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Background: Although metastatic cutaneous melanoma is associated with an unfavorable prognosis, innovative therapies including immunomodulating agents and targeted therapies have shown survival benefits in clinical trials. We assessed the impact of the introduction of innovative drugs into clinical practice on the survival of patients with metastatic cutaneous melanoma during the period 2004–2017, in Belgium. The evolution of associated expenses was also analyzed. Methods: This is a retrospective population‐based study using data from the national Belgian Cancer Registry, compulsory health insurance, and administrative survival data. The immunomodulating drugs were ipilimumab, nivolumab and pembrolizumab, while targeted therapies included vemurafenib, dabrafenib and trametinib. Results: We did not identify a trend for improvement over time. Median survival (years) was 1.5 (95% CI: 1.1–1.8) in 2004–2008, 1.1 (95% CI: 0.8–1.5) in 2009–2013, and 1.6 (95% CI: 1.3–2.4) in 2014–2017, respectively. In contrast, survival improved in those with unknown primary tumor localization. In this group, median survival time was 2.0 (95% CI: 1.4–2.9) in the most recent period, while it was 1.1 (95% CI: 0.7–1.3) in 2009–2013, and 0.9 (95% CI: 0.6–1.2) in 2004–2008. The uptake of innovative drugs remained modest, with no drug being used by more than 30% of patients. Yearly expenditure was almost non‐existent, and gradually increased, reaching several million euros in 2014–2017. Conclusion: Patients with metastatic cutaneous melanoma who were diagnosed between 2004 and 2017 showed no apparent improvement in survival. In contrast, increased survival was observed in the subgroup of patients with unknown primary tumor localization. [ABSTRACT FROM AUTHOR]

Nirmatrelvir‐ritonavir (NR) was approved to treat SARS‐CoV‐2 positive outpatients at high risk of progression to severe disease, based on a randomized trial in unvaccinated patients. Effectiveness in vaccinated patients and against Omicron has not yet been confirmed by clinical trial data, but a recent meta‐analysis suggested good real‐world effectiveness based on 12 studies. We updated this meta‐analysis by searching Medline and Embase databases for studies assessing effectiveness of NR on mortality, hospitalization, composite outcome of hospitalization and/or death, and progression to severe disease, published between October 1, 2022 and May 22, 2023. Random effects meta‐analysis and subgroup analysis for vaccinated patients was performed. A total of 32 studies were included in the meta‐analysis. Pooled RR for the effect of NR on mortality, hospitalization, hospitalization and/or mortality, and progression to severe disease were 0.36 (95% confidence interval [CI]: 0.25−0.52), 0.43 (CI: 0.37−0.51), 0.52 (CI: 0.45−0.61) and 0.54 (CI: 0.41−0.73), respectively. A subgroup analysis on vaccinated patients indicated lower effectiveness of NR on mortality (RR: 0.55, CI: 0.45−0.68), but similar effectiveness for hospitalization, hospitalization and/or mortality, or progression to severe disease (RR: 0.52, 0.58, and 0.66, respectively). This updated meta‐analysis robustly confirms the protective effects of NR on severe COVID‐19 outcomes. [ABSTRACT FROM AUTHOR]

Background: Several countries today struggle with suboptimal performances in many aspects of the fetal aneuploidy screening process and consider introducing non-invasive prenatal screening (NIPT) as a solution. In this study, costs and benefits of different scenarios for contingent NIPT screening in Belgium are evaluated with respect to partial redistribution of the national screening budget into quality improving measures for those screening activities that will be maintained when full NIPT screening is implemented.Methods: Data from the Belgian National Institute for Health and Disability Insurance and the Study Centre for Perinatal Epidemiology were used in modeled calculations of medical and economic impact of NIPT after prior conventional screening (1) at thresholds 1:300 and 1:600, and (2) at current and improved screening sensitivity.Results: Contingent NIPT screening under current screening conditions would maintain today's 7.9(0)/000 live birth prevalence of Down syndrome (LBPD) at an 11% reduction of overall short-term costs. Lowering the screening threshold to 1:600 or increasing sensitivity by 10% would reduce LBPD to 7(0)/000 at a maximum 3% increase of overall short-term costs.Conclusion: Today, in Belgium and in many other countries, full NIPT screening is considered too expensive for immediate introduction into the national fetal aneuploidy screening program. Contingent NIPT screening is both clinically and economically beneficial. A temporary contingent NIPT protocol allows for reinvesting economic savings into optimization of those screening aspects, which are to be maintained in parallel to full NIPT screening. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about the impact of human papillomavirus (HPV) 16/18 vaccination on preterm delivery, by Sjoborg and Eskild.