A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induced Myopathy in Patients Initiating a Statin in Secondary Cardiovascular Prevention

Mitchell, Dominic; Guertin, Jason R.; Dubois, Anick; Dubé, Marie‐Pierre; Tardif, Jean‐Claude; Iliza, Ange Christelle; Fanton-Aita, Fiorella; Matteau, Alexis; LeLorier, Jacques

doi:10.1007/s40291-018-0323-2

Cited by 14 publications

(7 citation statements)

References 40 publications

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“…E 2 is secreted by the follicles in the ovaries, and this hormone can promote increased endometrial thickness and provide conditions for conception [ 21 ]. LH, SH, and E 2 levels are too low, then the sinus follicles are recruited and selected, inhibiting the formation of dominant follicles and leading to the occurrence of anovulation [ 22 ]. The combination of letrozole with urotropin significantly increases reproductive hormone levels and facilitates the production of estrogen in the late follicular development and postovulatory luteal phase, which acts on the endometrium and increases its thickness, making it more conducive to pregnancy [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study

Peng

Yuan

Mao

et al. 2022

Computational and Mathematical Methods in Medicine

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Aims. To ask lots of questions and try to find the truth about the medicine-based effectiveness of letrozole (LE) combined with human menopausal gonadotropin (HMG) in the treatment of inability to have children crops patients with endocrine (things that are different from what is usually expected and the effect on ovulation-related chemicals produced by the body). Materials and Methods. A total of 160 unable to have children crops patients with endocrine things that are different from what is usually expected who were treated in our hospital from March 2019 to March 2022 were selected as the subjects of this look at how things were in the past study and were divided into instance of watching, making a statement group was treated with human menopausal gonadotropin on the basis of the control group. The differences in serum related to the process of making children, chemical produced by the body levels, ovarian function, and ovulation induction effect between the two groups were watched and compared. Results. After treatment, LH, FSH, PRL, and E2 in the observation group were better than those in the control group. The ovarian volume, follicle size, follicle diameter, and endometrial thickness of the two groups of patients were significantly improved, and the observation group was better than the control group. Significance is P < 0.05 . After treatment, the ovarian volume, follicle size, follicle diameter, and endometrial thickness in the two groups were significantly improved, and the observation group was better than the control group, and the difference was statistically significant ( P < 0.05 ). The ovulation rate, pregnancy rate, singleton pregnancy rate, and multiple pregnancy rate of the observation group were higher than those of the control group, and the difference was statistically significant by the chi-square test ( P < 0.05 ). Conclusion. Letrozole can promote the improvement of sex hormones in infertile patients. After being combined with human menopausal gonadotropin treatment, the follicle development and ovulation of patients are significantly improved, and infertility is improved to a certain extent. It has a certain reference value in the clinical treatment of endocrine abnormal infertility.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study

Peng

Yuan

Mao

et al. 2022

Computational and Mathematical Methods in Medicine

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“…This study found that the use of a pharmacogenomic test is a beneficial strategy for any test costing less than CAN$356 (Canadian dollars) [35]. This was further supported by another study that found that in highrisk populations, using pharmacogenomic testing is also cost-effective to maintain patients on a statin given the cardiovascular benefit, despite possible risk of rhabdomyolysis [36].…”

Section: The Somatosensory Amplification Scale (Sas)mentioning

confidence: 57%

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Singh¹,

Sirna²,

Dajani³

et al. 2019

Cardiovasc Disord Med

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Background: Lipid management with statins is one of the mainstays of treatment for atherosclerotic cardiovascular disease. Statins are often discontinued by patients secondary to muscle-related complaints independent of elevations in creatine kinase. It has also been suggested that there is a link between mental health disorders and noncompliance. The associations between negative affect and somatization reported as medication-related side effects requires further clarification. One possible cause of statin discontinuation is perceived myopathy secondary to somatization.Objective: This study examines the relationship between affect in statin tolerant and statin intolerant (SI) groups.Methods: This study incorporated patients unable to tolerate at least two different statins (any statin or dosage prescribed) due to side effects or abnormal laboratory markers. Patients completed The Depression Anxiety Stress Scales, the McGill Pain Questionnaire, and the Somatosensory Amplification Scale.Results: There were 20 statin tolerant (ST) patients and 13 SI patients (n=36). There was a significant difference between SI and ST groups, respectively, in age (63 vs. 70 years, p=0.04), total cholesterol (204 vs.136, p <0.01), and LDL cholesterol (129 vs. 136, p < 0.05). There were no significant differences between ST and SI groups for somatic pain, affective pain, somatosensory amplification, depressive symptoms, anxiety symptoms, and stress scores. Conclusion:Our study suggests the discrepancy between statin intolerance in clinical trials and clinical practice cannot be explained solely by somatosensory amplification, anxiety, depression or pain disorders. Nevertheless, an affective and/or anxiety disorder will likely augment the pain perception and somatization in a SI patient.

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“…Other approaches such as using decision trees might be limited by the robustness of findings as it over-simplifies the complexity of the consequences of the decisions [ 20 ]. While the Discrete Event Simulation (DES) model is more flexible and offers retention of patient history and risk profile updates for each event, it is much more complicated and not readily replicable compared to the Markov model [ 19 , 21 ]. Decision models such as the decision tree are too simplistic, while the dynamic model requires advanced knowledge in statistics or programming and usually more preferable in infectious disease modelling [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

Mohd Hassan,

Bahari,

Raman

et al. 2024

BMC Health Serv Res

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Background Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). Methods A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. Results Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies. Conclusions The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.

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A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induced Myopathy in Patients Initiating a Statin in Secondary Cardiovascular Prevention

Cited by 14 publications

References 40 publications

Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study

Efficacy of Letrozole Combined with Urinary Gonadotropin for Ovulation Induction in Endocrine Abnormal Infertility Patients: A Retrospective Single-Center, Case-Control Study

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

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