Cost-utility analysis of four common surgical treatment pathways for breast cancer.

Background: The aim was to evaluate the cost-utility of four common surgical treatment pathways for breast cancer: mastectomy, breast-conserving therapy (BCT), implant breast reconstruction (BR) and autologous-BR.

Methods: Patient-level healthcare consumption data and results of a large quality of life (QoL) study from five Dutch hospitals were combined. The cost-effectiveness was assessed in terms of incremental costs and quality adjusted life years (QALYs) over a 10-year follow-up period.

Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients.

Objectives: Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions.

Severity-Adjusted Probability of Being Cost Effective.

Background: In the context of priority setting, a differential cost-effectiveness threshold can be used to reflect a higher societal willingness to pay for quality-adjusted life-year gains in the worse off. However, uncertainty in the estimate of severity can lead to problems when evaluating the outcomes of cost-effectiveness analyses.

Objectives: This study standardizes the assessment of severity, integrates its uncertainty with the uncertainty in cost-effectiveness results and provides decision makers with a new estimate: the severity-adjusted probability of being cost effective.

Cost Effectiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Pharmacoeconomic Guidelines.

Objectives: To describe the adaptation of a global health economic model to determine whether treatment with the angiotensin receptor neprilysin inhibitor LCZ696 is cost effective compared with the angiotensin-converting enzyme inhibitor enalapril in adult patients with chronic heart failure with reduced left ventricular ejection fraction in the Netherlands; and to explore the effect of performing the cost-effectiveness analyses according to the new pharmacoeconomic Dutch guidelines (updated during the submission process of LCZ696), which require a value-of-information analysis and the inclusion of indirect medical costs of life-years gained.

Methods: We adapted a UK model to reflect the societal perspective in the Netherlands by including travel expenses, productivity loss, informal care costs, and indirect medical costs during the life-years gained and performed a preliminary value-of-information analysis.

Results: The incremental cost-effectiveness ratio obtained was €17,600 per quality-adjusted life-year (QALY) gained.

Faecal immunochemical tests (FIT) can help to rule out colorectal cancer in patients presenting in primary care with lower abdominal symptoms: a systematic review conducted to inform new NICE DG30 diagnostic guidance.

Background: This study has attempted to assess the effectiveness of quantitative faecal immunochemical tests (FIT) for triage of people presenting with lower abdominal symptoms, where a referral to secondary care for investigation of suspected colorectal cancer (CRC) is being considered, particularly when the 2-week criteria are not met.

Methods: We conducted a systematic review following published guidelines for systematic reviews of diagnostic tests. Twenty-one resources were searched up until March 2016.

Correlations of Objective Metrics for Quantifying Dysfunctional Lens Syndrome With Visual Acuity and Phacodynamics.

Purpose: To study the relationship between objective metrics for quantifying crystalline lens dysfunction with visual impairment and phacodynamics parameters in age-related nuclear cataracts.

Methods: A total of 51 eyes (34 patients) with age-related nuclear cataract had phacoemulsification. The Dysfunctional Lens Index (0 to 10 points) was measured by a ray-tracing aberrometry (iTrace Visual Function Analyzer; Tracey Technologies, Houston, TX).

Enhanced Combined Tomography and Biomechanics Data for Distinguishing Forme Fruste Keratoconus.

Purpose: To evaluate the performance of the Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Depew, NY) variables and Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany) tomographic parameters in differentiating forme fruste keratoconus (FFKC) from normal corneas, and to assess a combined biomechanical and tomographic parameter to improve outcomes.

Methods: Seventy-six eyes of 76 normal patients and 21 eyes of 21 patients with FFKC were included in the study. Fifteen variables were derived from exported ORA signals to characterize putative indicators of biomechanical behavior and 37 ORA waveform parameters were tested.

Astigmatic Vector Analysis of Posterior Corneal Surface: A Comparison Among Healthy, Forme Fruste, and Overt Keratoconic Corneas.

Purpose: To determine novel diagnostic parameters for keratoconus, and to assess the correlation between anterior and posterior corneal surfaces based on vectorial astigmatism analyses.

Design: Retrospective case-control study.

Methods: Six hundred and ninety-eight eyes of 698 patients were enrolled in the study.

Application of different Scheimpflug-based lens densitometry methods in phacodynamics prediction.

Purpose: To evaluate the correlations between preoperative Scheimpflug-based lens densitometry metrics and phacodynamics.

Methods: The Lens Opacities Classification System III (LOCS III) was used to grade nuclear opalescence (NO), along with different methods of lens densitometry evaluation (absolute scale from 0% to 100%): three-dimensional (3D), linear, and region of interest (ROI) modes. Cumulative dissipated energy (CDE) and total ultrasound (US) time were recorded and correlated with the different methods of cataract grading.

Comparison of Dysfunctional Lens Index and Scheimpflug Lens Densitometry in the Evaluation of Age-Related Nuclear Cataracts.

Purpose: To describe the Dysfunctional Lens Index (DLI) from ray-tracing aberrometry and to test its correlations with logMAR corrected distance visual acuity (CDVA) and lens grading based on the Lens Opacities Classification System III (LOCS III) and the Scheimpflug-based lens density.

Methods: The DLI was calculated by the i-Trace Visual Functional Analyzer (Tracey Technologies, Houston, TX). Forty eyes of 30 patients with mild to moderate age-related nuclear cataract were included retrospectively.

Detection of ectatic corneal diseases based on pentacam.

Pentacam is a rotating Scheimpflug-based corneal and anterior segment tomographer that gives as comprehensive analysis of corneal 3D geometry. With this device the detection of mild keratoconus or ectasia susceptibility is possible. This is fundamental for screening ectasia risk prior to laser vision correction.

Use of Value of Information in Healthcare Decision Making: Exploring Multiple Perspectives.

Background: Value of information (VOI) is a tool that can be used to inform decisions concerning additional research in healthcare. VOI estimates the value of obtaining additional information and indicates the optimal design for additional research. Although it is recognized as good practice in handling uncertainty, it is still hardly used in decision making in the Netherlands.

The Missing Stakeholder Group: Why Patients Should be Involved in Health Economic Modelling.

Evaluations of healthcare interventions, e.g. new drugs or other new treatment strategies, commonly include a cost-effectiveness analysis (CEA) that is based on the application of health economic (HE) models.

Costs of Hospital Stay in Specialized Diabetic Foot Department in Russia.

Background: Diabetic foot ulcer (DFU) is considered to be one of the most common and costly diabetic complications. The approach unanimously recommended for patients with DFU is treatment by a multidisciplinary foot care team, which in Russia mainly is limited to few federal and regional hospitals. Currently, financing schemes for medical institutions are changing, thus raising the issue of setting adequate tariffs.

Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis.

Background: Patients with substantive bleeding usually require transfusion and/or (re-)operation. Red blood cell (RBC) transfusion is independently associated with a greater risk of infection, morbidity, increased hospital stay and mortality. ROTEM (ROTEM® Delta, TEM International GmbH, Munich, Germany; www.

Determining the impact of modeling additional sources of uncertainty in value-of-information analysis.

Background: The conditional reimbursement policy for expensive medicines in The Netherlands requires data collection on actual use and cost-effectiveness after the initial decision to reimburse a drug. This introduces new sources of uncertainty (less important in a randomized controlled trial than in daily practice), which may affect priorities for further research.

Objectives: This article focuses on determining the impact of including these uncertainties at the time a decision is made, and whether more complex models are always needed to address prioritization of additional research.

Corneal densitometry in keratoconus.

Purpose: The aim of this study was to compare corneal densitometry measured by Scheimpflug tomography in normal and keratoconic eyes and to assess the differences in densitometry values among the stages of keratoconus.

Methods: Keratoconic and normal corneas were examined using the Pentacam. Corneal densitometry was measured over a 12-mm diameter area, divided by annular concentric zones and depths.

Impact of chamber pressure and material properties on the deformation response of corneal models measured by dynamic ultra-high-speed Scheimpflug imaging.

Purpose: To study the deformation response of three distinct contact lenses with known structures, which served as corneal models, under different chamber pressures using ultra-high-speed (UHS) Scheimpflug imaging.

Methods: Three hydrophilic contact lenses were mounted on a sealed water chamber with precisely adjustable pressure: TAN-G5X (41% hydroxyethylmethacrylate/glycolmethacrylate, 550 µm thick), TAN-40 (62% hydroxyethylmethacrylate, 525 µm thick) and TAN-58 (42% methylmethacrylate, 258 µm thick). Each model was tested five times under different pressures (5, 15, 25, 35 and 45 mmHg), using ultra-high-speed Scheimpflug imaging during non-contact tonometry.

Comprehensive anterior segment normal values generated by rotating Scheimpflug tomography.

Purpose: To identify normal values for tomographic parameters that are considered useful in screening patients for refractive surgery.

Setting: Private center, Albany, New York, USA.

Design: Database study.

Variability of subjective classifications of corneal topography maps from LASIK candidates.

Purpose: To evaluate the variability of subjective corneal topography map classification between different experienced examiners and the impact of changing from an absolute to a normative scale on the classifications.

Methods: Preoperative axial curvature maps using Scheimpflug imaging obtained with the Pentacam HR (Oculus Optikgeräte, Wetzlar, Germany) and clinical parameters were sent to 11 corneal topography specialists for subjective classification according to the Ectasia Risk Scoring System. The study population included two groups: 11 eyes that developed ectasia after LASIK and 14 eyes that had successful and stable LASIK outcomes.

ORA waveform-derived biomechanical parameters to distinguish normal from keratoconic eyes.

Purpose: To evaluate the ability of the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY) to distinguish between normal and keratoconic eyes, by comparing pressure and waveform signal-derived parameters.

Methods: This retrospective comparative case series study included 112 patients with normal corneas and 41 patients with bilateral keratoconic eyes. One eye from each subject was randomly selected for analysis.