Impact of model calibration on cost-effectiveness analysis of cervical cancer prevention

Markov chain models are commonly used to simulate the natural history of human papillomavirus infection and subsequent cervical lesions with the aim of predicting future benefits of health interventions. Developing and calibrating these models entails making a number of critical decisions that will influence the ability of the model to reflect real conditions and predict future situations. Accuracy of selected inputs and calibration procedures are two of the crucial aspects for model performance and understanding their influence is essential, especially when involves policy decisions. The aim of this work is to assess the health and economic impact on cervical cancer prevention strategies currently under discussion according to the most common methods of model calibration combined with different accuracy degree of initial inputs. Model results show large differences on the goodness of fit and cost-effectiveness outcomes depending on the calibration approach used, and these variations may affect health policy decisions. Our findings strengthen the importance of obtaining good calibrated probability matrices to get reliable health and cost outcomes, and are directly generalizable to any cost-effectiveness analysis based on Markov chain models

Moving towards an organized cervical cancer screening: costs and impact

Background: HPV screening has been shown to be more cost-effective than cytology screening under most scenarios. Furthermore, it should be offered only in organized programmes with good quality assurance mechanisms. This study analyses the comparative cost of the current policy of opportunistic cytology screening vs. a hypothetical organized programme based on primary HPV screening. Methods: Total cervical cancer expenditure was defined as the sum of three cost elements: (i) direct (medical and non-medical) costs, obtained from a calibrated Markov model of the natural history of HPV and cervical cancer; (ii) programmatic costs, estimated based on other organized screening programmes; and (iii) indirect costs, extrapolated from previously published data. Results: Organized HPV screening at 5-year intervals costs consistently less across all coverage levels than opportunistic cytology screening at 3-year intervals. The current annual direct medical cost to the public health system of the opportunistic cytology at 40% coverage is estimated at (sic)33.2 per woman screened aged 25-64. Under an organized programme of primary HPV screening at 70% coverage, the cost is estimated to be (sic)18.4 per woman screened aged 25-64. Conclusion: Our study concludes that the economic resources currently devoted to providing opportunistic cytology screening to 40% of the target population at 3-year intervals could be more effectively used to screen 70% of the target population at 5-year intervals by switching to an organized programme based on primary HPV screening. This finding is of relevance to other European countries or regions with similar screening policies and health infrastructures

Quantifying the under-reporting of uncorrelated longitudal data: the genital warts example

Abstract Background: Genital warts are a common and highly contagious sexually transmitted disease. They have a large economic burden and affect several aspects of quality of life. Incidence data underestimate the real occurrence of genital warts because this infection is often under-reported, mostly due to their specific characteristics such as the asymptomatic course. Methods: Genital warts cases for the analysis were obtained from the Catalan public health system database (SIDIAP) for the period 2009-2016. People under 15 and over 94 years old were excluded from the analysis as the incidence of genital warts in this population is negligible. This work introduces a time series model based on a mixture of two distributions, capable of detecting the presence of under-reporting in the data. In order to identify potential differences in the magnitude of the under-reporting issue depending on sex and age, these covariates were included in the model. Results: This work shows that only about 80% in average of genital warts incidence in Catalunya in the period 2009-2016 was registered, although the frequency of under-reporting has been decreasing over the study period. It can also be seen that this issue has a deeper impact on women over 30 years old. Conclusions: Although this study shows that the quality of the registered data has improved over the considered period of time, the Catalan public health system is underestimating genital warts real burden in almost 10,000 cases, around 23% of the registered cases. The total annual cost is underestimated in about 10 million Euros respect the 54 million Euros annually devoted to genital warts in Catalunya, representing 0.4% of the total budget

Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis

Background: Since 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths. Methods: Between Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level. Findings: From June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39-55 million) received the full course of vaccine, representing a total population coverage of 1.4% (95% CI 1.1-1.6), and 59 million women (48-71 million) had received at least one dose, representing a total population coverage of 1.7% (1.4-2.1). In more developed regions, 33.6% (95% CI 25.9-41.7) of females aged 10-20 years received the full course of vaccine, compared with only 2.7% (1.8-3.6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178 192 averted cases by age 75 years) than in high-income countries (165 033 averted cases), despite the lower number of vaccinated women (13.3 million vs 32.2 million). Interpretation Many women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention

Transició energètica i indústria

L’objectiu d’aquest estudi és donar resposta a les demandes plantejades pel Pacte Nacional per a la Indústria, les quals es fonamenten en definir les implicacions que pugui tenir la transició energètica (TE) a la indústria catalana. L’enfocament que s’ha pres es caracteritza per analitzar, en primer lloc, les raons que justifiquen realitzar una TE a Catalunya. D’acord amb això, es presenta la situació en què es troba actualment i els elements clau que hauria de complir per fer-la efectiva (infraestructura de renovables, electrificació i descarbonització ). A més, en el transcurs de l’anàlisi, es fa valdre el caràcter transversal de la TE explorant els seus efectes i relacions, no només entre sectors industrials, sinó també els que involucren altres esferes del teixit productiu com l’ocupació i la formació.Objectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant::7.1 - Per a 2030, garantir l’accés universal a serveis d’energia assequibles, confiables i modernsObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant::7.2 - Per a 2030, augmentar substancialment el percentatge d’energia renovable en el con­junt de fonts d’energiaObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No ContaminantObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant::7.3 - Per a 2030, duplicar la taxa mundial de millora de l’eficiència energèticaObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant::7.a - Per a 2030, augmentar la cooperació internacional per tal de facilitar l’accés a la investigació i a les tecnolo­gies energètiques no contaminants, incloses les fonts d’energia renovables, l’eficiència energètica i les tecnologies de combustibles fòssils avançades i menys contaminants, i promoure la inversió en infraestructures energètiques i tecnologies d’energia no contaminantObjectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant::7.b - Per a 2030, ampliar la infraestructura i millorar la tecnologia per tal d’oferir serveis d’energia moderns i sos­tenibles per a tots els països en desenvolupament, en particular els països menys avançats, els petits estats insulars en desenvolupament i els països en desenvolupament sense litoral, d’acord amb els programes de suport respectiusObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i InfraestructuraObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i Infraestructura::9.2 - Promoure una industrialització inclusiva i sostenible i, a tot tardar el 2030, augmentar de manera significativa la contribució de la indústria a l’ocupació i al producte interior brut, d’acord amb les circumstàncies nacionals, i duplicar aquesta contribució als països menys avançatsObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i Infraestructura::9.4 - Per a 2030, modernitzar les infraestructures i reconvertir les indústries perquè siguin sostenibles, usant els recursos amb més eficàcia i promovent l’adopció de tecnologies i processos industrials nets i racionals ambiental­ment, i aconseguint que tots els països adoptin mesures d’acord amb les capacitats respectivesObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i Infraestructura::9.5 - Augmentar la investigació científica i millorar la capacitat tecnològica dels sectors industrials de tots els països, en particular els països en desenvolupament, entre d’altres maneres fomentant la innovació i augmentant substancialment, d’aquí al 2030, el nombre de persones que treballen en el camp de la investigació i el desenvolupa­ment per cada milió d’habitants, així com la despesa en investigació i desenvolupament dels sectors públic i privatObjectius de Desenvolupament Sostenible::13 - Acció per al ClimaObjectius de Desenvolupament Sostenible::12 - Producció i Consum ResponsablesObjectius de Desenvolupament Sostenible::12 - Producció i Consum Responsables::12.2 - Per a 2030, assolir la gestió sostenible i l’ús eficient dels recursos naturalsObjectius de Desenvolupament Sostenible::12 - Producció i Consum Responsables::12.4 - Per a 2020, aconseguir la gestió ecològicament racional dels productes químics i de tots els residus al llarg del seu cicle de vida, de conformitat amb els marcs internacionals convinguts, i reduir-ne de manera significativa l’alliberament a l’atmosfera, a l’aigua i al sòl a fi de minimitzar-ne els efectes adversos sobre la salut humana i el medi ambientObjectius de Desenvolupament Sostenible::12 - Producció i Consum Responsables::12.5 - Per a 2030, disminuir de manera substancial la generació de residus mitjançant polítiques de prevenció, reducció, reciclatge i reutilitzacióObjectius de Desenvolupament Sostenible::12 - Producció i Consum Responsables::12.6 - Encoratjar les empreses, en especial les grans empreses i les empreses transnacionals, a adoptar pràctiques sostenibles i a incorporar informació sobre la sostenibilitat en el seu cicle de presentació d’informesObjectius de Desenvolupament Sostenible::13 - Acció per al Clima::13.3 - Millorar l’educació, la conscienciació i la capacitat humana i institucional en relació amb la mitigació del canvi climàtic, l’adaptació a aquest, la reducció dels efectes i l’alerta primerencaObjectius de Desenvolupament Sostenible::13 - Acció per al Clima::13.2 - Incorporar mesures relatives al canvi climàtic en les polítiques, les estratègies i els plans nacionalsPostprint (published version

Src-Homology 2 Domain-Containing Phosphatase 2 in Resected EGFR Mutation-Positive Lung Adenocarcinoma

Funding: supported by a La Caixa Foundation grant and the Spanish Association Against Cancer (PROYE18012ROSE)EGFR mutation-positive lung adenocarcinoma (LUAD) displays impaired phosphorylation of ERK and Src-homology 2 domain-containing phosphatase 2 (SHP2) in comparison with EGFR wild-type LUADs. We hypothesize that SHP2 expression could be predictive in patients positive with resected EGFR mutation versus patients with EGFR wild-type LUAD. We examined resected LUAD cases from Japan and Spain. mRNA expression levels of AXL, MET, CDCP1, STAT3, YAP1, and SHP2 were analyzed by quantitative reverse transcriptase polymerase chain reaction. The activity of SHP2 inhibitors plus erlotinib were tested in EGFR -mutant cell lines and analyzed by cell viability assay, Western blot, and immunofluorescence. A total of 50 of 100 EGFR mutation-positive LUADs relapsed, among them, patients with higher SHP2 mRNA expression revealed shorter progression-free survival, in comparison with those having low SHP2 mRNA (hazard ratio: 1.83; 95% confidence interval: 1.05-3.23; p = 0.0329). However, SHP2 was not associated with prognosis in the remaining 167 patients with wild-type EGFR. In EGFR -mutant cell lines, the combination of SHP099 or RMC-4550 (SHP2 inhibitors) with erlotinib revealed synergism via abrogation of phosphorylated AKT (S473) and ERK1/2 (T202/Y204). Although erlotinib translocates phosphorylated SHP2 (Y542) into the nucleus, either RMC-4550 alone, or in combination with erlotinib, relocates SHP2 into the cytoplasm membrane, limiting AKT and ERK1/2 activation. Elevated SHP2 mRNA levels are associated with recurrence in resected EGFR mutation-positive LUADs, but not in EGFR wild-type. EGFR tyrosine kinase inhibitors can enhance SHP2 activation, hindering adjuvant therapy. SHP2 inhibitors could improve the benefit of adjuvant therapy in EGFR mutation-positive LUADs

Impact of the COVID-19 pandemic in the early-onset colorectal cancer

COVID-19 pandemic; Early-onset colorectal cancerPandemia de COVID-19 Cáncer colorrectal precozPandèmia de COVID-19; Càncer colorectal precoçThe COVID19 pandemic has affected the spectrum of cancer care worldwide. Early onset colorectal cancer (EOCRC) is defined as diagnosis below the age of 50. Patients with EOCRC faced multiple challenges during the COVID19 pandemic and in some institutions it jeopardized cancer diagnosis and care delivery. Our study aims to identify the clinicopathological features and outcomes of patients with EOCRC in our Centre during the first wave of the pandemic in comparison with the same period in 2019 and 2021. Patients with EOCRC visited for the first time at Vall d'Hebron University Hospital in Spain from the 1st March to 31st August of 2019, 2020 and 2021 were included in the analysis. 177 patients with EOCRC were visited for the first time between 2019 and 2021, of which 90 patients met the inclusion criteria (2019: 30 patients, 2020: 29 patients, 2021: 31 patients). Neither differences in frequency nor in stage at diagnosis or at first visit during the given periods were observed. Of note, indication of systemic therapy in the adjuvant or metastatic setting was not altered. Days to treatment initiation and enrollment in clinical trials in this subpopulation was not affected due to the COVID-19 outbreak.This work was supported by the Cancer Research UK (CRUK) grant OPTIMISTICC (C10674/A27140)

Comprehensive Control of Human Papillomavirus Infections and Related Diseases

Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread optimally universal implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. (C) 2013 Elsevier Ltd. All rights reserved

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone