uncertainty on cost-effectiveness models for adjuvant endocrine breast cancer treatments: The need for disease-specific model standardization and improved guidance

__Abstract__ Introduction: Structural uncertainty relates to differences in model structure and parameterization. For many published health economic analyses in oncology, substantial differences in model structure exist, leading to differences in analysis outcomes and potentially impacting decision-making processes. The objectives of this analysis were (1) to identify differences in model structure and parameterization for cost-effectiveness analyses (CEAs) comparing tamoxifen and anastrazole for adjuvant breast cancer (ABC) treatment; and (2) to quantify the impact of these differences on analysis outcome metrics. Methods: The analysis consisted of four steps: (1) review of the literature for identification of eligible CEAs; (2) definition and implementation of a base model structure, which included the core structural components for all identified CEAs; (3) definition and implementation of changes or additions in the base model structure or parameterization; and (4) quantification of the impact of changes in model structure or parameterizations on the analysis outcome metrics life-years gained (LYG), incremental costs (IC) and the incremental cost-effectiveness ratio (ICER). Results: Eleven CEA analyses comparing anastrazole and tamoxifen as ABC treatment were identified. The base model consisted of the following health states: (1) on treatment; (2) off treatment; (3) local recurrence; (4) metastatic disease; (5) death due to breast cancer; and (6) death due to other causes. The base model estimates of anastrazole versus tamoxifen for the LYG, IC and ICER were 0.263 years, €3,647 and €13,868/LYG, respectively. In the published models that were evaluated, differences in model structure included the addition of different recurrence health states, and associated transition rates were identified. Differences in parameterization were related to the incidences of recurrence, local recurrence to metastatic disease, and metastatic disease to death. The separate impact of these model components on the LYG ranged from 0.207 to 0.356 years, while incremental costs ranged from €3,490 to €3,714 and ICERs ranged from €9,804/LYG to €17,966/LYG. When we re-analyzed the published CEAs in our framework by including their respective model properties, the LYG ranged from 0.207 to 0.383 years, IC ranged from €3,556 to €3,731 and ICERs ranged from €9,683/LYG to €17,570/LYG. Conclusion:

Phase I/II Clinical Trial-Based Early Economic Evaluation of Acalabrutinib for Relapsed Chronic Lymphocytic Leukaemia

Objectives: The objective of this study was to construct an early economic evaluation for acalabrutinib for relapsed chronic lymphocytic leukaemia (CLL) to assist early reimbursement decision making. Scenarios were assessed to find the relative impact of critical parameters on incremental costs and quality-adjusted life-years (QALYs). Methods: A partitioned survival model was constructed comparing acalabrutinib and ibrutinib from a UK national health service perspective. This model included states for progression-free survival (PFS), post-progression survival (PPS) and death. PFS and overall survival (OS) were parametrically extrapolated from ibrutinib publications and a preliminary hazard ratio based on phase I/II data was applied for acalabrutinib. Deterministic and probabilistic sensitivity analyses were performed, and 1296 scenarios were assessed. Results: The base-case inc