85 research outputs found
Which is more cost‐effective under the MELD system: primary liver transplantation, or salvage transplantation after hepatic resection or after loco‐regional therapy for hepatocellular carcinoma within Milan criteria?
AbstractObjectiveThe optimal strategy for treating hepatocellular carcinoma (HCC), a disease with increasing incidence, in patients with Child–Pugh class A cirrhosis has long been debated. This study evaluated the cost‐effectiveness of hepatic resection (HR) or locoregional therapy (LRT) followed by salvage orthotopic liver transplantation (SOLT) vs. that of primary orthotopic liver transplantation (POLT) for HCC within the Milan Criteria.MethodsA Markov‐based decision analytic model simulated outcomes, expressed in costs and quality‐adjusted life years (QALYs), for the three treatment strategies. Baseline parameters were determined from a literature review. Sensitivity analyses tested model strength and parameter variability.ResultsBoth HR and LRT followed by SOLT were associated with earlier recurrence, decreased survival, increased costs and decreased quality of life (QoL), whereas POLT resulted in decreased recurrence, increased survival, decreased costs and increased QoL. Specifically, HR/SOLT yielded 3.1QALYs (at US74000/QALY), whereas POLT yielded 5.5QALYs (at US$52000/QALY). Sensitivity analyses supported these findings at clinically meaningful probabilities.ConclusionsUnder the Model for End‐stage Liver Disease (MELD) system, in patients with HCC within the Milan Criteria, POLT increases survival and QoL at decreased costs compared with HR or LRT followed by SOLT. Therefore, POLT is the most cost‐effective strategy for the treatment of HCC
Is liver transplantation using organs donated after cardiac death cost‐effective or does it decrease waitlist death by increasing recipient death?
AbstractObjectivesThe aim of this study was to evaluate the cost‐effectiveness in liver transplantation (LT) of utilizing organs donated after cardiac death (DCD) compared with organs donated after brain death (DBD).MethodsA Markov‐based decision analytic model was created to compare two LT waitlist strategies distinguished by organ type: (i) DBD organs only, and (ii) DBD and DCD organs. The model simulated outcomes for patients over 10 years with annual cycles through one of four health states: survival; ischaemic cholangiopathy; retransplantation, and death. Baseline values and ranges were determined from an extensive literature review. Sensitivity analyses tested model strength and parameter variability.ResultsOverall survival is decreased, and biliary complications and retransplantation are increased in recipients of DCD livers. Recipients of DBD livers gained 5.6 quality‐adjusted life years (QALYs) at a cost of US61 000/QALY. The DBD + DCD organ strategy was superior to the DBD organ‐only strategy.conclusionsThe extension of life and quality of life provided by DCD LT to patients on the waiting list who might otherwise not receive a liver transplant makes the continued use of DCD livers cost‐effective
Which is more cost‐effective under the MELD system: primary liver transplantation, or salvage transplantation after hepatic resection or after loco‐regional therapy for hepatocellular carcinoma within Milan criteria?
AbstractObjectiveThe optimal strategy for treating hepatocellular carcinoma (HCC), a disease with increasing incidence, in patients with Child–Pugh class A cirrhosis has long been debated. This study evaluated the cost‐effectiveness of hepatic resection (HR) or locoregional therapy (LRT) followed by salvage orthotopic liver transplantation (SOLT) vs. that of primary orthotopic liver transplantation (POLT) for HCC within the Milan Criteria.MethodsA Markov‐based decision analytic model simulated outcomes, expressed in costs and quality‐adjusted life years (QALYs), for the three treatment strategies. Baseline parameters were determined from a literature review. Sensitivity analyses tested model strength and parameter variability.ResultsBoth HR and LRT followed by SOLT were associated with earlier recurrence, decreased survival, increased costs and decreased quality of life (QoL), whereas POLT resulted in decreased recurrence, increased survival, decreased costs and increased QoL. Specifically, HR/SOLT yielded 3.1QALYs (at US74000/QALY), whereas POLT yielded 5.5QALYs (at US$52000/QALY). Sensitivity analyses supported these findings at clinically meaningful probabilities.ConclusionsUnder the Model for End‐stage Liver Disease (MELD) system, in patients with HCC within the Milan Criteria, POLT increases survival and QoL at decreased costs compared with HR or LRT followed by SOLT. Therefore, POLT is the most cost‐effective strategy for the treatment of HCC
Profile of health-related quality of life outcomes after liver transplantation: univariate effects and multivariate models
AbstractAim. To test the effects of pre- and post-transplant clinical covariates on post-transplant health-related quality of life (HRQOL) score profiles in liver transplant recipients. Material and methods. HRQOL was measured before and after transplantation using the SF-36® Health Survey. Clinical data [diagnosis, model of end-stage liver disease (MELD) score, post-transplant rejection and infection episodes], pre-transplant functional performance (FP), and demographics were collected. Multivariate models for the eight SF-36 scales and two summary components were developed using multiple regression. Discriminant analysis was used to test whether the score profiles differentiated among recipients with and without hepatitis C virus (HCV) infection. Results. 104 adults reported pre- and post-transplant HRQOL. Time post-transplant averaged 9±8 months (range 1–39). Scores on all SF-36 measures improved from pre- to post-transplant (p<0.001), and 7 of 10 models were significant (p<0.05). After controlling for pre-transplant HRQOL and time post-transplant, HCV infection had a negative effect on the role physical, bodily pain, and role emotional scales. History of a rejection episode had a negative effect on the bodily pain and vitality scales. MELD scores ≥18 had a positive effect on the role physical scale. Pre-transplant FP and post-transplant infection episodes did not affect post-transplant HRQOL. HCV infection had a significant effect on the SF-36 score profile (canonical correlation=0.50; p<0.001). Conclusions. Pre-transplant HCV infection, MELD score, and post-transplant rejection episodes have significant independent effects on HRQOL after liver transplantation. Their specific effects vary among the individual SF-36 scales, and HRQOL score profiles differ among HCV+ and HCV– recipients
Water warming garment versus forced air warming system in prevention of intraoperative hypothermia during liver transplantation: a randomized controlled trial [ISRCTN32154832]
BACKGROUND: The authors compared two strategies for the maintenance of intraoperative normothermia during orthotopic liver transplantation (OLT): the routine forced-air warming system and the newly developed, whole body water garment. METHODS: In this prospective, randomized and open-labelled study, 24 adult patients were enrolled in one of two intraoperative temperature management groups during OLT. The water-garment group (N = 12) received warming with a body temperature (esophageal) set point of 36.8°C. The forced air-warmer group (N = 12) received routine warming therapy using upper- and lower-body forced-air warming system. Body core temperature (primary outcome) was recorded intraoperatively and during the two hours after surgery in both groups. RESULTS: The mean core temperatures during incision, one hour after incision and during the skin closing were significantly higher (p < 0.05, t test with Bonferroni corrections for the individual tests) in the water warmer group compared to the control group (36.7 ± 0.1, 36.7 ± 0.2, 36.8 ± 0.1 vs 36.1 ± 0.4, 36.1 ± 0.4, 36.07 ± 0.4°C, respectively). Moreover, significantly higher core temperatures were observed in the water warmer group than in the control group during the placement of cold liver allograft (36.75 ± 0.17 vs 36.09 ± 0.38°C, respectively) and during the allograft reperfusion period (36.3 ± 0.26 vs 35.52 ± 0.42°C, respectively). In addition, the core temperatures immediately after admission to the SICU (36.75 ± 0.13 vs 36.22 ± 0.3°C, respectively) and at one hr (36.95 ± 0.13 vs 36.46 ± 0.2°C, respectively) were significantly higher in the water warmer group, compared to the control group, whereas the core temperature did not differ significantly afte two hours in ICU in both groups. CONCLUSIONS: The investigated water warming system results in better maintenance of intraoperative normothermia than routine air forced warming applied to upper- and lower body
meson production in Au collisions at GeV
The PHENIX experiment has measured meson production in Au
collisions at GeV using the dimuon and dielectron decay
channels. The meson is measured in the forward (backward) -going
(Au-going) direction, () in the transverse-momentum
() range from 1--7 GeV/, and at midrapidity in the
range below 7 GeV/. The meson invariant yields and
nuclear-modification factors as a function of , rapidity, and centrality
are reported. An enhancement of meson production is observed in the
Au-going direction, while suppression is seen in the -going direction, and
no modification is observed at midrapidity relative to the yield in
collisions scaled by the number of binary collisions. Similar behavior was
previously observed for inclusive charged hadrons and open heavy flavor
indicating similar cold-nuclear-matter effects.Comment: 484 authors, 16 pages, 12 figures, 6 tables. v1 is the version
accepted for publication in Phys. Rev. C. Data tables for the points plotted
in the figures are given in the paper itsel
Systematic study of charged-pion and kaon femtoscopy in AuAu collisions at =200 GeV
We present a systematic study of charged pion and kaon interferometry in
AuAu collisions at =200 GeV. The kaon mean source radii
are found to be larger than pion radii in the outward and longitudinal
directions for the same transverse mass; this difference increases for more
central collisions. The azimuthal-angle dependence of the radii was measured
with respect to the second-order event plane and similar oscillations of the
source radii were found for pions and kaons. Hydrodynamic models qualitatively
describe the similar oscillations of the mean source radii for pions and kaons,
but they do not fully describe the transverse-mass dependence of the
oscillations.Comment: 499 authors, 27 pages, 13 figures, and 11 tables. v2 is the version
accepted for publication in Phys. Rev. C. Plain text data tables for the
points plotted in figures for this and previous PHENIX publications are (or
will be) publicly available at http://www.phenix.bnl.gov/papers.htm
Measurements of elliptic and triangular flow in high-multiplicity HeAu collisions at GeV
We present the first measurement of elliptic () and triangular ()
flow in high-multiplicity HeAu collisions at
GeV. Two-particle correlations, where the particles have a large separation in
pseudorapidity, are compared in HeAu and in collisions and
indicate that collective effects dominate the second and third Fourier
components for the correlations observed in the HeAu system. The
collective behavior is quantified in terms of elliptic and triangular
anisotropy coefficients measured with respect to their corresponding
event planes. The values are comparable to those previously measured in
Au collisions at the same nucleon-nucleon center-of-mass energy.
Comparison with various theoretical predictions are made, including to models
where the hot spots created by the impact of the three He nucleons on the
Au nucleus expand hydrodynamically to generate the triangular flow. The
agreement of these models with data may indicate the formation of low-viscosity
quark-gluon plasma even in these small collision systems.Comment: 630 authors, 9 pages, 4 figures, 2 tables. v2 is the version accepted
for publication by Physical Review Letters. Plain text data tables for the
points plotted in figures for this and previous PHENIX publications are (or
will be) publicly available at http://www.phenix.bnl.gov/papers.htm
Cross Section and Transverse Single-Spin Asymmetry of Mesons in Collisions at GeV at Forward Rapidity
We present a measurement of the cross section and transverse single-spin
asymmetry () for mesons at large pseudorapidity from
~GeV collisions. The measured cross section for
~GeV/ and is well described by a
next-to-leading-order perturbative-quantum-chromodynamics calculation. The
asymmetries have been measured as a function of Feynman- () from
, as well as transverse momentum () from
~GeV/. The asymmetry averaged over positive is
. The results are consistent with prior
transverse single-spin measurements of forward and mesons at
various energies in overlapping ranges. Comparison of different particle
species can help to determine the origin of the large observed asymmetries in
collisions.Comment: 484 authors, 13 pages, 11 figures, 4 tables, 2008 data. v2 is version
accepted by Phys. Rev. D. Plain text data tables for the points plotted in
figures for this and previous PHENIX publications are (or will be)publicly
available at http://www.phenix.bnl.gov/papers.htm
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