Cost-effectiveness analysis of the use of immunotherapy in metastatic solid tumours in Austria by applying the ESMO-magnitude of clinical benefit scale (ESMO-MCBS) version 1.1

BACKGROUND: Immune checkpoint inhibitors (ICIs) treatment is a breakthrough in managing metastatic solid tumours, but its use is associated with a high financial burden for public health care systems. Validated tools such as the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) are frameworks that might help to better assess the clinical benefit of these novel innovative cancer drugs. METHODS: Here, we systematically analysed the number of European Medicines Agency-approved ICIs labels with an ESMO-MCBS grade <4 and the impact of the ICIs on incremental costs, gain of life years (LYs), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio in the Austrian population. RESULTS: Of 23 ICIs treatment settings, we identified three clinical scenarios in metastatic solid cancers with an ESMO-MCBS grade <4 with no otherwise approved alternatives. In triple-negative breast cancer (TNBC), the addition of first-line atezolizumab increased QALYs by 0.33 compared with nab-paclitaxel only, with an incremental cost per QALY of €143 853. In small-cell lung cancer (SCLC), the addition of first-line atezolizumab increased the QALY by 0.09, with an incremental cost per QALY of €373 256, and the addition of first-line durvalumab increased the QALYs by 0.11, with an incremental cost per QALY of €589 527. CONCLUSIONS: Overall, most of the approved ICIs carry significant clinical benefit (≥4). Although TNBC and SCLC are challenging treatment scenarios, currently approved ICIs with an ESMO-MCBS grade <4 substantially increase the cost of medical treatment, and under a willingness-to-pay threshold of €100 000, they do not have a cost-effective comparative benefit

Apolipoprotein D synthesis progressively increases in frontal cortex during human lifespan

Apolipoprotein D (apo D) is a lipocalin present in the nervous system that may be related to processes of reinnervation, regeneration and neuronal cell protection. In the other way, apo D expression has been correlated, in some brain regions, with normal aging and neurodegenerative diseases. To elucidate the regional and cellular expression of apo D in normal human brain during aging, we performed a detailed and extensive study in samples of post-mortem human cerebral cortices. To achieve this study, slot blot techniques, for protein and mRNA, as well as immunohistochemistry and hybridohistochemistry methods were used. A positive correlation for apo D expression with aging was found; furthermore, mRNA levels, as well as the protein ones, were higher in the white than in the grey matter. Immunohistochemistry and non-isotopic HIS showed that apo D is synthesized in both neurons and glial cells. Apo D expression is notorious in oligodendrocytes but with aging the number of neurons that synthesize apo D is increased. Our results indicate that apo D could play a fundamental role in central nervous system aging and in the reduction of products derivated from lipid peroxidation. The increment in the expression of apo D with aging can be included in a global mechanism of cellular protection to prevent the deleterious effects caused by aging

Cultural and leadership predictors of corporate social responsibility values of top management: A GLOBE study of 15 countries.

This paper examines cultural and leadership variables associated with corporate social responsibility values that managers apply to their decision-making. In this longitudinal study, we analyze data from 561 firms located in 15 countries on five continents to illustrate how the cultural dimensions of institutional collectivism and power distance predict social responsibility values on the part of top management team members. CEO visionary leadership and integrity were also uniquely predictive of such values. Journal of International Business Studies (2006) 37, 823–837. doi:10.1057/palgrave.jibs.8400230