Sorafenib is the only chemotherapeutic approved for treatment of advanced hepatocellular carcinoma (HCC). However, its effectiveness in patients with Child‐Pugh class B cirrhosis and any moderating effects of health system characteristics are unclear. We examined the survival and cost‐effectiveness associated with sorafenib in elderly patients with advanced HCC. We performed an analysis of Medicare beneficiaries with HCC diagnoses from 2007 to 2009. We compared advanced stage patients with HCC (American Joint Committee on Cancer stage III/IV) who received sorafenib within 6 months of diagnosis (and were otherwise untreated) to advanced stage patients with HCC who received no therapy (control). We performed univariate and multivariate analyses to identify predictors of survival. Incremental cost‐effectiveness ratios (ICERs) were calculated for sorafenib‐treated and control patients. We included 228 sorafenib‐treated patients and 870 control patients. The median survival of the sorafenib‐treated patients was 150.5 days versus 62 days for control patients. On multivariate analysis, significant predictors of improved survival were treatment with sorafenib (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.57‐0.77), being seen at a National Cancer Institute–designated cancer center (HR, 0.77; 95% CI, 0.62‐0.97), and being seen at a transplantation center (HR, 0.77; 95% CI, 0.65‐0.93). Predictors of worse survival included stage IV disease (HR, 1.40; 95% CI, 1.24‐1.58), decompensated cirrhosis (HR, 1.49; 95% CI, 1.30‐1.70), and treatment in an urban setting (HR, 1.45; 95% CI, 1.21‐1.73.) Although sorafenib use was associated with a survival benefit (HR, 0.61; 95% CI, 0.47‐0.79) among patients with decompensated cirrhosis, the median survival benefit was 31 days, and it was not cost‐effective (ICER, $224,914 per life year gained). Conclusion: Sorafenib is associated with improved survival in elderly patients with advanced HCC; however, it is not cost‐effective among those with hepatic decompensation. (Hepatology 2017;65:122‐133).

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In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in survival, 90-day hospitalization, or costs. These data highlight the need for a randomized clinical trial comparing these two modalities.

Purpose This study evaluated spatial access to mammography centers in Appalachia using both traditional access measures and the two-step floating catchment area (2SFCA) method. Methods Ratios of county mammography centers to women age 45 and older, driving time to nearest mammography facility, and various 2SFCA approaches were compared throughout Pennsylvania, Ohio, Kentucky, and North Carolina. Results Closest travel time measures favored urban areas. The 2SFCA method produced varied results depending on the parameters chosen. Appalachia areas had greater travel times to their closest mammography center. Appalachia areas in OH and NC had worse 2SFCA scores than non-Appalachia areas of the same states. Conclusion A relative 2SFCA approach, the spatial access ratio (SPAR) method, was recommended because it helped minimize the differences between various 2SFCA approaches.

This multicentre evaluation of a stewardship intervention in hospitalized CAP patients reduced the total antibiotic DOT and increased guideline-concordant DOT without adversely affecting patient outcomes.