Long-term cost-effectiveness of the fixed-dose combination tiotropium plus olodaterol based on the DYNAGITO trial results. Int J COPD.

Purpose: Combinations of long-acting bronchodilators are recommended to reduce the rate of COPD exacerbations. Evidence from the DYNAGITO trial showed that the fixed-dose combination of tiotropium + olodaterol reduced the annual rate of total exacerbations (P,0.05) compared with tiotropium monotherapy. This study aimed to estimate the cost-effectiveness of the fixed-dose combination of tiotropium + olodaterol vs tiotropium monotherapy in COPD patients in the French setting. Patients and methods: A recently developed COPD patient-level simulation model was used to simulate the lifetime effects and costs for 15,000 patients receiving either tiotropium + olodaterol or tiotropium monotherapy by applying the reduction in annual exacerbation rate as observed in the DYNAGITO trial. The model was adapted to the French setting by including French unit costs for treatment medication, COPD maintenance treatment, COPD exacerbations (moderate or severe), and pneumonia. The main outcomes were the annual (severe) exacerbation rate, the number of quality-adjusted life-years (QALYs), and total lifetime costs. Results: The number of QALYs for treatment with tiotropium + olodaterol was 0.042 higher compared with tiotropium monotherapy. Using a societal perspective, tiotropium + olodaterol resulted in a cost increase of +€123 and an incremental cost-effectiveness ratio (ICER) of €2,900 per QALY compared with tiotropium monotherapy. From a French National Sickness Fund perspective, total lifetime costs were reduced by €272 with tiotropium + olodaterol, resulting in tiotropium + olodaterol being the dominant treatment option, that is, more effects with less costs. Sensitivity analyses showed that reducing the cost of exacerbations by 34% increased the ICER to €15,400, which could still be considered cost-effective in the French setting. Conclusion: Treatment with tiotropium + olodaterol resulted in a gain in QALYs and savings in costs compared with tiotropium monotherapy using a National Sickness Fund perspective in France. From the societal perspective, tiotropium + olodaterol was found to be cost-effective with a low cost per QALY

SPHERE: the exoplanet imager for the Very Large Telescope

Observations of circumstellar environments to look for the direct signal of exoplanets and the scattered light from disks has significant instrumental implications. In the past 15 years, major developments in adaptive optics, coronagraphy, optical manufacturing, wavefront sensing and data processing, together with a consistent global system analysis have enabled a new generation of high-contrast imagers and spectrographs on large ground-based telescopes with much better performance. One of the most productive is the Spectro-Polarimetic High contrast imager for Exoplanets REsearch (SPHERE) designed and built for the ESO Very Large Telescope (VLT) in Chile. SPHERE includes an extreme adaptive optics system, a highly stable common path interface, several types of coronagraphs and three science instruments. Two of them, the Integral Field Spectrograph (IFS) and the Infra-Red Dual-band Imager and Spectrograph (IRDIS), are designed to efficiently cover the near-infrared (NIR) range in a single observation for efficient young planet search. The third one, ZIMPOL, is designed for visible (VIR) polarimetric observation to look for the reflected light of exoplanets and the light scattered by debris disks. This suite of three science instruments enables to study circumstellar environments at unprecedented angular resolution both in the visible and the near-infrared. In this work, we present the complete instrument and its on-sky performance after 4 years of operations at the VLT.Comment: Final version accepted for publication in A&

Euclid Near Infrared Spectrometer and Photometer instrument concept and first test results obtained for different breadboards models at the end of phase C

The Euclid mission objective is to understand why the expansion of the Universe is accelerating through by mapping the geometry of the dark Universe by investigating the distance-redshift relationship and tracing the evolution of cosmic structures. The Euclid project is part of ESA's Cosmic Vision program with its launch planned for 2020 (ref [1]). The NISP (Near Infrared Spectrometer and Photometer) is one of the two Euclid instruments and is operating in the near-IR spectral region (900- 2000nm) as a photometer and spectrometer. The instrument is composed of: - a cold (135K) optomechanical subsystem consisting of a Silicon carbide structure, an optical assembly (corrector and camera lens), a filter wheel mechanism, a grism wheel mechanism, a calibration unit and a thermal control system - a detection subsystem based on a mosaic of 16 HAWAII2RG cooled to 95K with their front-end readout electronic cooled to 140K, integrated on a mechanical focal plane structure made with molybdenum and aluminum. The detection subsystem is mounted on the optomechanical subsystem structure - a warm electronic subsystem (280K) composed of a data processing / detector control unit and of an instrument control unit that interfaces with the spacecraft via a 1553 bus for command and control and via Spacewire links for science data This presentation describes the architecture of the instrument at the end of the phase C (Detailed Design Review), the expected performance, the technological key challenges and preliminary test results obtained for different NISP subsystem breadboards and for the NISP Structural and Thermal model (STM)

Chaufage des bâtiments : intermittence et lois de régulation en boucle ouverte

International audienceLe principe de la régulation en boucle ouverte (RBO) est bien connu: pour assurer une température convenable à l'intérieur d'un bâtiment, il convient de moduler la puissance délivrée en fonction des conditions extérieures. On utilise pour cela une loi de correspondance linéaire (ou linéaire par morceaux): la courbe de chauffe. Mais on ne connaît pas bien les causes réelles de fonctionnement ou de disfonctionnement de telles régulations. Une première idée répandue est de dire que, basées sur une équation de bilan thermique statique du bâtiment, elles ne peuvent qu'imparfaitement en maîtriser les évolutions dynamiques. Mais cela n'est que partiellement vrai. En effet, dans le cas d'une consigne constante, les RBO parviennent parfaitement à réguler l'ambiance intérieure d'un bâtimen

Muito além do "Teste do Pezinho" Far beyond "neonatal screening"

A doença falciforme caracteriza-se por uma alteração genética que resulta na produção da hemoglobina S. A triagem neonatal para a HbS é de fundamental importância para o diagnóstico da anemia falciforme, possibilitando a instituição de tratamento preventivo, no sentido de diminuir a morbidade e mortalidade na infância. Embora o diagnóstico precoce, através do "Teste do Pezinho", esteja ocorrendo praticamente em todo o país, que medidas estão sendo tomadas após a confirmação do diagnóstico? Realizamos um estudo transversal e retrospectivo em 22.785 (96,97%) de 23.497 nascidos vivos que foram submetidos ao exame de triagem neonatal. Todos os exames foram realizados no primeiro mês de vida. Foram diagnosticados quatro recém-nascidos com o padrão HbSS e dois HbSC. A primeira avaliação especializada ocorreu de 2 a 9 meses após o diagnóstico. Em apenas um caso houve a administração adequada das imunizações e da antibioticoterapia profilática. O tempo de realização do teste de triagem e a chegada dos resultados na Unidade coletora da amostra estão geralmente adequados. Levando-se em consideração a necessidade da instituição de um tratamento profilático em um centro especializado, é fundamental elaborar um fluxo que melhor articule todos os atores envolvidos, visando amenizar as prováveis consequências e sequelas desta doença.Sickle disease is characterized by a genetic alteration which produces hemoglobin S. Neonatal screening for HbS has a major importance in the diagnosis of sickle anemia, thereby enabling preventive treatment in order to reduce childhood morbidity and mortality. Although early diagnosis by neonatal screening is being performed in practically the entire country, what measures are being taken after diagnostic confirmation? We carried out a cross-sectional retrospective study of 22,785 (96.97%) of 23,595 live births submitted to neonatal screening. All tests were performed within the first month of life. Four newborns with HbSS and two with HbSC were diagnosed. The first specialized evaluation occurred between 2 and 9 months after the disease had been identified. Only one case received correct immunization and prophylactic antibiotic therapy. The time between the screening test and the samples arriving at the collecting units was appropriate. Taking into account the necessity of establishing prophylactic treatment at specialized centers, effective communication between healthcare services is essential to safeguard against possible consequences and sequelae related to the disease

Long-term cost-effectiveness of the fixed-dose combination of tiotropium plus olodaterol based on the DYNAGITO trial results

Martine Hoogendoorn,1 Isaac Corro Ramos,1 Michael Baldwin,2 Laura Luciani,3 Cecile Fabron,4 Bruno Detournay,4 Maureen PMH Rutten-van Mölken1,5 1institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands; 2Boehringer Ingelheim GmbH, Ingelheim, Germany; 3Boehringer Ingelheim France, Paris, France; 4Cemka-Eval, Bourg-la-Reine, France; 5Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands Purpose: Combinations of long-acting bronchodilators are recommended to reduce the rate of COPD exacerbations. Evidence from the DYNAGITO trial showed that the fixed-dose combination of tiotropium + olodaterol reduced the annual rate of total exacerbations (P<0.05) compared with tiotropium monotherapy. This study aimed to estimate the cost-effectiveness of the fixed-dose combination of tiotropium + olodaterol vs tiotropium monotherapy in COPD patients in the French setting. Patients and methods: A recently developed COPD patient-level simulation model was used to simulate the lifetime effects and costs for 15,000 patients receiving either tiotropium + olodaterol or tiotropium monotherapy by applying the reduction in annual exacerbation rate as observed in the DYNAGITO trial. The model was adapted to the French setting by including French unit costs for treatment medication, COPD maintenance treatment, COPD exacerbations (moderate or severe), and pneumonia. The main outcomes were the annual (severe) exacerbation rate, the number of quality-adjusted life-years (QALYs), and total lifetime costs. Results: The number of QALYs for treatment with tiotropium + olodaterol was 0.042 higher compared with tiotropium monotherapy. Using a societal perspective, tiotropium + olodaterol resulted in a cost increase of +€123 and an incremental cost-effectiveness ratio (ICER) of €2,900 per QALY compared with tiotropium monotherapy. From a French National Sickness Fund perspective, total lifetime costs were reduced by €272 with tiotropium + olodaterol, resulting in tiotropium + olodaterol being the dominant treatment option, that is, more effects with less costs. Sensitivity analyses showed that reducing the cost of exacerbations by 34% increased the ICER to €15,400, which could still be considered cost-effective in the French setting. Conclusion: Treatment with tiotropium + olodaterol resulted in a gain in QALYs and savings in costs compared with tiotropium monotherapy using a National Sickness Fund perspective in France. From the societal perspective, tiotropium + olodaterol was found to be cost-effective with a low cost per QALY. Keywords: COPD, tiotropium, olodaterol, exacerbations, modeling, QALYs, cost