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Purpose The COV-BARRIER Phase 3 trial demonstrated that treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care significantly reduced mortality over 28 days in hospitalized COVID-19 participants, with a similar safety profile to standard of care. We assessed the cost-effectiveness of baricitinib plus standard of care versus standard of care alone (which included systemic corticosteroids and remdesivir) in patients hospitalized in the United States with COVID-19. Methods An economic model was developed in Microsoft Excel to simulate the inpatient stay, discharge to post-acute care, and recovered patients. Costs modelled included payer costs, hospital costs, and indirect costs. Benefits modelled included life years, quality-adjusted life years, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payer perspective over a lifetime horizon; a secondary analysis was also performed from the hospital perspective. The base case analysis modelled the numerical differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial. Findings In the base case payer perspective, combination treatment with baricitinib plus standard of care resulted in an incremental total cost of $17,276, a total quality-adjusted life year (QALY) gain of 0.6703, and a total life-year gain of 0.837 compared with standard of care alone. The addition of baricitinib also increased survival by 5.1% and reduced the use of mechanical ventilation by 1.6%. The base-case incremental cost-effectiveness ratios were $25,774 per QALY gained and $20,638 per life year gained; the “mortality only” scenario analysis yielded similar results of $26,862 per QALY gained and $21,433 per life year gained. For the hospital perspective, combination treatment with baricitinib plus standard of care was more effective and less costly than standard of care alone in the base case, and it resulted in an incremental cost of $38,964 per death avoided in the “mortality only” scenario. Implications Our study showed that adding baricitinib to standard of care is cost effective for hospitalized COVID-19 patients in the United States. Cost effectiveness was demonstrated for both payer and hospital perspectives. These findings were robust to sensitivity analyses and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.

Using the de Haas-van Alphen effect we have measured the evolution of the Fermi surface of BaFe2(As1-xPx){2} as a function of isoelectric substitution (As/P) for 0.41

Contains fulltext : 145259.pdf (Publisher’s version ) (Open Access) 5 p.

Background: This retrospective, real-world claims data base study in patients (pts) with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) demonstrated that prasugrel (pras) was non-inferior to ticagrelor (ticag) for 30 day safety and effectiveness outcomes. This report provides further evaluation between pras vs ticag of 30 day readmission rates for myocardial infarction (MI), revascularization (revasc), and bleeding. Methods: IMS Patient-Centric Data Warehouse claims data was used to identify ACS-PCI pts ≥18 years old with at least one in-hospital claim for pras or ticag between 8/1/11-4/30/13. The groups were propensity matched (PM) based upon demographic and clinical characteristics using index and prior hospitalization records dating back to 1/1/2008. Relative risk (RR) and 95% confidence interval (CI) were estimated to assess binary endpoints. Non-inferiority was computed by comparing the mean from a normal distribution of log (RR) with log (1.2), a predefined non-inferiority margin. Three cohorts were predefined: ACS-PCI (primary), ACS-PCI without prior TIA or stroke (label), ACS-PCI pts without prior TIA or stroke and if age ≥75 years with evidence of diabetes or prior MI (core). Results: Prior to PM, the primary cohort included 16,098 pts; 13,134 (82%) on pras, 2,964 (18 %) on ticag. Compared to pras, ticag pts were older, more often female, had increased cardiovascular risk factors, and more often treated at a teaching hospital. Unstable angina was seen more often in pras pts with no difference in STEMI or NSTEMI between the 2 groups. Using PM pts (table), pras was non-inferior to ticag in the primary cohort for rehosp for MI, revasc, and bleeding at 30 days post discharge. Rehosp for MI and bleeding was significantly lower with pras vs ticag while rehosp for revasc was lower, but not significantly. Results for the label and core cohorts had the same directionality as the primary cohort. Conclusion: Rehosp for MI, revasc or bleeding was non-inferior for pras compared to ticag at 30 days post discharge. Pts treated with pras had lower 30 day rehosp rates, particularly related to readmission for MI, compared with ticag. Although limited by selection bias, these results support the clinical utility of pras, regardless of cohort, to limit 30 day rehosp for pts undergoing PCI for ACS.

Objectives: To compare all-cause healthcare resource utilization and costs with prasugrel (pras) vs. ticagrelor (ticag) with real world data in patients (pts) with ACS managed with PCI. Methods: The IMS Patient-Centric Data Warehouse was used to identify ACS-PCI pts ≥18 years with an in-hospital claim for pras or ticag (index date) between 8/1/11 and 4/30/13. The baseline period began on 1/1/08 with the follow-up period spanning until 7/29/13. The two drug groups were propensity-matched (PM) based upon demographic and clinical characteristics. Three cohorts were pre-defined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI patients without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). Hospital specific cost:charge ratios were used to determine costs and adjusted to 2013 US dollars. Total costs were the sum of medical costs, including lab and diagnostic tests, and pharmacy costs during hospitalization. Generalized estimating equations were used to evaluate PM-adjusted differences in length of stay (LOS) and costs. Costs are reported on a per patient basis. Resource utilization and costs were assessed during index hospitalization, 30 and 90 days post-discharge. Results: 16,098 pts were in the primary cohort (pras: 13,134 [82%] and ticag: 2,964 [18%]). Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P Conclusion: Economic outcomes of ACS-PCI pts receiving pras were similar to ticag for the primary population with significant savings in total and medical costs for pts without prior TIA or stroke. These data indicate that ticag has no economic advantage compared with pras in routine clinical practice.

Objective: To show that prasugrel (pras) was non-inferior to ticagrelor (ticag) in terms of healthcare resource utilization (HCRU) based upon 30- and 90-day all-cause rehospitalization rates among patients (pts) with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI). Methods: This retrospective study used anonymized hospital data from the IMS Patient-Centric Data Warehouse to identify ACS-PCI pts aged ≥18 years with ≥1 in-hospital claim for pras or ticag between 8/1/11-4/30/13. Three cohorts were predefined and analyzed: ACS-PCI (primary cohort), ACS-PCI without prior TIA or stroke (label cohort), and ACS-PCI pts without prior TIA or stroke and if age ≥75 years required evidence of diabetes or prior MI (core cohort). The McNemar’s test was used to evaluate adjusted outcome differences between propensity matched (PM) groups. P-value for non-inferiority (p-NI) test was obtained through a one-sided Z test by comparing log (RR) with log(1.2), a predefined margin. Results: Among 16,098 eligible pts, 13,134 (82%) received pras and 2,964 (18%) received ticag. Compared to ticag pts, pras pts were younger, more likely men, and less likely to have cardiovascular or bleeding risk factors (P Conclusions: All-cause rehospitalizations at 30-and 90-days post discharge in ACS-PCI pts were non-inferior with pras vs. ticag in all 3 cohorts. Pras was associated with significantly lower risk for 90-day all-cause rehospitalizations compared with ticag in the label and core cohorts, which are the majority of pts receiving pras. Although there appears to be inherent bias and unmeasured confounders related to use of pras vs. ticag, these data show reductions in HCRU with pras compared with ticag in the real-world setting at 30- and 90-days post-discharge.

Background Despite widespread acceptance of NCEP guidelines, the extent of treatment of hyperlipidemia in patients with cardiovascular disease (CVD) remains poor. This analysis investigated factors associated with treatment with antihyperlipidemic agents in a US representative cohort of patients with evidence of CVD. Methods We used the 2005-2006 NHANES to explore the research question of interest. Self reports of physician diagnosis indicating the presence of coronary heart disease, myocardial infarction, angina, congestive heart failure, or stroke served as evidence of established CVD. We used multivariate logistic regression to examine factors independently associated with current antihyperlipidemic treatment, maintaining factors in the final model if p Results Nearly 50% of the 561 subjects with established CVD were not taking any antihyperlipidemic agents. Compared with those not receiving treatment, greater percentage of those treated were male (58.8% vs. 42.2%), non-Hispanic whites (84.8% vs. 71.7%), aged 55-74 (56.3% vs. 30.4%), holders of private insurance (57.3% vs. 52.2%), Medicare insured (65.8% vs. 50.5%), and obese (47.4% vs. 39.4%). Greater percentage of untreated patients was African American (15.1% vs. 10.4%), had a break in their health insurance coverage in past 12 months (21.9% vs. 7.0%) & was current smoker (29.4% vs. 15.2%). In multivariate results, the following factors remained significantly associated (OR [95%CI]) with treatment: male gender (1.89 [1.06 -3.39]), White race (2.45 [1.53 - 3.95]), older age (P < 0.0001), high school education compared with less than 9 th grade education (2.53 [1.35 - 4.71]), and anti-diabetic treatment (3.31 [2.20 - 4.99]). Conclusion Treatment with antihyperlipidemic agents in patients with CVD are related to individual (behavioral) and contextual (institutional, structural) factors. Further investigation is required to understand unmeasured factors associated with treatment initiation and to develop and test appropriate behavioral and contextual interventions to remove barriers to treatment initiation. Younger age groups, women, individuals with education < 9 th grade and racial/ethnic minorities who have CVD should especially be the target of such intervention.

We report a previously unobserved quantum oscillation frequency in YbRh2Si2. This is the first quantum oscillation that can definitely be assigned to the larger of the two major sheets of the Fermi surface predicted by band structure calculations. Previously observed frequencies were interpreted in terms of a large Fermi surface, which includes the Yb 4f-hole in the Fermi volume, that has been so strongly spin-split that it closely resembles the small Fermi surface, which does not include the Yb 4f -hole in the Fermi volume. The new frequency can also be incorporated into this picture, however there are some indications that the a need for more advanced energy band calculations., Comment: 5 pages, 3 figures, submitted to Physica Status Solidi on 24 September 2009, fixed lingering issues with figures

Contains fulltext : 127153.pdf (Publisher’s version ) (Open Access) Radboud Universiteit Nijmegen, 03 juni 2014 Promotor : Maan, J.C. Co-promotores : MC Collam, A., Zeitler, U. VII, 125 p.