Economic evaluation of prophylactic antiemetic regimens for prevention of chemotherapy -induced nausea and vomiting (CINV)

New antiemetic agents, aprepitant and palonosetron have been approved for prevention of chemotherapy-induced nausea and vomiting (CINV). The objectives of the two phases of the study were: (1) to conduct cost-effectiveness analysis of antiemetic regimens for prevention of CINV in patients receiving highly emetogenic chemotherapy (HEC) and in patients receiving moderately emetogenic chemotherapy (MEC) using decision models, and (2) to determine the monetary value of improved emesis control and conduct cost-benefit analysis of the new antiemetic regimens. Regimen A, one of the four antiemetic strategies included in the HEC decision model was a combination of aprepitant and the standard regimen of ondansetron+dexamethasone. The other three regimens had standard regimen in the acute phase but differed in the delayed phase regimens: regimen B - dexamethasone only, regimen C - dexamethasone+metoclopramide and regimen D - dexamethasone+ondansetron. The four antiemetic strategies for prevention of CINV due to MEC were: regimen (1) IV palonosetron, (2) IV ondansetron, (3) ondansetron+dexamethasone in acute phase, only dexamethasone in delayed phase, (4) ondansetron+dexamethasone in acute and delayed phase. The outcome measure was the incremental cost-effectiveness ratios (ICER) measured as cost/patient with complete control of emesis. For the HEC model, the ICER of regimen A compared to C was {dollar}3,363.18 and {dollar}2,881.61 per patient with complete control of emesis, from payer and societal perspectives respectively. One-way and probabilistic sensitivity analyses indicated that the conclusions were relatively stable to variations in multiple parameters. For MEC model, regimen 1 was found to be most cost-effective with ICER of {dollar}3,582.48 and {dollar}3,549.02, from payer and societal perspectives respectively. Overall, the ICER results showed that the regimen A and regimen 1 could be considered cost-effective therapies for prevention of CINV. In phase II, a contingent valuation survey was developed and administered to 120 cancer patients who were either receiving or had received chemotherapy. The results showed that respondents were willing-to-pay on average {dollar}83.50 for a single dose of palonosetron and {dollar}89.90 for a three-day regimen of aprepitant. Phase II qualitative results also emphasized that cancer patients receiving chemotherapy placed a high importance on receiving even a modest improvement in the control of CINV

Diffusion MR Characteristics Following Concurrent Radiochemotherapy Predicts Progression-Free and Overall Survival in Newly Diagnosed Glioblastoma.

The standard of care for newly diagnosed glioblastoma (GBM) is surgery, then radiotherapy (RT) with concurrent temozolomide (TMZ), followed by adjuvant TMZ. We hypothesized patients with low diffusivity measured using apparent diffusion coefficient (ADC) histogram analysis evaluated after RT+TMZ, prior to adjuvant TMZ, would have a significantly shorter progression-free (PFS) and overall survival (OS). To test this hypothesis we evaluated 120 patients with newly diagnosed GBM receiving RT+TMZ followed by adjuvant TMZ. MRI was performed after completion of RT+TMZ, prior to initiation of adjuvant TMZ. A double Gaussian mixed model was used to describe the ADC histograms within the enhancing tumor, where ADCL and ADCH were defined as the mean ADC value of the lower and higher Gaussian distribution, respectively. An ADCL value of 1.0 um2/ms and ADCH value of 1.6 um2/ms were used to stratify patients into high and low risk categories. Results suggest patients with low ADCL had significantly shorter PFS (Cox Hazard Ratio = 0.12, P = 0.0006). OS was significantly shorter with low ADCL tumors, showing a median OS of 407 vs. 644 days (Cox Hazard Ratio = 0.31, P = 0.047). ADCH was not predictive of PFS or OS when accounting for age and ADCL. In summary, newly diagnosed glioblastoma patients with low ADCL after completion of RT+TMZ are likely to progress and die earlier than patients with higher ADCL. Results suggest ADC histogram analysis may be useful for patient risk stratification following completion of RT+TMZ

Seasonal patterns of abdominal pain consultations among adults and children

Consultations for chronic abdominal pain are frequent in adults and children. A seasonal pattern of abdominal pain consultations with winter predominance was shown in previous pediatric studies; however, no studies have investigated whether such a pattern exists in adult patients. Understanding the differences in seasonal patterns of abdominal pain consultations among adults and children may indicate that either different mechanisms exist for common chronic pain conditions or triggering factors may vary by age. The aim of the study was to investigate whether a seasonal variation in abdominal pain consultation patterns exists among adults and children. The number of outpatient consultations among children (5-17 years) and adults (18 years or older) with a diagnosis of abdominal pain of nonspecified origin (International Classification of Diseases-9 code 789.0) from May 2000 to December 2008 was identified in an administrative claims database. The primary outcome measure was the rate of abdominal pain consultations (total number of abdominal pain consultations/total number of distinct patients by month×1000) by season in children and adults. Seasons were defined as follows: winter (December-February), spring (March-May), summer (June-August), and fall (September-November). A trend test was conducted to determine the degree of linearity in the patterns between the 2 groups. Among children, subanalyses by age 5 to 11 years and 12 to 17 years and sex were conducted. A total of 172.4 million distinct patients (13.4% children, 87.6% adults) were identified in the database between May 2000 and December 2008. During the same time period, 15.6 million patient consultations for abdominal pain were identified (10.1% children, 89.9% adults). Children demonstrated a seasonal pattern in abdominal pain consultations, which best fit a quadratic regression curve, with consultations less common during the summer months. Abdominal pain consultations in adults were linear with no seasonal predominance. The trend in seasonal variation of abdominal pain consultations among children stratified by age and sex remained consistent with the overall child population. Abdominal pain consultations in children are less common during summer months, whereas no evidence of seasonal pattern of consultation was found in adults. Factors involved in the pathogenesis of abdominal pain in adults and children may differ