Background Acquired haemophilia A (AHA) is an autoimmune bleeding disorder with significant morbidity and mortality. Bleeding AHA patients with high titre inhibitors can be treated with either activated prothrombin complex concentrate (aPCC) or recombinant activated factor VII (rFVIIa). Given that both replacement therapies have inherent benefits and limitations, a cost‐effectiveness analysis (CEA) was performed in this population to compare rFVIIa with aPCC. Methods In high‐titered AHA patients with bleeding treated with either aPCC or rFVIIa, during a 5‐day study period, a Markov model was developed such that these patients were transitioned into four different health states: (1) continuous bleeding, (2) thrombosis, (3) stop bleeding and (4) death, with states (2), (3) and (4) modelled as absorbing states. Model parameters, including probabilities, health utility index and costs, were gathered from the medical literature, except for the costs of aPCC and rFVIIa, which were obtained from our institutional data. Results During the 5‐day period, the total treatment cost of rFVIIa was substantially more than the cost of aPCC ($13 635 vs. $1741). The average quality‐adjusted life days (QALDs) gained for rFVIIa were slightly lower compared to aPCC (4·08 vs. 4·09). Overall, aPCC prevailed over rFVIIa. Sensitivity analysis confirmed the robustness of the model across tested ranges of all input variables. Conclusion In high‐titered AHA patients with bleeding, aPCC is a cost‐effective treatment option when compared to rFVIIa. Thus, aPCC may be considered in these patients, if available, and provided there is no clinical contraindication.
High-quality evidence to support clinical practice is lacking in apheresis medicine compared to other therapeutic modalities. A potential source of evidence comes from the abstracts submitted to the Annual Meetings of the American Society for Apheresis (ASFA). Therefore, the goal of this study is to determine the proportion of abstracts from the 2005 to 2012 ASFA Annual Meetings that subsequently became PubMed-indexed publications. Furthermore, we sought to determine the factor(s) that were associated with the likelihood of abstracts to be published as full manuscripts. During the 8-year study period, 684 abstracts were available for analysis (median: 82/year, range: 64-118). Most abstracts (74%) were from US institutions, and 67% of first authors were affiliated with academic centers. There were more abstracts (64%) on therapeutic versus donor apheresis (20%) and cellular therapy (16%). Overall, 16% of the abstracts have been published in PubMed-indexed journals, with a median time of 17 months from the ASFA Annual Meeting (range: 1-96 months). Abstracts whose first authors were affiliated with academic institutions were 3.14 times more likely to have been published than abstracts with ones affiliated with an apheresis organization and/or a community hospital. However, neither the first author's location nor the type of apheresis procedure significantly affected the publication rate after adjusting for other covariates. In conclusion, the rate of publication is low and authors should be encouraged to follow their presentations at the meeting with peer-reviewed manuscripts. This change is essential to provide more published evidence for future apheresis practice guidelines. J. Clin. Apheresis 31:353-358, 2016. © 2015 Wiley Periodicals, Inc.
Purpose: Identification of mental healthcare disparities through scales or questionnaires is an initial step to improve mental healthcare equity. This study was designed to investigate the performance of a single-item question relative to two psychiatric scales with multiple items in assessing mental healthcare disparities among U.S. adults using the Behavioral Risk Factor Surveillance System (BRFSS) data.Methods: The current depression (CD) and serious psychological distress (SPD) were analyzed in 2010 and 2012 with the BRFSS using two multiple-item scales in selected states. Receipt of mental health diagnosis and mental health treatment was ascertained respectively. In both years, a single item of the number of mentally unhealthy days from Centers for Disease Control Health-Related Quality of Life-4 (CDC-HRQOL-4) core questions was used to ascertain frequent mental distress (FMD) in all states. Logistic regression was used to identify mental healthcare disparities among subpopulations. The t-test was used to analyze missing data patterns.Results: Among adults who experienced FMD or CD in 2010, men, persons 65 years of age or older, non-Hispanic Blacks, persons who were currently or never married, and persons who were employed had a lower likelihood of receiving diagnosis of depression. Among adults who experienced FMD or SPD in 2012, men, persons 65 years of age or older, Hispanics and Blacks, persons who were currently employed or homemakers/students, and persons without healthcare coverage had a lower likelihood to receive mental health treatment. The missing rates of FMD were 1.8% (2010) and 1.4% (2012), while the missing rates of Patient Health Questionnaire 8 (PHQ-8) and Kessler 6 (K6) were 12.8% (2010) and 17.4% (2012). The samples with missing data were different from those without.Conclusions: The single-item question is a valuable alternative in a large population surveillance to identify vulnerable subpopulations for lower mental health diagnosis and treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.