No abstract

Due to the possibility to cure the disease, treatment duration in HCV is limited to a maximum of 48 weeks. The lengths of use of direct acting agents (DAA=s) are significantly different: 12 weeks with telaprevir vs. 24, 32 or 44 weeks with boceprevir. These factors make the implementation of futility rules in economic models critical. OBJECTIVES: To provide an insight on the proper application of the futility rules in economic evaluations of DAA=s. METHODS: A decision tree model was developed to assess cost-efficacy for each DAA, considering 4 patient types: naïve, relapsers, partial responders, and null responders. Average acquisition costs have been estimated with and without the use of futility rules; if these rules are used, corresponding salvage treatment costs were included. The efficacy of triple therapy treatment was defined by patient type based on each DAA's summary of product characteristics. Cost per patient with sustained virological response (SVR) and the number of cured and not cured patients was calculated with a fixed budget. RESULTS: For a 10 million EUR investment in each patient type for either DAA, using telaprevir offers maximum cured (726 vs. 587) and minimum non-cured patients (399 vs. 517) if futility rules are not considered. If the futility rules are used, there are still maximum cured patients (759 vs. 734) and minimum non-cured patients (450 vs. 697) when telaprevir is used. We performed one-way and two-way sensitivity analyses and the overall conclusion does not change vs. boceprevir. CONCLUSIONS: Telaprevir offers maximum cured and minimum non-cured patients regardless of the futility rule consideration when compared to boceprevir. If stopping rules are considered in economic evaluations for the treatment of HCV, an appropriate horizon timeline should also be considered to capture future unavoidable costs of non-cured patients: salvage treatment and/or potential disease progression.OBJECTIVES: Invasive Fungal Infections (IFIs) present a major issue in clinical practice, due to their high morbidity and mortality rates. In a pivotal multicentre, randomized clinical trial posaconazole prophylaxis prevented IFIs more effectively than did either fluconazole or itraconazole, and improved overall survival. The aim of this study was to perform an economic evaluation of the afore-mentioned therapeutic strategies for IFI prophylaxis in neutropenic patients, in the Greek health care setting. METHODS: A decision analytic model was developed, which described the course of neutropenic patients under posaconazole or standard azole (fluconazole or itraconazole) treatment. The effectiveness data for each treatment regimen were derived from published results of a pivotal, multicentre, randomized clinical trial. The cost and health care resources utilization data used, depict Greek clinical practice and are derived from official Greek sources. In order to obtain some of the model imputs, expert opinion from Greek Hematologists specializing in treating IFIs, was also used. RESULTS: Prophylaxis with Pos...

Forbidden transitions in the near-UV and visible wavelength of highly charged tungsten (W) ions are potentially useful as novel tungsten diagnostics means of fusion plasmas. Emission lines in 290–360 nm from Wq+ ions interacting with an electron beam of 540–1370 eV are measured, using a compact electron-beam-ion-trap. The charge states of 64 lines are identified as W20+–W29+. A magnetic-dipole (M1) line of W29+ between the excited states (4d84f)[(4d5/2−2)44f7/2]13/2→[(4d5/2−2)44f5/2]13/2 is newly identified; the wavelength is determined as 351.03(10) nm in air. The theoretical wavelength calculated using the multiconfiguration Dirac–Hartree–Fock method is in a good agreement with the measurement.