Accounting for Cured Patients in Cost-Effectiveness Analysis

Background

Economic evaluations often measure an intervention effect with mean overall survival (OS). Emerging types of cancer treatments offer the possibility of being “cured” in that patients can become long-term survivors whose risk of death is the same as that of a disease-free person. Describing cured and noncured patients with one shared mean value may provide a biased assessment of a therapy with a cured proportion.

Assessing the prediction accuracy of a cure model for censored survival data with long-term survivors: Application to breast cancer data

The Cox proportional hazards cure model is a survival model incorporating a cure rate with the assumption that the population contains both uncured and cured individuals. It contains a logistic regression for the cure rate, and a Cox regression to estimate the hazard for uncured patients. A single predictive model for both the cure and hazard can be developed by using a cure model that simultaneously predicts the cure rate and hazards for uncured patients; however, model selection is a challenge because of the lack of a measure for quantifying the predictive accuracy of a cure model. Recently, we developed an area under the receiver operating characteristic curve (AUC) for determining the cure rate in a cure model (Asano et al., 2014), but the hazards measure for uncured patients was not resolved. In this article, we propose novel C-statistics that are weighted by the patients’ cure status (i.e., cured, uncured, or censored cases) for the cure model. The operating characteristics of the proposed C-statistics and their confidence interval were examined by simulation analyses. We also illustrate methods for predictive model selection and for further interpretation of variables using the proposed AUCs and C-statistics via application to breast cancer data.     

Barriers to HIV remission research in low‐ and middle‐income countries

Introduction : HIV eradication and remission research has largely taken place in high‐income countries. In low‐ and middle‐income countries (LMIC), there may be factors that have a substantial impact on the size of the latent HIV reservoir and the immunological response to infection. If a curative strategy is to be available to all HIV‐infected individuals, these factors must be understood. Methods : We use a scoping review to examine the literature on biological factors that may have an impact on HIV persistence in LMIC. Three databases were searched without date restrictions. Results : Uncontrolled viral replication and higher coinfection prevalence may alter the immunological milieu of individuals in LMIC and increase the size of the HIV reservoir. Differences in HIV subtype could also influence the measurement and size of the HIV reservoir. Immune activation may differ due to late presentation to care, presence of chronic infections, increased gut translocation of bacterial products and poor nutrition. Conclusions : Research on HIV remission is urgently needed in LMIC. Research into chronic immune activation in resource poor environments, the immune response to infection, the mechanisms of HIV persistence and latency in different viral clades and the effect of the microbiological milieu must be performed. Geographic differences, which may be substantial and may delay access to curative strategies, should be identified.     

Symptomatology, localization and treatment of recurrent cervical carcinoma

In a group of 367 women treated for invasive carcinoma of the cervix tumor recurrence was discovered at an asymptomatic stage in 16 (23%) patients. The tumor recurrence was localized to the pelvis in 29 (41%) cases, in the vaginal wall in 3 (4%) cases, and 39 (55%) patients had distant metastases (with or without recurrent tumor in the pelvis). Curative treatment (surgery, n = 2; radiotherapy, n = 8) was applied in 5/29 (17%) patients whose recurrent disease was confined to the pelvis, in all 3 patients with vaginal recurrence and in 2/39 (5%) of the patients with distant metastases. Permanent remission (follow-up > 36 months) was observed in 2 patients with vaginal recurrence and in one with central recurrence. Temporary complete remission (mean 22 months, range 12–30 months) was observed in 3 patients (2 with central recurrence and one with vaginal recurrence). In 20 (69%) of the patients with central or locoregional recurrence, the primary treatment had been so radical (including adjuvant postoperative or full radiotherapy) that surgical treatment or radiotherapy of the recurrence was not considered possible or worthwhile; moreover, 4 of the patients were older than 80 years of age. In retrospect, exenterative treatment could have been considered in 14 patients (< 70 years) and based on 50% operability, could have led to a cure in 2 to 4 patients with tumor recurrence in the pelvis without distant metastases. Chemotherapy was applied to 10 patients, one of whom went into complete remission of lung metastases (follow-up 108 months).     

Single-dose methotrexate Combined with Chinese medicinal herbs treated unruptured and ruptured ectopic pregnancy

pregnancy(EP)hasbeenincreasingyearbyyear.Recently,variouskindsofmedicinesusedfortreatmentofEPhavebeenreported.Themethotrexate(MTX)isthecommonestone,whichhasbeenusedindifferentways,suchas.IIntramuscularorintravenousinjection('),oraladministration(2),injectionwithinthegestationalsacunderlaparoscopicandvaginalultrasonographicguidance(').WhenasmalldoseofMTXwasusedrepeatedly,sideeffectratecouldreach20%--30%(4).UPtonow,asfarasweknow,EPistreatedbyMTXdomesticallyorinternationallyonlyforunruptur…     

Superficial Mycoses: Ketoconazole Treatment Oberflächliche Mykosen: Ketoconazol-Behandlung

Summary: A group of 55 patients were treated with 200 mg/day of ketoconazole. Infections treated:

• 1 P. versicolor 20 cases
• 2 Herpes circinatus (T. corporis) 10 cases
• 3 Eczema marginatum (T. inguinalis) 10 cases
• 4 Vulvo-vaginal candidosis (Candida vaginitis) 10 cases
• 5 Candidal intertrigo 5 cases

They all responded well to the treatment and recovery was obtained in all cases; however P. versicolor in all cases presented positive mycological tests with disappearance of short filaments. Ketoconazole showed good antifungal activity against all species of fungi isolated from our patients, confirmed “in vitro” by contact test Zusammenfassung: Eine Gruppe von 55 Patienten wurde mit einer täglichen Dosis von 200 mg Ketoconazol antimykotiscb behandelt. Im einzelnen lagen folgende Mykosen vor:

• 1 Pityriasis versicolor (20 Fälle)
• 2 Herpes circinatus (Tinea corporis) (10 Fälle)
• 3 Ekzema marginatum (Tinea inguinalis) (10 Fälle)
• 4 Vulvovaginitis candidomycetica (10 Fälle)
• 5 Candida-Intertrigo (5 Fälle).

Alle Mykosen sprachen gut auf die Behandlung an, so daß in jedem Fall Heilung erreicht wurde. Bei der Pityriasis versicolor zeigten sich jedoch in allen Fällen weiterhin positive mykologische Befunde im Nativpräparat, wobei die kurzen Fllamente verschwanden. Ketoconazol zeigte gute Aktivität gegen alle von unseren Patienten isolierten Pilze, was auch in vitro mit dem Kontakttest bestätigt werden konnte.     

万载县1959—1997年丝虫病防治效果分析

目的：通过分析我县1959－1997年丝虫防治效果,为以后丝防工作提供决策依据。方法：应用1959－1997年万载县丝载虫病防治资料进行分析。结果：1959年对载县进行丝虫病普查,发现我县仅有罗城、三兴、高村、鹅峰等四个乡（镇）有丝虫病的发生和流行。病原体为马来和斑氏丝虫、媒虫为中华按蚊及致乏库蚊,1959年丝虫病流行区感染率为3．2361％。经过对感染采用海群生群体防治措施,丝虫病感染率逐渐下降,1983年基本消来丝虫病,比过了省里验收,1990－1997年感染率已下降为0。说明我县以预防为主,加强丝虫病监测,采杉群防群治措施得力,结果明显,成绩显。但是今后仍应继续做好丝虫病的监测工作。     

自拟疏肝散结方治疗乳腺增生症148例疗效观察

目的 :观察疏肝散结方治疗乳腺增生的临床疗效。方法 :自拟中药疏肝散结方内服。结果 :148例患者中 ,治愈 10 3例 ,显效 2 5例 ,有效 18例 ,无效 2例 ,总有效率 98%。结论 :疏肝散结方治疗乳腺增生 ,疗效确切 ,疗程较短 ,且无不良反应 ,值得临床推广应用。     

A flexible cure rate model with dependent censoring and a known cure threshold

We propose a flexible cure rate model that accommodates different censoring distributions for the cured and uncured groups and also allows for some individuals to be observed as cured when their survival time exceeds a known threshold. We model the survival times for the uncured group using an accelerated failure time model with errors distributed according to the seminonparametric distribution, potentially truncated at a known threshold. We suggest a straightforward extension of the usual expectation–maximization algorithm approach for obtaining estimates in cure rate models to accommodate the cure threshold and dependent censoring. We additionally suggest a likelihood ratio test for testing for the presence of dependent censoring in the proposed cure rate model. We show through numerical studies that our model has desirable properties and leads to approximately unbiased parameter estimates in a variety of scenarios. To demonstrate how our method performs in practice, we analyze data from a bone marrow transplantation study and a liver transplant study. Copyright © 2016 John Wiley & Sons, Ltd.     

火针疗法治疗痹证的临床疗效研究

目的：观察火针治疗痹证的临床疗效。方法：采用火针疗法治疗痹证175例进行疗效观察，同时设立了毫针对照组219例，结果：火针治疗组临床疗效优于毫针对照组，火针治疗组总治愈率及总有效率分别达到86．3％和97．7％，毫针对照组总治愈率及总有效率分别达到78．1％和94．1％，两组治疗“3次有效率”对比，两组“平均治愈时间”对比，火针治疗组明显优于毫针对照组（P＜0．01），病程超过3年时，火针治疗组优于毫针对照组（P＜0．05），3年以内则无显著性差异，结论：火针治疗痹症有显著而肯定的疗效。