BACKGROUND:High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA).OBJECTIVE:To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service.METHODS:We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, life-years, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed.RESULTS:The incremental cost-effectiveness ratios are below €10 000 in all evaluated outcomes, being around €9100 per quality-adjusted life-year gained, €6700 per life-year gained, and €8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of €20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year.CONCLUSION:5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.ABBREVIATIONS:5-ALA, 5-aminolevulinic acidICER, incremental cost-effectiveness ratioLY, life-yearPFLY, progression-free life-yearQALY, quality-adjusted life-year
While routine monitoring poultry meat was obtained from breeding hens, dioxins contaminations were detected in Portugal. Levels of 430.9 pg PCDD/F-WHO-TEQ/g 1 were found, which are higher than the official limits legally allowed for this matrix (1.75 pg PCDD/F-WHO-TEQ/g). To identify the magnitude of the contaminations, 60 samples were collected from poultry farms and different matrices, namely: feed, water, wood shavings from the litters, muscle of the breeding hens, hatching eggs collected in the positive farm and muscle collected from broilers farms supplied by the positive breeding farm. The comparison of the dioxins congeners profiles showed that there was a coincidence of peaks of higher relative concentrations in the wood shavings, with the peaks of the highest relative concentration in the hatching eggs, especially the relative concentrations of the congeners 1,2,3,4,6,7,8-HpCDD and OCDD, which may be explained by the role of VLDLy in the delivery of triglycerides to the oocyte, where they will be used as the energy source for the developing embryo. The comparison of the dioxins congeners profiles of the breeding hens muscle with the poultry muscle, showed a coincidence of peaks of higher relative concentrations in the con- geners 1,2,3,7,8-PeCDD, 1,2,3,6,7,8-HxCDD, 1,2,3,4,6,7,8-HpCDD and OCDD which may indicate a dechlorination pathway "in vivo". Results allowed concluding that those wood shavings, improperly used as poultry litters, were certainly the source of contamination of the food chain.
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