Current chemotherapy strategies used in clinic appear with lots of disadvantages due to the low targeting effects of drugs and strong side effects, which significantly restricts the drug potency, causes multiple dysfunctions in the body, and even drives the emergence of diseases. Immunotherapy has been proved to boost the body’s innate and adaptive defenses for more effective disease control and treatment. As a trace element, selenium plays vital roles in human health by regulating the antioxidant defense, enzyme activity, and immune response through various specific pathways. Profiting from novel nanotechnology, selenium nanoparticles have been widely developed to reveal great potential in anticancer, antibacterial, and anti-inflammation treatments. More interestingly, increasing evidence has also shown that functional selenium nanoparticles can be applied for potential immunotherapy, which would achieve more effective treatment efficiency as adjunctive therapy strategies for the current chemotherapy. By directly interacting with innate immune cells, such as macrophages, dendritic cells, and natural killer cells, selenium nanoparticles can regulate innate immunity to intervene disease developments, which were reported to boost the anticancer, anti-infection, and anti-inflammation treatments. Moreover, selenium nanoparticles can also activate and recover different T cells for adaptive immunity regulations to enhance their cytotoxic to combat cancer cells, indicating the potential of selenium nanoparticles for potential immunotherapy strategy development. Here, aiming to enhance our understanding of the potential immunotherapy strategy development based on Se NPs, this review will summarize the immunological regulation effects of selenium nanoparticles and the application of selenium nanoparticle-based immunotherapy strategies. Furthermore, we will discuss the advancing perspective of selenium nanoparticle-based potential immunotherapy as a kind of novel adjunctive therapy to enhance the efficiency of current chemotherapies and also introduce the current obstacles for the development of selenium nanoparticles for potential immunotherapy strategy development. This work is expected to promote the future research on selenium nanoparticle-assisted immunotherapy and finally benefit the more effective disease treatments against the threatening cancer and infectious and chronic diseases.

Background Hyperkalemia (HK) is a barrier to optimization of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy in heart failure (HF) and chronic kidney disease (CKD). We investigated cardiorenal risk associated with changes in RAASi regimen after an episode of HK in patients with HF and/or CKD. Methods This observational study utilized data from hospital records, claims, and health registers from the US (Optum’s de-identified Market Clarity Data) and Japan (Medical Data Vision). Included patients had an index episode of HK between July 2019 and September 2021 (US), or May 2020 and September 2021 (Japan), with prior diagnosis of HF or CKD (stage 3 or 4), and RAASi use. Risk of a cardiorenal composite outcome (HF emergency visit, HF hospitalization, or progression to end-stage kidney disease) was determined in patients who discontinued RAASi, down-titrated their dose by > 25%, or maintained or up-titrated their dose following the HK episode. Results A total of 15,488 and 6020 patients were included from the US and Japan, respectively. Prior to the episode of HK, 59% (US) and 27% (Japan) of patients had achieved > 50% target RAASi dose. Following the episode of HK, 33% (US) and 32% (Japan) of patients did not fill a new RAASi prescription. Risk of the cardiorenal outcome at 6 months was higher in patients who discontinued or down-titrated versus maintained or up-titrated RAASi treatment both in the US (17.5, 18.3, and 10.6%; p <  0.001) and in Japan (19.7, 20.0, and 15.1%; p <  0.001). Conclusion HK-related RAASi discontinuation or down-titration was associated with higher risk of cardiorenal events versus maintained or up-titrated RAASi.

Background Hyperkalaemia is common in patients with chronic kidney disease (CKD) and is associated with a range of adverse outcomes. Historically, options for management of chronic hyperkalaemia in the outpatient setting have been limited. Novel oral potassium binders provide a safe, effective therapy for maintenance of normokalaemia in patients with CKD, but despite being approved for reimbursement in many countries, prescription data indicate uptake has been slower than anticipated. This analysis aimed to demonstrate the value to patients and the healthcare system of the potassium binder sodium zirconium cyclosilicate (SZC) for treatment of hyperkalaemia in patients with CKD in Norway and Sweden. Methods A published simulation model reflecting the natural history of CKD was adapted to the Norwegian and Swedish settings and used to predict long-term health economic outcomes of treating hyperkalaemia with SZC versus usual care. Results SZC was highly cost effective compared to usual care in Norway and Sweden, with incremental cost-effectiveness ratios of €14,838/QALY in Norway and €14,352/QALY in Sweden, over a lifetime horizon. The acquisition cost of SZC was largely offset by cost savings associated with reductions in hyperkalaemia events and hospitalisations; a modest overall increase in costs was predominantly attributable to costs associated with gains in life years compared with usual care. SZC remained cost effective in all scenarios examined. Conclusions SZC was estimated to be cost effective for treating hyperkalaemia. Consequently, improving access to a clinically effective, safe and cost-effective therapy, such as SZC, may result in considerable benefits for CKD patients with hyperkalaemia.

Programme (DAP) evaluates the cost-effectiveness of diagnostic technologies. A decision-making process benchmarking the incremental costeffectiveness ratio (ICER) against a threshold while considering decision-modifying factors is common to NICE evaluations. This study investigated whether DAP decisions are consistent with the ICER thresholds described in the DAP manual, and to assess the impact of decision-modifying factors.Methods: DAP evaluations published before March 2018 were reviewed, and the following items were extracted: diagnostic technologies evaluated, decision problems assessed, Diagnostics Advisory Committee (DAC) decisions, incremental qualityadjusted life years (QALYs), incremental costs, ICERs considered to be most plausible by the DAC, and decision justifications.Results: All 30 evaluations were reviewed; 8 were excluded because the DAC concluded there was "insufficient evidence" for decision making. In the remaining 22 evaluations, 91 decision problems were identified for further analysis, of which 52, 15, and 24 received "recommended," "not recommended," and "not recommended-only in research" guidance, respectively. The overall consistency rate of the DAC decisions with the £20 000/QALY threshold was 73.6%. Diagnostic technologies that were not recommended, despite an ICER less than £20 000/QALY, were associated with a larger number of decision-modifying factors favoring the comparator, versus recommended diagnostic technologies with ICERs less than £20 000/QALY. For technologies with ICERs greater than £20 000/QALY, the number of decision-modifying factors was comparable for positive and negative recommendations.Conclusions: Most DAP decisions were consistent with the ICER threshold. However, cost-effectiveness was not the only determining factor in decision making; recommendations also considered patient-and healthcare-centric factors and uncertainty.

Background and Aims Chronic kidney disease (CKD) is a chronic and progressive disease which imposes a significant burden on patients and healthcare systems as the disease progresses, particularly in patients who reach end-stage kidney disease (ESKD). Dapagliflozin was established to be an efficacious treatment for CKD in the DAPA-CKD study, where it was associated with a significant reduction in the incidence of CKD progression, ESKD, hospitalization for heart failure (HHF) and death in comparison with standard care alone. A vital component of a new treatment's health economic evaluation is to assess its potential budget impact, particularly in conditions with high prevalence in the general population such as CKD. As such, this study's objective was to estimate the budget impact of introducing dapagliflozin for the treatment of CKD in the UK from an NHS perspective. Method A model was developed to estimate the three-year budget impact of the introduction of dapagliflozin in addition to standard care (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) vs. standard care alone for the treatment of CKD in the UK. The size of the eligible patient population was estimated based on overall CKD prevalence, and the proportion of all CKD patients who would have been eligible for inclusion in DAPA-CKD. In total, 929,000 patients were estimated to be eligible for treatment with dapagliflozin in the UK. The analysis assumed that 5% of CKD patients would receive treatment with dapagliflozin in the first year, increasing to 15% in the second year and 20% in the third year. The relative market share of individual components of background standard care was assumed to remain constant over time, with the distribution informed by the baseline characteristics from DAPA-CKD. Event rates from DAPA-CKD were used to predict the incidence of CKD progression (≥50% decline in estimated glomerular filtration rate), ESKD, HHF, acute kidney injury, hyperkalaemia and death to estimate cost-offsets associated with reduced event incidence. Published event and drug acquisition costs were applied to the incidence of modelled events. Results The introduction of dapagliflozin was estimated to reduce total three-year costs associated with CKD management by £114.0M, from £6.6B to £6.5B in the patient population eligible for treatment with dapagliflozin. Cost-savings were driven by a reduction in the incidence of CKD progression events (122.7K vs. 130.5K with and without the introduction of dapagliflozin, respectively), ESKD (99.2K vs. 103.8K) and HHF (44.2K vs. 41.3K) over a three-year time horizon. Cumulative three-year drug acquisition costs were estimated to increase by £177.4M following the introduction of dapagliflozin when used in addition to standard care. However, the cumulative cost-offsets associated with reduced incidence of clinical events was £291.3M over the three-year model time horizon, with reduced incidence of ESKD resulting in the largest cost-saving (£4.8B vs. £5.0B). Conclusion The introduction of dapagliflozin for the treatment of CKD is estimated to be cost-saving over a three-year horizon in comparison with standard care, even when considering additional drug acquisition costs. Dapagliflozin has the potential to significantly ameliorate the clinical and economic burden imposed by CKD on patients and the NHS.