Introduction: This systematic literature review analyzed published evidence on IgA nephropathy (IgAN), focusing on US epidemiology, health-related quality of life (HRQoL), and economic burden of illness. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE®, Cochrane, and Econlit (January 2010 to June 2020) were searched, along with relevant congresses (2017-2020). Results: Of 123 epidemiologic studies selected for data extraction, 24 reported IgAN diagnosis rates ranging from 6.3% to 29.7% among adult and pediatric patients undergoing renal biopsy, with all reported US rates <15%. No US studies reported IgAN prevalence. A meta-analysis of US studies calculated an annual incidence of 1.29/100 000 people, translating to an annual US incidence of 4236 adults and children. Relative to Europe, the United States had more patients diagnosed with IgAN in later chronic kidney disease stages. US rates of transition to end-stage renal disease (ESRD) ranged from 12.5% to 23% during 3-3.9 years of observation, rising to 53% during 19 years of observation. Across 8 studies reporting HRQoL, pain and fatigue were the most reported symptoms, and patients consistently ranked kidney function and mortality as the most important treatment outcomes. Patients with glomerulopathy reported worse mental health than healthy controls or hemodialysis patients; proteinuria was significantly associated with poorer HRQoL and depression. Conclusion: While economic evidence in IgAN remains sparse, management of ESRD is a major cost driver. IgAN is a rare disease where disease progression causes increasing patient burden, underscoring the need for therapies that prevent kidney function decline and HRQoL deterioration while reducing mortality.

BackgroundPatients with type 2 diabetes (T2D) typically use several drug treatments during their lifetime. There is a debate about the best second-line therapy after metformin monotherapy failure due to the increasing number of available antidiabetic drugs and the lack of comparative clinical trials of secondary treatment regimens. While prior research compared the cost-effectiveness of two alternative drugs, the literature assessing T2D treatment pathways is scarce. The purpose of this study was to evaluate the long-term cost-effectiveness of dipeptidyl peptidase-4 inhibitors (DPP-4i) compared to sulfonylureas (SU) as second-line therapy in combination with metformin in patients with T2D.MethodsA Markov model was developed with four health states, 1 year cycle, and a 25-year time horizon. Clinical and cost data were collected from previous studies and other readily available secondary data sources. The incremental cost-effectiveness ratio (ICER) was estimated from the US third party payer perspective. Both, costs and outcomes, were discounted at a 3% annual discount rate. One way and probabilistic sensitivity analyses were performed to evaluate the impact of uncertainty on the base-case results.ResultsThe discounted incremental cost of metformin+DPP-4i compared to metformin+SU was $11,849 and the incremental life-years gained were 0.61, resulting in an ICER of $19,420 per life-year gained for patients in the metformin+DPP-4i treatment pathway. The ICER estimated in the probabilistic sensitivity analysis was $19,980 per life-year gained. Sensitivity analyses showed that the results of the study were not sensitive to changes in the parameters used in base-case.ConclusionsThe metformin+DPP-4i treatment pathway was cost-effective compared to metformin+SU as a long-term second-line therapy in the treatment of T2D from the US health care payer perspective. Study findings have the potential to provide clinicians and third party payers valuable evidence for the prescription and utilization of cost-effective second-line therapy after metformin monotherapy failure in the treatment of T2D.

Introduction: This systematic literature review analyzed published evidence on IgA nephropathy (IgAN), focusing on US epidemiology, health-related quality of life (HRQoL), and economic burden of illness.Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE®, Cochrane, and Econlit (January 2010 to June 2020) were searched, along with relevant congresses (2017)(2018)(2019)(2020).Results: Of 123 epidemiologic studies selected for data extraction, 24 reported IgAN diagnosis rates ranging from 6.3% to 29.7% among adult and pediatric patients undergoing renal biopsy, with all reported US rates <15%. No US studies reported IgAN prevalence. A meta-analysis of US studies calculated an annual incidence of 1.29/100 000 people, translating to an annual US incidence of 4236 adults and children. Relative to Europe, the United States had more patients diagnosed with IgAN in later chronic kidney disease stages. US rates of transition to end-stage renal disease (ESRD) ranged from 12.5% to 23% during 3-3.9 years of observation, rising to 53% during 19 years of observation. Across 8 studies reporting HRQoL, pain and fatigue were the most reported symptoms, and patients consistently ranked kidney function and mortality as the most important treatment outcomes. Patients with glomerulopathy reported worse mental health than healthy controls or hemodialysis patients; proteinuria was significantly associated with poorer HRQoL and depression. Conclusion:While economic evidence in IgAN remains sparse, management of ESRD is a major cost driver. IgAN is a rare disease where disease progression causes increasing patient burden, underscoring the need for therapies that prevent kidney function decline and HRQoL deterioration while reducing mortality. 37Kwon CS, et al. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCHthe potential for underdiagnosis or diagnostic delay in regions with limited screening, particularly for patients without severe symptoms. 2,3 It has been reported that up to 50% of patients with IgAN progress to ESRD within 20 years of clinical presentation. 4,[10][11][12] Risk factors for progression to ESRD include persistent proteinuria, hypertension, and reduced glomerular filtration rate. 6,9 Consequences of advanced CKD and kidney failure in IgAN include requirement for dialysis or transplantation, poor health-related quality of life (HRQoL), and increased mortality. 3,4,[13][14][15] Symptoms of CKD and adverse events due to dialysis have a substantial impact on HRQoL, daily living, and ability to work. 13,14 Moreover, patients who undergo transplantation remain at risk of IgAN recurrence due to the underlying pathophysiology. 16 All GN subtypes have the potential to recur post-transplantation, with the prevalence of GN recurrence between 3% and 15%. 17 In addition, kidney transplant patients must deal with the associated life-long regimen of medications to reduce the risk of graft rejection, lifestyle changes, self-care, and medical appointments required to maintain t...

The authors conducted a review of the medical charts of all patients between July 1998 and June 2002 who had undergone repair of advanced posterior vaginal prolapse and had at least 1 year of follow up. They identified 124 consecutive patients who had undergone site-specific rectocele repair and 183 consecutive patients who had standard posterior colporrhaphy without levator ani plication. This paper presents a comparison of patient outcomes from each of these procedures.A standard method was used for posterior colporrhaphy with no plication of the levator ani. In the site-specific procedure, the dissection to the rectovaginal septum was extended laterally to the arcus tendineus levator ani muscles and inferiorly to the perineal body, leaving an avascular plane of endopelvic connective tissue on the rectum. At this point, specific defects in the Denonvilliers' fascia were identified with the surgeon's finger in the patient's rectum. Using Allis clamps, connective tissues were pulled together over the defect and sutured using interrupted 0 polygalactin 910 sutures.There were no significant differences in patient characteristics or operative data between the 2 groups, but there were significant differences in rates of recurrence. Recurrence of posterior vaginal prolapse beyond the midvaginal plane (33% vs. 14%, P ϭ .001) or recurrence beyond the hymenal ring (11% vs. 4%, P ϭ .02), and recurrence of a symptomatic bulge (11% vs. 4%, P ϭ .02) were significantly more common among the patients who underwent site-specific repair compared with those who had posterior colporrhaphy. Also, the mean postoperative Bp point was significantly higher in the site-specific group (Ϫ2.2 vs. Ϫ2.7, P ϭ .001).The percentage of patients with dyspareunia before and after surgery for vaginal prolapse increased significantly (8% vs. 17%, P ϭ .001). Postoperative reports of constipation, diarrhea, abdominal pain, fecal incontinence, and flatus incontinence remained essentially unchanged from preoperative rates. There were no significant differences in pre-and postoperative symptoms, including dyspareunia, between the 2 groups. Rates of de novo occurrence and improvement of symptoms were similar in both groups. GYNECOLOGYVolume 60, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe "see and treat" method of cervical screening combines the diagnosis and treatment of premalignant cervical abnormalities by performing a loop electrosurgical excision procedure (LEEP) during the initial screening visit. Because 298Obstetrical and Gynecological Survey