Sex-Specific Immunization for Sexually Transmitted Infections Such as Human Papillomavirus: Insights from Mathematical Models

Johannes Bogaards and colleagues use mathematical models to investigate whether vaccinating females only, males only, or both sexes is the best way to achieve the most effective reduction in the population prevalence of sexually-transmitted infection

Cost-Effectiveness of Treatments for Genotype 1 Hepatitis C Virus Infection in Non-VA and VA Populations

Background: Chronic hepatitis C viral (HCV) infection affects millions of Americans. Health care systems face complex choices between highly efficacious, costly treatments. This study assessed the cost-effectiveness of treatments for chronic, genotype 1 HCV monoinfected, treatment-naïve individuals in the Department of Veterans Affairs (VA) and general US health care systems. Methods: The study used a decision-analytic Markov model, employing appropriate payer perspectives and time horizons, and discounting benefits and costs at 3% annually. Interventions included the following: sofosbuvir/ledipasvir (SOF-LDV); ombitasvir/paritaprevir/ritonavir/dasabuvir (3D); sofosbuvir/simeprevir (SOF-SMV); sofosbuvir/pegylated interferon/ribavirin (SOF-RBV-PEG); boceprevir/pegylated interferon/ribavirin (BOC-RBV-PEG); and pegylated interferon/ribavirin (PEG-RBV). Outcomes were sustained virologic response (SVR), advanced liver disease, costs, quality adjusted life years (QALYs), and incremental cost-effectiveness. Results: SOF-LDV and 3D achieve high SVR rates, reducing advanced liver disease (>20% relative to no treatment), and increasing QALYs by >2 years per person. For the non-VA population, at current prices ($5040 per week for SOF-LDV;$4796 per week for 3D), SOF-LDV’s lifetime cost ($293,370) is$18,000 lower than 3D’s because of its shorter duration in subgroups. SOF-LDV costs $17,100 per QALY gained relative to no treatment. 3D costs$208,000 per QALY gained relative to SOF-LDV. Both dominate other treatments and are even more cost-effective for the VA, though VA aggregate treatment costs still exceed $4 billion at SOF-LDV prices of$3308 per week. Drug prices strongly determine relative cost-effectiveness for SOF-LDV and 3D; with price reductions of 20% to 30% depending on health system, 3D could be cost-effective relative to SOF-LDV. We currently lack head-to-head regimen effectiveness trials. Conclusions: New HCV treatments are cost-effective in multiple health care systems if trial-estimated efficacy is achieved in practice, though, at current prices, total expenditures could present substantial challenges

Neo-Freudians

The term “Neo-Freudian” is routinely used in subtly different ways by those intimately familiar with the minutia of psychoanalysis (often used to group together one specific academic lineage) than by general commenters on the history of psychology (who use the term broadly to describe any dissenting heirs to Freud’s work). When speaking in the broad sense, a “Neo-Freudian” is any theorist or psychoanalyst whose initial education or work was grounded in Sigmund Freud’s theory, but which later made a conspicuous departure from the Freudian model, most commonly in the form of resisting the purported role of infant psychosexuality or in expanding the role of social and cultural factors in the formation of personality. By this definition, many of the most famous Neo-Freudians were students and contemporaries of Freud, who departed his company on grounds of theoretical dissent, such as Alfred Adler and Carl Jung. When speaking in the narrow sense, the “Neo-Freudians” were a tradition of mostly American psychiatrists and psychologists in mid-twentieth century, many of whom based their work in some aspects of Freud’s original theories, but continued in Adler’s direction of variously expanding, updating, or replacing biologically innate elements of Freud’s theories with social or cultural influences. By this definition, theorists such as Karen Horney and Harry Stack Sullivan are some of the quintessential Neo-Freudians