Cost-effectiveness of sorafenib for treatment of radioactive iodine (rai)-refractory locally advanced/metastatic differentiated thyroid cancer (dtc) in Turkey

WOS: 000354498503198OBJECTIVES: Sorafenib is the first product approved for treatment of RAI refractory locally advanced/metastatic DTC patients. This study was conducted in order to analyze cost-effectiveness of sorafenib for treatment of patients with RAI refractory locally advanced/metastatic DTC in Turkey. METHODS: A cohort partition model assigning patients to one of three health states according to the proportion of patients who are progression-free, progressed, or dead in each 28-days cycle was adapted to Turkish setting. The incremental cost-effectiveness ratios (ICER) were calculated per quality-adjusted life years (QALYs) and life-years (LYs) gained. Turkish payer’s perspective was taken and time-horizon was set as patient’s lifetime (maximum 30 years). Sorafenib was compared to the best supportive care (BSC) within the model since there are no agents for treatment of patients on this stage of the disease. Essential clinical inputs were derived from DECISION trial and local resource-utilization data were based on expert opinions through an expert panel. Sensitivity of the results was evaluated in terms of key inputs by deterministic oneway and probabilistic sensitivity analyses. All costs were calculated in Turkish Liras (TL) and converted to USD using TL/USD currency rate as 2.2 (mid-2014). RESULTS: Total cost of sorafenib-treated patients is 24,384 USD higher compared to BSC. Besides, sorafenib is associated with increments of 1.29 LYs and 0.80 QALYs compared to BSC. The ICER of sorafenib per LYs and QALYs gained compared to BSC were determined as 18,851 USD and 30,485 USD respectively. One-way sensitivity analysis demonstrated that results are not sensitive to the changes in model inputs and pharmacoeconomic analysis results were validated by probabilistic sensitivity analysis. CONCLUSIONS: Sorafenib is cost-effective for treatment of patients with RAI refractory locally advanced/metastatic DTC compared to BSC with an ICER value below the willingness-to-pay threshold (3-times GDP per capita ─ 32,346 USD) for Turkey

Effects of kefir on coccidial oocysts excretion and performance of dairy goat kids following weaning

The aim of this study was to investigate effects of kefir, a traditional source of probiotic, on coccidial oocysts excretion and on the performance of dairy goat kids following weaning. Twin kids were randomly allocated to one of two groups at weaning. Kids of the first group received 20 ml of kefir daily for 6 weeks (KEF), while kids in the control group were given a placebo (CON). Individual faecal samples were regularly (n = 18 per kid) taken to quantify the number of coccidial oocysts per gram of faeces (OpG). There were no differences between the groups in terms of body weight development (P > 0.05) and feed consumption. Kids of both groups were not able to consume enough feed to meet their nutrient requirements during the first 3 weeks following weaning. KEF had a lower frequency of OpG positive samples than CON (P = 0.043). Kefir did not affect the maximum oocyst excretion and age of the kids at the highest oocyst excretion (P > 0.05). KEF shed numerically 35% lower coccidial oocysts than the controls, which corresponded to a statistical tendency (P = 0.074) in lowering Log-OpG in comparison to CON. While KEF had a lower frequency of OpG positive samples and tended to shed lower OPG by around one-third, the frequency of diarrhea, level of highest oocyst excretion, and performance of the kids remained unaffected. Therefore, it is concluded that overall effects of kefir do not have a significant impact on sub-clinical infection and performance in weaned kids under relatively high-hygienic farming conditions

Uncovering the Importance of Selenium in Muscle Disease

A connection between selenium bioavailability and development of muscular disorders both in humans and livestock has been established for a long time. With the development of genomics, the function of several selenoproteins was shown to be involved in muscle activity, including SELENON, which was linked to an inherited form of myopathy. Development of animal models has helped to dissect the physiological dysfunction due to mutation in the SELENON gene; however the molecular activity remains elusive and only recent analysis using both in vivo and in vitro experiment provided hints toward its function in oxidative stress defence and calcium transport control. This review sets out to summarise most recent findings for the importance of selenium in muscle function and the contribution of this information to the design of strategies to cure the diseases

Comparison of initial efficacy and long-term follow-up of heparin-coated Jostent with conventional NIR stent.

The implantation of heparin-coated stents was reported to be well tolerated, but there are conflicting results about acute in-hospital complications. (sub)acute thrombosis rates, and long-term follow-up compared to uncoated stents. We compared the angiographic and clinical results after coronary placement of two stent models: the heparin-coated premounted Jostent and the uncoated premounted NIR stent. Of 710 patients revascularized, a total of 426 patients received Jostent (n = 230) or NIR stent (n = 196) implantation. The primary end points were acute or subacute thrombosis, urgent CABG, AMI or death, while the secondary end points were the comparison of the restenosis rates of the stents at the 6th month and of the functional angina classification of the stent groups at the 1st, 6th and 12th months. There were no significant differences between the Jostent and NIR stent groups regarding angiographic and procedural success. Acute thrombosis rates in the Jostent and NIR stent groups were similar while no subacute thrombosis was observed in either group. The major adverse cardiac event rates of the groups also did not differ. Angiographic restenosis occurred in 17% of the Jostent group and 16% of the NIR stent group (NS). The combined clinical and angiographic restenosis rate was also similar between the Jo and NIR groups (19% and 18%, respectively). Comparison of functional angina classes at the 1st, 6th and 12th months revealed no significant difference between the study groups. In conclusion, when compared with implantation of an uncoated premounted NIR stent, implantation of a heparin-coated premounted Jostent does not provide any more benefit with respect to initial efficacy, sub(acute) thrombosis and 6-month restenosis rates and 12-month clinical outcomes