Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany

To cite this article: Mertens J, Stock S, Lüngen M, Berg AV, Kr?mer U, Filipiak-Pittroff B, Heinrich J, Koletzko S, Grübl A, Wichmann H-E, Bauer C-P, Reinhardt D, Berdel D, Gerber A. Is Prevention of Atopic Eczema with Hydrolyzed Formulas Cost-Effective? A Health Economic Evaluation from Germany. Pediatr Allergy Immunol 2012: 23: 597-604. ABSTRACT: Objective: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4?months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. Patients and Methods: Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. Results: The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478?€ per child treated in the ITT analysis (CI95%: 12?€; 852?€) and 979?€ in the PP analysis (95%CI: 355?€; 1455?€) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404?€, PP -6358?€). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. Conclusions: For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.     

Bone marrow-derived mesenchymal stem cells versus adipose-derived mesenchymal stem cells for peripheral nerve regeneration

Studies have confirmed that bone marrow-derived mesenchymal stem cells(MSCs) can be used for treatment of several nervous system diseases. However, isolation of bone marrow-derived MSCs(BMSCs) is an invasive and painful process and the yield is very low. Therefore, there is a need to search for other alterative stem cell sources. Adipose-derived MSCs(ADSCs) have phenotypic and gene expression profiles similar to those of BMSCs. The production of ADSCs is greater than that of BMSCs, and ADSCs proliferate faster than BMSCs. To compare the effects of venous grafts containing BMSCs or ADSCs on sciatic nerve injury, in this study, rats were randomly divided into four groups: sham(only sciatic nerve exposed), Matrigel(MG; sciatic nerve injury + intravenous transplantation of MG vehicle), ADSCs(sciatic nerve injury + intravenous MG containing ADSCs), and BMSCs(sciatic nerve injury + intravenous MG containing BMSCs) groups. Sciatic functional index was calculated to evaluate the function of injured sciatic nerve. Morphologic characteristics of nerves distal to the lesion were observed by toluidine blue staining. Spinal motor neurons labeled with Fluoro-Gold were quantitatively assessed. Compared with sham-operated rats, sciatic functional index was lower, the density of small-diameter fibers was significantly increased, and the number of motor neurons significantly decreased in rats with sciatic nerve injury. Neither ADSCs nor BMSCs significantly improved the sciatic nerve function of rats with sciatic nerve injury, increased fiber density, fiber diameters, axonal diameters, myelin sheath thickness, and G ratios(axonal diameter/fiber diameter ratios) in the sciatic nerve distal to the lesion site. There was no significant difference in the number of spinal motor neurons among ADSCs, BMSCs and MG groups. These results suggest that neither BMSCs nor ADSCs provide satisfactory results for peripheral nerve repair when using MG as the conductor for engraftment.     

Hepatitis C virus reactivation in cancer patients in the era of targeted therapies

The purpose of this review is to summarize the evidence of hepatitis C reactivation in cancer patients in the era of targeted therapies.Targeted therapies are novel therapeutics frequently used in cancer patients.During treatment with targeted therapies,viral replication is one of the major problems that can occur.The PubMed database,ASCO,and ASCO Gastrointestinal Cancer Symposium abstracts were searched up until September 15,2013 using the following search keywords:"targeted therapies,rituximab,alemtuzumab,brentuximab,hepatitis,hepatitis C reactivation,tyrosine kinase inhibitors,imatinib,mammalian target of rapamycin(mTOR)inhibitors,everolimus,anti-HER therapies,trastuzumab,pertuzumab,lapatinib,antiepidermal growth factor receptor therapies,cetuximab,panitumumab,and ipilimumab".Papers considered relevant for the aim of this review were selected by the authors.The data about rituximab-induced hepatic flare in hepatitis C virus(HCV)positive patients is controver-sial.However,there is the possibility of life-threatening hepatic flare that can develop after HCV ribonucleic acid(HCV-RNA)viral load increases.Routine followup of liver function tests should be advised.Especially in high-risk patients,such as those with baseline chronic active hepatitis and cirrhosis,and where there are plans to administer rituximab concomitantly with corticosteroids,it is advised to have close follow-up of HCV viral load.The data is insufficient to make accurate statements about the association of alemtuzumab therapy and HCV reactivation.However,alemtuzumab may cause deep immunosuppression.Due to this,it is better to follow up with liver function tests and HCV RNA levels during alemtuzumab therapy.Brentuximab has effects on antibody dependent cellular toxicity and may decrease humoral immunity.Thus,we believe that during brentuximab treatment of HCV infected patients,clinicians may encounter hepatitis C reactivation.There have been no reported cases of hepatitis C reactivation with imatinib therapy.However,there are many reports of hepatitis B reactivation with imatinib treatment.Based on the evidence of hepatitis B reactivation with imatinib and the effects of imatinib on immune system functions,we suggest that imatinib therapy might be a risk factor for HCV reactivation.Anti-human epidermal growth factor receptor 2 therapies are not associated with hepatic flare in HCV infected patients.Post-transplant studies reported that mTOR was safely administered to patients with active hepatitis C without causing hepatic flare.Cetuximab and panitumumab have not been associated with HCV reactivation.Two cases of HCV infected melanoma were safely treated with ipilimumab without any HCV reactivation or hepatic flare.Targeted therapies are a new and emerging area of oncology treatment modalities.While treating HCV infected cancer patients,clinicians should be mindful of the immunosuppressive properties of targeted therapies.Further randomized trials are needed to establish algorithms for this issue.     

多方面分析患者病种让外科医生及时救死扶伤

随着交通的日益便捷，生活的水平提高，人们的患病率和病种也在不断的提高和增多。作为外科急诊手术医师，掌握患者病情，了解患者病种，对提高患者的存活率有很大的帮助。所以我院急诊外科医生整理了近三年的手术患者病种的疾病分类并进行了分析，提高了急诊医师的技术水平。     

Ecological study of gastric cancer in Brazil:Geographic and time trend analysis

AIM:To investigate the geographic distributions and time trends of gastric cancer(GC)incidence and mortality in Brazil.METHODS:An ecological study of the DATASUS registry was conducted by identifying hospitalizations for GC between January 2005 and December 2010.The data included information on the gender,age,and town of residence at the time of hospital admission and death.RESULTS:The GC rates,adjusted according to available hospital beds,decreased from 13.8 per 100000in 2005 to 12.7 per 100000 in 2010.The GC rates decreased more among the younger age groups,in which the male-to-female difference also decreased in comparison to the older age groups.Although the lethality rates tended to increase with age,young patients were proportionally more affected.The spatial GC distribution showed that the rates were higher in the south and southeast.However,while the rates decreased in the central-west and south,they increased in the northern regions.A geographic analysis showed higher rates of GC in more urbanized areas,with a coast-toinland gradient.Geographically,GC lethality overlapped greatly with the hospital admission rates.CONCLUSION:The results of this study support the hypothesis of a critical role for environmental factors in GC pathogenesis.The declining rates in young patients,particularly males,suggest a relatively recent decrease in the exposure to risk factors associated with GC.The spatial distribution of GC indicates an ongoing dynamic change within the Brazilian environment.     

尼勒克县哈萨克族弓形体感染状况的血清学调查

弓形体病是人畜共患寄生虫病,传染源是动物。在牧区哈萨克族与动物接触比较密切。为了解本民族弓形体感染状况,1992年底我们对新疆尼勒克县部分农牧场收集的人血清进行了弓形体血清学调查。