Addition of cetuximab to first-line chemotherapy in patients with advanced non-small-cell lung cancer: a cost-utility analysis

Background: Adding cetuximab to standard chemotherapy results in a moderate increase of overall survival in patients with advanced non-small-cell lung cancer (NSCLC), but the cost-effectiveness is unknown. Materials and methods: A Markov model was constructed based on the results of the First-Line ErbituX in lung cancer randomized trial, adding cetuximab to cisplatin-vinorelbine first-line chemotherapy in patients with advanced NSCLC. The primary outcome was the incremental cost-effectiveness ratio (ICER) of adding cetuximab, expressed as cost per quality-adjusted life year (QALY) gained, and relative to a willingness-to-pay threshold of €60 000/QALY. The impact of cetuximab intermittent dosing schedules on the ICER was also evaluated. Results: Adding cetuximab to standard chemotherapy leads to a gain of 0.07 QALYs per patient at an additional cost of €26 088. The ICER for adding cetuximab to chemotherapy was €376 205 per QALY gained. Intermittent cetuximab dosing schedules resulted in ICERs per QALY gained between €31 300 and €83 100, under the assumption of equal efficacy. Conclusions: From a health economic perspective, the addition of cetuximab to standard first-line chemotherapy in patients with epidermal growth factor receptor-expressing advanced NSCLC cannot be recommended to date, due to a high ICER compared with other health care interventions. Treatment schedules resulting in more favorable cost-utility ratios should be evaluate

Trastuzumab beyond progression: a cost-utility analysis

Background: The continuation of trastuzumab beyond progression in combination with capecitabine as secondary chemotherapy for HER2-positive metastatic breast cancer (MBC) prolongs progression-free survival without a substantial increase in toxicity. Patients and methods: A Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Information on response rates and major adverse effects was derived, and transition probabilities were estimated, based on the results of the Breast International Group 03-05 clinical trial. Direct costs were assessed from the perspective of the Swiss health care system. Results: The addition of trastuzumab to capecitabine is estimated to cost on average an additional of €33 980 and to yield a gain of 0.35 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of €98 329/QALYs gained. Probabilistic sensitivity analysis showed that the willingness-to-pay threshold of €60 000/QALY was reached in 12% of cases. Conclusion: The addition of trastuzumab to capecitabine in MBC patients is more expensive than what is typically regarded as cost-effective but falls within the value ranges found for established regimens in the treatment of MB

Structural properties of crumpled cream layers

The cream layer is a complex heterogeneous material of biological origin which forms spontaneously at the air-milk interface. Here, it is studied the crumpling of a single cream layer packing under its own weight at room temperature in three-dimensional space. The structure obtained in these circumstances has low volume fraction and anomalous fractal dimensions. Direct means and noninvasive NMR imaging technique are used to investigate the internal and external structure of these systems.Comment: 9 pages, 4 figures, accepted in J. Phys. D: Appl. Phy

Model-data comparisons of shear waves in the nearshore

Author Posting. © American Geophysical Union, 2005. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 110 (2005): C05019, doi:10.1029/2004JC002541.Observations of shear waves, alongshore propagating meanders of the mean alongshore current with periods of a few minutes and alongshore wavelengths of a few hundred meters, are compared with model predictions based on numerical solutions of the nonlinear shallow water equations. The model (after Özkan-Haller and Kirby (1999)) assumes alongshore homogeneity and temporally steady wave forcing and neglects wave-current interactions, eddy mixing, and spatial variation of the (nonlinear) bottom drag coefficient. Although the shapes of observed and modeled shear wave velocity spectra differ, and root-mean-square velocity fluctuations agree only to within a factor of about 3, aspects of the cross-shore structure of the observed (∼0.5–1.0 m above the seafloor) and modeled (vertically integrated) shear waves are qualitatively similar. Within the surf zone, where the mean alongshore current (V) is strong and shear waves are energetic, observed and modeled shear wave alongshore phase speeds agree and are close to both V and C lin (the phase speed of linearly unstable modes) consistent with previous results. Farther offshore, where V is weak and observed and modeled shear wave energy levels decay rapidly, modeled and observed C diverge from C lin and are close to the weak alongshore current V. The simulations suggest that the alongshore advection of eddies shed from the strong, sheared flow closer to shore may contribute to the offshore decrease in shear wave phase speeds. Similar to the observations, the modeled cross- and alongshore shear wave velocity fluctuations have approximately equal magnitude, and the modeled vorticity changes sign across the surf zone.This research was supported by the Office of Naval Research, the National Oceanographic Partnership Program, and the National Science Foundation

Soil Settlement and Uplift Damage to Architectural Heritage Structures in Belgium: Country-Scale Results from an InSAR-Based Analysis

Soil movement may be induced by a wide variety of natural and anthropogenic causes, which are detectable in the local scale, but may influence the movement of the soil over vast geographical expanses. Space borne interferometric synthetic aperture radar (InSAR) measurements of ground movement provide a method for the remote sensing of soil settlement and uplift over wide geographic areas. Based on this settlement and uplift evaluation, the assessment of the potential damage to architectural heritage structures is possible. In this paper an interdisciplinary monitoring and analysis method is presented that processes satellite, cadastral, patrimonial and building geometry data, used for the calculation of settlement and uplift damage to architectural heritage structures in Belgium. It uses processed InSAR data for the determination of the soil movement profile around each case study, of which the typology is determined from patrimonial information databases and the geometry is calculated from digital elevation models. The impact on the historic structures is calculated from the determined soil movement profile based on various soilstructure interaction models for buildings. The resulting damage is presented in terms of a numerical index illustrating its severity according to different criteria. In this way the potential soil movement damage is quantified in a large number of buildings in an easily interpretable and user-friendly fashion. The processing of InSAR data collected over the previous 3 decades allows the determination of the progress of settlement- and uplift-induced damage in this time period. With the integration of newly acquired and more accurate data, the methodology will continue to produce results in the coming years, both for the evaluation of soil settlement and uplift in Belgium as for introducing related damage risk data for existing architectural heritage buildings. Results of the analysis chain are presented in terms of potential current damage for selected areas and buildings

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

The effects of cow genetic group on the density of raw whole milk

peer reviewedThe density of milk is dependent upon various factors including temperature, processing conditions, and animal breed. This study evaluated the effect of different cow genetic groups, Jersey, elite Holstein Friesians (EHF), and national average Holstein Friesians (NAHF) on the compositional and physicochemical properties of milk. Approximately 1,040 representative (morning and evening) milk samples (~115 per month during 9 mo) were collected once every 2 wk. Milk composition was determined with a Bentley Dairyspec instrument. Data were analysed with a mixed linear model that included the fixed effects of sampling month, genetic group, interaction between month and genetic group and the random effects of cow to account for repeated measures on the same animal. Milk density was determined using three different analytical approaches – a portable and a standard desktop density meter and 100 cm3 calibrated glass pycnometers. Milk density was analysed with the same mixed model as for milk composition but including the analytical method as a fixed effect. Jersey cows had the greatest mean for fat content (5.69 ± 0.13%), followed by EHF (4.81 ± 0.16%) and NAHF (4.30 ± 0.15%). Milk density was significantly higher (1.0313 g/cm³ ± 0.00026, P < 0.05) for the milk of Jersey breed when compared to the EHF (1.0304 ± 0.00026 g/cm³) and NAHF (1.0303 ± 0.00024 g/cm³) genetic groups. The results from this study can be used by farmers and dairy processors alike to enhance accuracy when calculating the quantity and value of milk solids depending upon the genetic merit of the animal/herd, and may also improve milk payment systems through relating milk solids content and density

Milk coagulation properties and methods of detection

ABSTRACT: One of the most crucial steps in cheesemaking is the coagulation process, and knowledge of the parameters involved in the clotting process plays an important technological role in the dairy industry. Milk of different ruminant species vary in terms of their coagulation capacities because they are influenced by the milk composition and mainly by the milk protein genetic variants. The milk coagulation capacity can be measured by means of mechanical and/or optical devices, such as Lactodynamographic Analysis and Near-Infrared and Mid-Infrared Spectroscopy