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The worries of oncology specialists through the COVID-19 outbreak: results from the ESMO Durability Task Force survey The second.
The composite event rates were 0.19/1000 P-Y for the HBsAg seroclearance group and 2.45/1000 P-Y for the HBsAg-persistent group. Pooled RRs for the HBsAg seroclearance group were 0.28 for liver decompensation for liver decompensation (95% CI, 0.13-0.59; P=.001), 0.30 for HCC (95% CI, 0.20-0.44; P less then .001), 0.22 for liver transplantation and/or death (95% CI, 0.13-0.39; P less then .001), and 0.31 for the composite endpoint (95% CI, 0.23-0.43; 95% CI, .023-0.43; P less then .001). No differences in RR estimates were observed among subgroups of different study or patient characteristics. Conclusions In a systematic review and meta-analysis, we found seroclearance of HBsAg to be significantly associated with improved patient outcomes. The results are consistent among different types of studies, in all patient subpopulations examined, and support the use of HBsAg seroclearance as a primary endpoint of trials of patients with chronic HBV infection.Background Cost-effectiveness analysis of new interventions is increasingly required by policy makers. For intact complex aortic aneurysms (CAA), fenestrated-branched endovascular aortic repair (F-BEVAR) offers a minimally invasive alternative option for patients who are physically ineligible for open surgical repair (OSR). Thus, F-BEVAR is increasingly used, but whether it represents a cost-effective treatment option remains unknown. Methods A scoping review of the literature was conducted from the PubMed, Ovid Embase and Scopus databases. They were searched to identify relevant English-language articles published from inception to December 31, 2019. All costs in the identified literature were transformed to USD values based on the following exchange rate 1 GBP = 1.3 USD; 1 EUR = 1.1 USD. Results At this literature search, no RCT assessing cost-effectiveness of F-BEVAR versus OSR for intact CAA were found. Also, no health economic evaluation studies were found regarding use of F-BEVAR in patients unfit for O (879 TAAA repairs, 45% OSR) the unadjusted total hospitalization cost of OSR was significantly higher compared with F-BEVAR (median $44,355 versus $36,612; p=.004). In-hospital mortality as well as major complications were 2-3 times higher after OSR, indicating that endovascular repair might be the economically dominant strategy. Conclusion The literature regarding cost-effectiveness analysis of F-BEVAR for CAA is scarce and ambiguous. Based on the limited non-randomized available evidence, stent-grafts are the main driver for F-BEVAR expenses, whilst cost-effectiveness in relation to OSR may vary depending on healthcare setting and patient selection.Introduction In the current era of cost containment, the financial impact of high-cost procedures such as endovascular aortic repair (EVAR) remains an area of intensive interest. Prior reports suggest slim to negative operating margins with EVAR, prompting widespread initiatives to reduce cost and improve reimbursement. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced the reclassification of EVAR to more specific diagnosis-related group (DRG) coding and predicted an overall increase in hospital reimbursement. The potential impact of this change has not been described. Methods Patients undergoing elective EVAR at a single institution between January 2014 and December 2018 were identified retrospectively, then stratified by date Group 1 underwent EVAR prior to DRG change in 2015 and were classified with DRG 237/238, major cardiovascular procedure; Group 2 patients underwent EVAR after the change and were classified as DRG 268/269, aortic/heart assist procedures. The total direct cost incl8 in Group 1 to $2,361 in Group 2 (-$477 or -17.0% per encounter). Conclusion A significant improvement in hospital CTI was observed for elective EVAR over the course of the study. The increased DRG reimbursement following CMS coding changes in 2015 was a major driver of this salutary change. Notably, efforts to reduce implant and OR cost, as well as improve coding and documentation accuracy over time, had an equally important impact on financial return.Objectives Immediate access arteriovenous grafts (IAAVGs), or early cannulation arteriovenous grafts, are more expensive than standard grafts (sAVGs) but can be used immediately after placement, reducing the need for a tunneled dialysis catheter (TDC). We hypothesized that a decrease in TDC-related complications would make IAAVGs a cost-effective alternative to sAVGs. Methods We constructed a Markov state transition model in which patients initially received either (1) an IAAVG or (2) a sAVG, and a TDC until graft usability; patients were followed through multiple subsequent access procedures for a 60-month time horizon. The model simulated mortality and typical graft- and TDC-related complications, with parameter estimates including probabilities, costs, and utilities derived from previous literature. A key parameter was median time to TDC removal after graft placement, which was studied under both real-world (7 days for IAAVG and 70 days for sAVG) and ideal conditions (no TDC placed with IAAVG and 1 month fward improvement with IAAVG (6.1% vs. Saracatinib 6.8% at five years, P = .052). Conclusions The Markov decision-analysis model supported our hypothesis that IAAVGs come with added initial cost but are ultimately cost-saving and more effective. This apparent benefit is due to our prediction that a decreased number of catheter-days per patient would lead to a decreased number of access-related infections.Background Chronic exertional compartment syndrome (CECS) is an overuse injury typically seen in young and athletic patients. The five cardinal symptoms are pain, tightness, cramping, weakness and paraesthesia. These classically occur during exertion and disappear with cessation of the activity, with no permanent damage to tissues within the compartment; nonetheless, CECS presents a significant functional impairment to those affected. Regulating exercise has been shown to alleviate symptoms but this may not be acceptable to some patients e.g. professional athletes. For patients that fail to respond to conservative management or where exercise reduction is unrealistic, fasciotomy can be considered. There are no established guidelines on the management of CECS, and it remains underdiagnosed. The aim of this systematic review is to compare the outcomes in patients suffering from CECS managed with either fasciotomy or non-operative means by examining functional outcomes and resolution of symptoms. Methods MEDLINE, Embase databases and clinical trial registries were searched comprehensively.
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