Objectives: To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high-risk non-muscle-invasive bladder cancer (HRNMIBC).
Patients And Methods: We performed real-world clinical data-driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens-surveillance intensity escalation and de-escalation-which had a surveillance intensity moderately higher and lower, respectively, than the guideline-recommended regimens. We evaluated the 10-year cumulative incidence of muscle-invasive bladder cancer (MIBC), cancer-specific survival (CSS), overall survival (OS), and cost-effectiveness from a United States healthcare payer perspective.
Results: The guideline-recommended surveillance regimens led to an estimated 10-year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10-year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3-10.7%), CSS of 95.4% (95% CI 95.2-95.5%), and OS of 69.9% (95% CI 69.6-70.1%), vs 11.9% (95% CI 11.7-12.1%), 94.9% (95% CI 94.8-95.1%), and 69.6% (95% CI 69.3-69.9%), respectively, from surveillance intensity de-escalation. By increasing surveillance intensity, the number-needed-to-treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer-related mortality. Compared to surveillance intensity de-escalation, higher-intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality-adjusted life year gained, which well exceeded conventional willingness-to-pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer-related mortality avoided.
Conclusion: In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de-escalation appears associated with an insignificant change in 10-year OS and furthermore is cost-effective vs higher-intensity surveillance regimens. These results suggest that moderate surveillance de-escalation can reduce costs of care without compromising life expectancy for many patients.
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http://dx.doi.org/10.1111/bju.16521 | DOI Listing |
Expert Opin Drug Saf
December 2024
Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
Background: Drug-induced nephrolithiasis is a recognized complication in clinical practice. The objective of this study is to identify drugs that are significantly associated with an increased risk of inducing nephrolithiasis based on the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS).
Research Design And Methods: We collected adverse event reports associated with drug-induced nephrolithiasis from the first quarter of 2004 (2004 Q1) to the fourth quarter of 2023 (2023 Q4) in the FAERS database.
Parasitol Res
December 2024
Department of Parasitology and Parasitic Diseases, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Manaștur 3-5, 400372, Cluj-Napoca, Romania.
This is the first study that targets the epidemiology of Gasterophilus spp. in slaughtered horses from Romania. Previously to our research, there were five recorded species: Gasterophilus haemorrhoidalis, Gasterophilus inermis, Gasterophilus intestinalis, Gasterophilus nasalis, and Gasterophilus pecorum with a dispersed distribution throughout the country, the data being recorded more than 73 years ago.
View Article and Find Full Text PDFPsychooncology
December 2024
Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colordo, USA.
Background: Advancements in precision oncology have led to a growing community of adults with advanced cancer who live longer but face prognostic uncertainty, with corresponding fears of the future. Their worst future fears related to cancer remain understudied, hindering support efforts.
Aims: This study aimed to characterize the presence, content, and predictors of imagined future worst-case scenarios related to cancer (WCS) among distressed adults with advanced cancer.
Int J Infect Dis
December 2024
School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai, China. Electronic address:
Objectives: The COVID-19 pandemic significantly disrupted the global influenza seasonal patterns due to non-pharmaceutical interventions. This study aims to describe the influenza seasonal characteristics in the first two seasons after lifting COVID-19 NPIs and assess shifts before, during, and after the pandemic.
Methods: We analyzed country-specific weekly influenza data (2011-2024) from WHO FluNet and collected COVID-19 NPI timing from official announcements.
BMC Womens Health
December 2024
Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical sciences, Mashhad, Iran.
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