Background A systematic literature review of the performance of 18Fluorine-fluciclovine PET/CT for imaging of men with recurrent prostate cancer was performed. Methods Scientific literature databases (MEDLINE, ScienceDirect and Cochrane Libraries) were searched systematically during Oct 2020 using PRISMA criteria. No limit was put on the date of publication. Prospective studies reporting a patient-level 18F-fluciclovine detection rate (DR) from ≥25 patients with recurrent prostate cancer were sought. Proceedings of relevant meetings held from 2018 through Oct 2020 were searched for abstracts meeting criteria. Results Searches identified 321 unique articles. In total, nine articles (six papers and three conference abstracts), comprising a total of 850 patients met inclusion criteria. Most studies (n = 6) relied on ASTRO-Phoenix Criteria, EAU-ESTRO-SIOG, and/or ASTRO-AUA guidelines to identify patients with biochemical recurrence. Patients’ PSA levels ranged from 0.02–301.7 ng/mL (median level per study, 0.34–4.10 ng/mL [n = 8]). Approximately 64% of patients had undergone prostatectomy, but three studies focused solely on post-prostatectomy patients. Adherence to imaging protocol guidelines was heterogeneous, with variance seen in administered activity, uptake and scan times. Overall patient-level DR varied between studies from 26% to 83%, with 78% of studies reporting a DR > 50%. DR was proportional to PSA, but even at PSA < 0.5 ng/mL DR of up to 53% were reported. Prostate/bed DR (n = 7) ranged from 18% to 78% and extra-prostatic rates (n = 6) from 8% to 72%. Pelvic node and bone lesion DR ranged from 8% to 47% and 0% to 26%, respectively (n = 5). 18F-Fluciclovine PET/CT was shown to impact patient management and outcomes. Two studies reported 59–63% of patients to have a management change post-scan. A further study showed significant increase in failure-free survival following 18F-fluciclovine-guided compared with conventional imaging-guided radiotherapy planning. Conclusions 18F-Fluciclovine PET/CT shows good performance in patients with recurrent prostate cancer leading to measurable clinical benefits. Careful adherence to recommended imaging protocols may help optimize DR.

Computer modeling and simulations using a meta-model built from data extracted from publications suggest that rapid and straightforward conversion from transdermal to buccal buprenorphine is feasible.

The objective of this study was to evaluate the modern utilization of penile prosthesis surgery based on data derived from national claim databases and contrast to an analysis of patients similarly treated at an academic center during a contemporaneous period. A retrospective claim analysis utilizing a national database (MarketScan, Thomson Reuters) was performed for Commercial insurer and Medicare databases between January 2000 and March 2011. A retrospective analysis of contemporaneous penile prosthesis implantation at the Johns Hopkins Hospital (JHH) was done. Population demographics, comorbidities, previous (ED) therapies and time from ED diagnosis to surgery were assessed. Median ages for patients undergoing penile prosthesis implantation were 58, 70 and 63 years for the Commercial, Medicare and JHH cohorts, respectively. For the claim databases (Commercial, Medicare, respectively), hypertension (72%, 78%), dyslipidemia (71%, 56%) and diabetes mellitus (45%, 40%) were predominant comorbidities, whereas for the JHH database prostate cancer (51%) and its management by prostatectomy (45%) or radiation (12%) were predominant. Previous use of PDE5 inhibitors was similar across databases (60, 58 and 69% for Commercial, Medicare and JHH cohorts, respectively), although previous use of non-oral ED therapies was greater in the JHH database. Median time to surgery from initial ED diagnosis was 2, 2 and 4 years for the Commercial, Medicare and JHH patients, respectively. Demographic variables and ED risk factors associated with penile prosthesis surgery at a national population-based level over a contemporary period were defined. Some differences in utilization trends of penile prosthesis surgery exist at a single institutional level.

Purpose: To quantify the total cost for a 3-month episode of care after treatment with collagenase Clostridium histolyticum (CCH) (Xiaflex) versus fasciectomy for Dupuytren contracture (DC) in the United States. Methods: Adult patients treated for DC (single finger only) with either CCH or fasciectomy from January, 2012 to June, 2016 were identified (the first treatment was the index date) from the IQVIA Real-World Data Adjudicated Claims-US Database. Patients had continuous health plan enrollment 360 days or more pre-index (pre-index) and 90 days or more post-index (follow-up), and one or more pre-index medical claims with a DC diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification 728.6; International Classification of Diseases, 10th Revision, Clinical Modification M72.0). Patients with pre-index treatment for DC were excluded. The primary outcome was the comparison of allcause and DC-specific health care costs paid by the health plan over the 3-month follow-up. We defined DC-specific as claims with a DC diagnosis, DC-related therapies, and all claims associated with the index date and day after. Generalized linear models compared adjusted all-cause and disease-specific total costs. Results: A total of 1,654 CCH and 2,745 fasciectomy patients were identified (mean age, 59.7 and 58.0 years; 81.8% and 74.4% male; respectively). Fasciectomy patients had higher mean total all-cause costs compared with CCH patients in the follow-up

The objective of this study was to quantify the direct medical resources used and the corresponding burden of disease in the treatment of patients with schizophrenia. Because low-frequency administration (LFA) of risperidone guarantees adherence during treatment intervals and offers fewer opportunities to discontinue, adherence and persistence were assumed to improve, thereby reducing relapses of major symptoms.A decision tree model including Markov processes with monthly cycles and a five-year maximum timeframe was constructed. Costs were adapted from the literature and discounted at a 3% annual rate. The population is a demographically homogeneous cohort of patients with schizophrenia, differentiated by initial disease severity (mildly ill, moderately ill, and severely ill). Treatment parameters are estimated using published information for once-daily risperidone standard oral therapy (RIS-SOT) and once-monthly risperidone long-acting injection (RIS-LAI) with LFA therapy characteristics derived from observed study trends. One-year and five-year results are expressed as discounted direct medical costs and mean number of relapses per patient (inpatient, outpatient, total) and are estimated for LFA therapies given at three, six, and nine month intervals.The one-year results show that LFA therapy every 3 months (LFA-3) ($6,088) is less costly than either RIS-SOT ($10,721) or RIS-LAI ($9,450) with similar trends in the 5-year results. Moreover, the model predicts that LFA-3 vs. RIS-SOT vs. RIS LAI therapy will reduce costly inpatient relapses (0.16 vs. 0.51 vs. 0.41). Extending the interval to six (LFA-6) and nine (LFA-9) months resulted in further reductions in relapse and costs.Limitations include the fact that LFA therapeutic options are hypothetical and do not yet exist and limited applicability to compare one antipsychotic agent versus another as only risperidone therapy is evaluated. However, study results have quantified the potential health state improvements and potential direct medical cost savings achievable with the development and use of LFA medication delivery technologies.