The addition of dexamethasone to mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with mepivacaine alone.

The recently reported Chest Radiotherapy Extensive Stage Trial (CREST) showed that administering thoracic radiation therapy (TRT) after a response to first-line chemotherapy improves 2-year overall (OS) and progression-free survival, without an increase in adverse events, in patients with extensive stage small cell lung cancer (ES-SCLC). We evaluated the cost-effectiveness of adding TRT to chemotherapy and prophylactic cranial irradiation (PCI) in ES-SCLC patients. Materials/Methods: Using a partitioned survival model, a cost-utility analysis was performed to compare strategies of TRT (30 Gy in 10 fractions via 3-D conformal RT) plus PCI versus PCI alone. The time horizon was limited to 24 months, the median follow-up of CREST. OS was partitioned into three mutually exclusive health states: alive with no progression (ANP), alive with progression (AWP), and dead. The proportion of patients in each health state over time was based on the empirical survival functions reported in CREST. Institutional treatment costs from a payer perspective were used while utilities were derived from the published literature. Incremental cost-effectiveness ratios (ICER) were calculated per quality-adjusted life year (QALY) using a 3% discount rate. Sensitivity analyses addressed plausible ranges of uncertainty in key variables including costs, utilities, and the TRT survival benefit.

No abstract