Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom

Objective: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. Setting TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Methods: Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Main outcome measures: Quality-adjusted life-years (QALYs). Results: In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGITIORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses. Conclusions: TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain

A radiating dyon solution

We give a non-static exact solution of the Einstein-Maxwell equations (with null fluid), which is a non-static magnetic charge generalization to the Bonnor-Vaidya solution and describes the gravitational and electromagnetic fields of a nonrotating massive radiating dyon. In addition, using the energy-momentum pseudotensors of Einstein and Landau and Lifshitz we obtain the energy, momentum, and power output of the radiating dyon and find that both prescriptions give the same result.Comment: 9 pages, LaTe

Propagation of high amplitude higher order sounds in slightly soft rectangular ducts, carrying mean flow

The resonance expansion method, developed to study the propagation of sound in rigid rectangular ducts is applied to the case of slightly soft ducts. Expressions for the generation and decay of various harmonics are obtained. The effect of wall admittance is seen through a dissipation function in the system of nonlinear differential equations, governing the generation of harmonics. As the wall admittance increases, the resonance is reduced. For a given wall admittance this phenomenon is stronger at higher input intensities. Both the first and second order solutions are obtained and the results are extended to the case of ducts having mean flow

Mixed potentials in radiative stellar collapse

We study the behaviour of a radiating star when the interior expanding, shearing fluid particles are traveling in geodesic motion. We demonstrate that it is possible to obtain new classes of exact solutions in terms of elementary functions without assuming a separable form for the gravitational potentials or initially fixing the temporal evolution of the model unlike earlier treatments. A systematic approach enables us to write the junction condition as a Riccati equation which under particular conditions may be transformed into a separable equation. New classes of solutions are generated which allow for mixed spatial and temporal dependence in the metric functions. We regain particular models found previously from our general classes of solutions.Comment: 10 pages, To appear in J. Math. Phy

Astrophysical fluid simulations of thermally ideal gases with non-constant adiabatic index: numerical implementation

An Equation of State (\textit{EoS}) closes the set of fluid equations. Although an ideal EoS with a constant \textit{adiabatic index} $\Gamma$ is the preferred choice due to its simplistic implementation, many astrophysical fluid simulations may benefit from a more sophisticated treatment that can account for diverse chemical processes. Here, we first review the basic thermodynamic principles of a gas mixture in terms of its thermal and caloric EoS by including effects like ionization, dissociation as well as temperature dependent degrees of freedom such as molecular vibrations and rotations. The formulation is revisited in the context of plasmas that are either in equilibrium conditions (local thermodynamic- or collisional excitation- equilibria) or described by non-equilibrium chemistry coupled to optically thin radiative cooling. We then present a numerical implementation of thermally ideal gases obeying a more general caloric EoS with non-constant adiabatic index in Godunov-type numerical schemes.We discuss the necessary modifications to the Riemann solver and to the conversion between total energy and pressure (or vice-versa) routinely invoked in Godunov-type schemes. We then present two different approaches for computing the EoS.The first one employs root-finder methods and it is best suited for EoS in analytical form. The second one leans on lookup table and interpolation and results in a more computationally efficient approach although care must be taken to ensure thermodynamic consistency. A number of selected benchmarks demonstrate that the employment of a non-ideal EoS can lead to important differences in the solution when the temperature range is $500-10^4$ K where dissociation and ionization occur. The implementation of selected EoS introduces additional computational costs although using lookup table methods can significantly reduce the overhead by a factor $3\sim 4$.Comment: 17 pages, 10 figures, Accepted for publication in A&