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Aims: To develop a model to evaluate the cost-effectiveness of 4 mg dibotermin alfa/absorbable collagen sponge (ACS) versus iliac crest bone graft (ICBG) in patients with lumbar degenerative disc disease in the United Kingdom. Materials & methods: A Markov decision-analytic model was constructed to calculate costs and quality-adjusted life-years over a 4-year time horizon in each treatment group, from a United Kingdom National Health Service perspective. An individual patient data meta-analysis was undertaken to synthesize data from four randomized controlled trials and two single-arm studies concerning health-related quality of life and procedural resource use. Current cost data from the United Kingdom were then applied to determine the overall mean cost per patient in each group. One-way and probabilistic sensitivity analyses were undertaken to explore the impact of parameter uncertainty. Results: The model predicted 4-year discounted cost savings of £192 per patient treated with dibotermin alfa/ACS, compared with ICBG, and a gain of 0.0114 QALYs per patient over the same time period. Sensitivity analyses indicated that the results were most sensitive to variability in the differences in health-related quality of life and secondary surgery rate, with dibotermin alfa/ACS having a 60% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained. Limitations: There is uncertainty in the difference in cost and QALYs between the two groups. However, comprehensive sensitivity analyses were undertaken to explore this and present the results in a transparent manner. Conclusions: Our results provide an economic case for the use of 4 mg dibotermin alfa/ACS versus iliac crest bone graft, with additional health benefits predicted at reduced overall cost.

By combining information such as genomics, proteomics, and metabolomics data, multi-omics methodologies have the potential to reveal the otherwise invisible processes of carcinogenesis. Using these data, a new generation point-of-care (POC) devices may support patient care through rapid diagnosis involving accurate and simultaneous multi-omics measurements. In this work we present a proof-of-concept portable system capable of measuring a metabolite (glutamate) and a protein (proteolytically active prostate-specific antigen - aPSA) simultaneously on single device in a two-minute interval using on-chip optical methods. The device has the potential to improve the current diagnostic pathways of prostate cancer by reducing the high false-positive rate with the widely used total prostate-specific antigen test. We demonstrate simultaneous assay of glutamate and aPSA in buffer and synthetic urine. For the glutamate assay, the limit of detection (LOD) and resolution were found to be 0.9 μM and 2.7 μM. LOD and resolution for aPSA were 0.5 ng/ml and 2.0 ng/ml. The LOD and resolution achieved using this device are therefore in line with human physiological ranges. The platform is suitable for accommodating two independent optical assays therefore chemistry can be modified to measure different analytes regardless of their nature. This technological breakthrough has the potential to deliver an accurate multi-omics portable device for prostate cancer and may be extended to other diseases.

The detection of metabolites such as choline in blood are important in clinical care for patients with cancer and cardiovascular disease. Choline is only present in human blood at low concentrations hence accurate measurement in an affordable point-of-care format is extremely challenging. Integration of microfluidics on to complementary metal-oxide semiconductor (CMOS) technology has the potential to enable advanced sensing technologies with extremely low limit of detection that are well suited to multiple clinical metabolite measurements. Although CMOS and microfluidics are individually mature technologies, their integration has presented challenges that we overcome in a novel, cost-effective, single-step process. To demonstrate the process, we present the microfluidic integration of a metabolomics-on-CMOS point-of-care platform with four capillary microfluidic channels on top of a CMOS optical sensor array. The fabricated device was characterised to verify the required structural profile, mechanical strength, optical spectra, and fluid flow. As a proof of concept, we used the device for the in-vitro quantification of choline in human blood plasma with a limit of detection of 3.2 M and a resolution of 1.6 M.

No abstract available.