Economic Evaluation of Potential Applications of Gene Expression Profiling in Clinical Oncology

Histopathological analysis of tumor is currently the main tool used to guide cancer management. Gene expression profiling may provide additional valuable information for both classification and prognostication of individual tumors. A number of gene expression profiling assays have been developed recently to inform therapy decisions in women with early stage breast cancer and help identify the primary tumor site in patients with metastatic cancer of unknown primary. The impact of these assays on health and economic outcomes, if introduced into general practice, has not been determined. I aimed to conduct an economic evaluation of regulatory-approved gene expression profiling assays for breast cancer and cancer of unknown primary for the purpose of determining whether these technologies represent value for money from the perspective of the Canadian health care system. I developed decision-analytic models to project the lifetime clinical and economic consequences of early stage breast cancer and metastatic cancer of unknown primary. I used Manitoba Cancer Registry and Manitoba administrative health databases to model current “real-world” Canadian clinical practices. I applied available data about gene expression profiling assays from secondary sources on these models to predict the impact of these assays on current clinical and economic outcomes. In the base case, gene expression profiling assays in early stage breast cancer and cancer of unknown primary resulted in incremental cost effectiveness ratios of less than $100,000 per quality-adjusted life-year gained. These results were most sensitive to the uncertainty associated with the accuracy of the assay, patient-physician response to gene expression profiling information and patient survival. The potential application of these gene expression profiling assays in clinical oncology appears to be cost-effective in the Canadian healthcare system. Field evaluation of these assays to establish their impact on cancer management and patient survival may have a large societal impact and should be initiated in Canada to ensure their clinical utility and cost-effectiveness. The use of Canadian provincial administrative population data in decision modeling is useful to quantify uncertainty about gene expression profiling assays and guide the use of novel funding models such as conditional funding alongside a field evaluation

Co-Channel Interference Between IEEE 802.11 WLAN and Bluetooth

Electrical Engineering Technolog

ПОВЕДІНКОВІ МЕХАНІЗМИ ГІБРІДНОЇ СОЦІАЛЬНО-ЕКОНОМІЧНОЇ ВІЙНИ В НАДІНДУСТРІАЛЬНУ ЕПОХУ РОЗВИТКУ СВІТУ

Annotation. The purpose of the article is to theoretically summarize the mechanisms of modern hybrid socio-economic war from the standpoint of behavioral economics. The choice of socio-economic war as an object of measures of influence on the development of socio-technical systems of activity is substantiated. Methods. The concept of development of socio-technical systems is proposed, which is determined by the objective involvement of the behavioral economy in the process of designing such systems. The Results. An approach of external behavioral interaction with the society was created, to ensure the development of socio-technical systems and to integrate the regulation of such development in the pre-industrial era. Scientific novelty. New is the generalization of views on the development and maintenance of socio-technical systems in terms of conducting and using the results of research, design and expert work at all stages of the life cycle of such systems. The practical significance. New insights into the behavioral mechanisms of hybrid socio-economic warfare contain skills in dealing with the flow of continuous behavioral information about economic development. The interpretation of meaningful, procedural and effective information is brought to the level of approach to the theoretical assessment of the reliability of the socio-technical system of activity.Мета. Метою статті є теоретичне узагальнення  сучасних механізмів гібридної соціально-економічної війни з позицій поведінкової економіки. Обґрунтовано поведінкове підґрунтя гібридної соціально-економічної війни в якості об’єкта заходів впливу на сучасний розвиток соціотехнічних систем. Методика. Запропоновано концепцію розвитку соціотехнічних систем, яка детермінована об’єктивною залученістю поведінкової економіки до процесу проектування таких систем. Результати. Створено підхід зовнішньої поведінкової взаємодії з соціумом, забезпечення розвитку соціотехнічних систем та інтегральної регуляції такого розвитку в надіндустріальну епоху. Наукова новизна. Новим є узагальнення поглядів на забезпечення розвитку та супровід соціотехнчних систем с точки зору проведення та використання результатів дослідницьких, проектувальних та експертних робіт на всіх стадіях життєвого циклу таких систем. Практична значимість. Нові уявлення про поведінкові механізми гібридної соціально-економічної війни містять навички роботи потоками неперервної поведінкової інформації про економічний розвиток. Трактування змістовної, процедурної та результативної інформації доведено до рівня підходу до теоретичної оцінки надійності соціотехнічної системи діяльності

The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study.

PurposeSeveral genomic tests have recently been developed to identify the primary tumour in cancer of unknown primary tumour (CUP). However, the value of identifying the primary tumour in clinical practice for CUP patients remains questionable and difficult to prove in randomized trials.ObjectiveWe aimed to assess the clinical and economic value of primary tumour identification in CUP using a retrospective matched cohort study.MethodsWe used the Manitoba Cancer Registry to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients as having CUP if their primary tumour was found 6 months or more after initial diagnosis or never found during the course of disease. Otherwise, we considered patients to have metastatic cancer from a known primary tumour (CKP). We linked all patients with Manitoba Health databases to estimate their direct healthcare costs using a phase-of-care approach. We used the propensity score matching technique to match each CUP patient with a CKP patient on clinicopathologic characteristics. We compared treatment patterns, overall survival (OS) and phase-specific healthcare costs between the two patient groups and assessed association with OS using Cox regression adjustment.ResultsOf 5839 patients diagnosed with metastatic cancer, 395 had CUP (6.8%); 1:1 matching created a matched group of 395 CKP patients. CUP patients were less likely to receive surgery, radiation, hormonal and targeted therapy and more likely to receive cytotoxic empiric chemotherapeutic agents. Having CUP was associated with reduced OS (hazard ratio [HR] 1.31; 95% confidence interval 1.1-1.58), but this lost statistical significance with adjustment for treatment differences. CUP patients had a significant increase in the mean net cost of initial diagnostic workup before diagnosis and a significant reduction in the mean net cost of continuing cancer care.ConclusionIdentifying the primary tumour in CUP patients might enable the use of more effective therapies, improve OS and allow more efficient allocation of healthcare resources

Apport des technologies numériques à l’étude des fortifications du génie militaire français dans une ville d’Algérie au début de la colonisation : Djidjelli, 1839-1862

[FR] Le point de départ de ce travail était de combler un manque cruel dans l’histoire de la ville de Djidjelli, au tout début de sa colonisation, du moins pour ce qui concerne sa transformation, période méconnue des jijeliens actuels eux-mêmes – et pourtant une des plus structurantes de son histoire. Se basant sur les travaux de certains auteurs et sur les deux fonds d’archives qui conservent en France des documents relatifs à l’Algérie ; ce sont le Centre National des archives d’Outre-Mer (CAOM à Aixen-Provence, archives nationales) et le Service Historique de la Défense (SHD à Vincennes). Parmi tous les dossiers, ceux parmi lesquels on peut trouver les documents qui concernent Djidjelli. Notre travail consistera en la sélection et la digitalisation des principales cartes des archives de la défense en vue de la modélisation 2d et 3d de l’intervention du génie militaires et des fortifications. La méthode développée permet de résoudre et de générer des volumétries urbaines plausibles dans les cas les plus fréquents. Le modèle 3D obtenu, malgré sa simplicité géométrique, permet de visionner la cité et ses fortifications sous différents angles, aussi il sera possible de retrouver les traces de ces fortifications dans la ville actuelle ce qui permettra de comprendre la configuration actuelle de la ville et d’ouvrir aussi de nouvelles pistes de recherches en histoire, architecture et urbanisme.Blibli, M.; Bouchair, A.; Hannouf, F. (2015). Apport des technologies numériques à l’étude des fortifications du génie militaire français dans une ville d’Algérie au début de la colonisation : Djidjelli, 1839-1862. En Defensive architecture of the mediterranean: XV to XVIII centuries. Vol. I. Editorial Universitat Politècnica de València. 291-298. https://doi.org/10.4995/FORTMED2015.2015.1710OCS29129

Contracts to Promote Optimal Use of Optional Diagnostic Tests in Cancer Treatment

In this study, we examine performance-based payment contracts to promote the optimal use of an optional diagnostic test for newly diagnosed cancer patients. Our work is inspired by three trends: tremendous increases in the cost of new, advanced cancer drugs; development of new diagnostic tests to allow physicians to tailor treatment to patients; and changes in healthcare funding models that reward quality care. We model the interaction between two parties—a healthcare payer and an oncologist, in which the oncologist has private information about patients’ characteristics (adverse selection) and the payer does not know whether the oncologist takes the optimal course of action (moral hazard). We show that, in the presence of information asymmetry, a healthcare payer should never incentivize an oncologist to use a diagnostic test for all patients, even if the diagnostic test is available for free. Moreover, although the oncologist has additional information about a patient\u27s risk, he cannot always benefit from this private information. We also find that social welfare may not increase as a result of a decrease in the oncologist\u27s concerns regarding the health outcome of patients. Finally, we show that it is not always socially optimal to make a diagnostic test compulsory even if such a policy can be implemented for free

Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary.

We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was$36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test\u27s clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.The Pharmacogenomics Journal advance online publication, 29 March 2016; doi:10.1038/tpj.2015.94

The clinical significance of occult gastrointestinal primary tumours in metastatic cancer: A population retrospective cohort study

© 2018 by the Korean Cancer Association. Purpose The purpose of this study was to estimate the incidence of occult gastrointestinal (GI) primary tumours in patients with metastatic cancer of uncertain primary origin and evaluate their influence on treatments and overall survival (OS). Materials and Methods We used population heath data from Manitoba, Canada to identify all patients initially diagnosed with metastatic cancer between 2002 and 2011. We defined patients to have occult primary tumour if the primary was found at least 6 months after initial diagnosis. Otherwise, we considered primary tumours as obvious. We used propensity-score methods to match each patient with occult GI tumour to four patients with obvious GI tumour on all known clinicopathologic features. We compared treatments and 2-year survival data between the two patient groups and assessed treatment effect on OS using Cox regression adjustment. Results Eighty-three patients had occult GI primary tumours, accounting for 17.6% of men and 14% of women with metastatic cancer of uncertain primary. A 1:4 matching created a matched group of 332 patients with obvious GI primary tumour. Occult cases compared to the matched group were less likely to receive surgical interventions and targeted biological therapy, and more likely to receive cytotoxic empiric chemotherapeutic agents. Having an occult GI tumour was associated with reduced OS and appeared to be a nonsignificant independent predictor of OS when adjusting for treatment differences. Conclusion GI tumours are the most common occult primary tumours in men and the second most common in women. Patients with occult GI primary tumours are potentially being undertreated with available GI site-specific and targeted therapies

Identification and survival outcomes of a cohort of patients with cancer of unknown primary in Ontario, Canada.

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS). MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. We cross-validated CUP diagnosis and obtained additional information about metastasis through data linkage with the SDS/DAD database. OS was assessed using Cox regression models adjusting for histology and sites of metastases. RESULTS: We identified 3564 patients diagnosed with CUP. Patients without histologically confirmed disease (n = 1821) had a one-year OS of 10.9%, whereas patients with confirmed histology (n = 1743) had a one-year OS of 15.6%. The most common metastatic sites were in the respiratory or digestive systems (n = 1603), and the most common histology was adenocarcinoma (n = 939). Three-year survival rates were 3.5%, 5.3%, 41.6% and 3.6% among adenocarcinoma, unspecified carcinoma, squamous cell carcinoma and undifferentiated histology, respectively. Three-year survival rates were 40%, 2.4%, 8.0% and 4.6% among patients with metastases localised to lymph nodes, the respiratory or digestive systems, other specified sites, and unspecified sites, respectively. CONCLUSION: CUP patients in Ontario have a poor prognosis. Some subgroups may have better survival rates, such as patients with metastases localised to lymph nodes and patients with squamous cell histology