Search

Shinichi Noto,1 Tatsunori Murata,2 Shota Saito,2 Takahiro Watanabe,3 Makoto Kobayashi2 1Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan; 2CRECON Medical Assessment Inc, Tokyo, Japan; 3Rehabilitation Center, Niigata University Medical and Dental General Hospital, Niigata, JapanCorrespondence: Shinichi Noto, Department of Rehabilitation, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata, Japan, Email noto@nuhw.ac.jpObjective: To investigate the preferences of persons with a history of stroke for various attributes of rehabilitation using a discrete choice experiment (DCE).Design: Cross-sectional study.Setting: A web-based survey.Participants: A total of 600 adults with a history of stroke who were not asked whether or not they had participated in previous rehabilitation.Intervention: None.Main Outcome Measures: Preference weights by attribute ie, treatment time (30 minutes, one hour, one and a half hours), treatment content (walking exercises, activities of daily living; ADL exercises), priority treatment of paralyzed limbs (upper extremity, lower upper extremity), treatment location (hospital visit, home visit), therapist gender, and out-of-pocket costs for stroke rehabilitation using discrete choice experiment.Results: The most common self-reported diagnosis was cerebral infarction (408 patients, 68%). The mean age was 62.0 ± 9.8 years, and 515 (85.8%) were male. Of the five attributes, excluding out-of-pocket costs, the highest relative importance score was treatment location (0.331), followed by treatment time (0.304). Among the rehabilitation programs, the statistically significant coefficients calculated were one hour of therapy (0.173, 95% CI = 0.088– 0.258), hospital visits (0.241, 95% CI = 0.180– 0.303), and female therapists (0.186, 95% CI = 0.125– 0. 247). No significant differences were obtained regarding the treatment contents or the paralyzed limb to be treated.Conclusion: A discrete choice experiment revealed that persons with a history of stroke prefer a one-hour hospital rehabilitation program with a female therapist, with cost being a major consideration for rehabilitation. The results of this study may provide useful information for rehabilitation professionals.Keywords: stroke, rehabilitation, preference, physical therapy, occupational therapy

Toshihiko Taguchi,1 Kazutaka Nozawa,2 Shigeki Zeniya,3 Tatsunori Murata,3 Thomas Laurent,4 Takahiro Hirano,4 Koichi Fujii2 1Japan Organization of Occupational Health and Safety, Yamaguchi Rosai Hospital, Sanyo-Onoda, Yamaguchi, Japan; 2Medical Affairs, Pfizer Japan Inc, Tokyo, Japan; 3CRECON Medical Assessment Inc., Tokyo, Japan; 4Clinical Study Support, Inc, Nagoya, JapanCorrespondence: Kazutaka NozawaPfizer Japan Inc., Shibuya Bunka Quint Bldg., 22-7, Yoyogi 3-chome, Shibuya-ku, Tokyo, 150-8589, JapanTel +81-3-5309-7000Email kazutaka.nozawa@pfizer.comBackground: Chronic low back pain or chronic cervical pain often has a neuropathic pain (NeP) component and patients with these conditions complain of sleep deprivation, loss of physical function, and reduced productivity due to pain. The objective of this study was to clarify the pathway by which pain, sleep disturbance due to pain, and physical function status influence QOL measures in chronic low back pain patients with NeP associated with lumbar spine diseases (CLBP-NeP) and in chronic cervical pain patients with NeP associated with cervical spine diseases (CCP-NeP).Methods: A model assuming pain numeric rating scale (NRS), pain-related sleep interference scale (PRSIS), and functional indices (Roland Morris Disability Questionnaire [RMDQ], Neck Disability index [NDI]) as factors that can affect outcomes such as QOL (calculated using EuroQoL 5 Dimensions (EQ-5D)), the Patient Global Impression of Change (PGIC), and the Clinical Global Impression of Change (CGIC) was developed using structural equation modeling.Results: Overall trends were frequently observed in both patients with CLBP-NeP and CCP-NeP. Pain NRS had the largest comprehensive direct impact on QOL based on EQ-5D and an overall impression of changing symptoms. The effects of pain NRS on each outcome were largely due to direct pain-related effects; however, for EQ-5D, an indirect effect via functional improvement was the primary factor.Conclusion: Although the results of this study suggest that the indirect functional improvement of pain relief may not be recognized as a significant component of therapeutic effects by both physicians and patients, the pain-relieving intervention contributes directly to improvement of patients’ overall QOL and also indirectly via functional improvement in Japanese primary care settings. Accordingly, to achieve the therapeutic goal for patients with NeP and minimize the impact of pain burden, our findings indicate that pain relief interventions are also crucial from the perspective of the patient’s HRQOL.Keywords: neuropathic pain, spine diseases, pregabalin, function, structural equation modeling, EuroQoL 5 Dimensions

Manabu Akazawa,1 Ataru Igarashi,2 Nozomi Ebata,3 Tatsunori Murata,4 Shigeki Zeniya,4 Yuri Haga,5 Kazutaka Nozawa,3 Koichi Fujii,3 Toshihiko Taguchi6 1Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan; 2Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan; 3Medical Affairs, Pfizer Japan Inc., Tokyo, Japan; 4CRECON Medical Assessment Inc., Tokyo, Japan; 5Clinical Research Division, Clinical Study Support, Inc., Nagoya, Japan; 6Yamaguchi Rosai Hospital, Yamaguchi, JapanCorrespondence: Nozomi EbataMedical Affairs, Pfizer Japan Inc., 3-22-7 Yoyogi, Shibuya-ku, Tokyo 151-8589 JapanTel +81 3 80 3393 0745Fax +81 3 5309 9198Email nozomi.ebata@pfizer.comPurpose: To evaluate the cost-effectiveness of pregabalin versus other analgesics among patients with chronic cervical pain with neuropathic components during routine clinical practice in Japan.Patients and methods: The analysis considered patients with chronic cervical pain with a neuropathic pain component (radiating pain to the upper limb) and who were treated with pregabalin with or without other analgesics (pregabalin-containing treatments) or other analgesics alone (usual care) for 8 weeks. Other analgesics included non-steroidal anti-inflammatory drugs (NSAIDs), weak opioids, antidepressants, and antiepileptic drugs. A Markov cohort simulation model was constructed to estimate costs and effectiveness (in terms of quality-adjusted life-years, QALYs) of each treatment over a 12-month time horizon. In the model, patients transitioned among three states of pain severity (no/mild, moderate, and severe). Data were derived from a previous observational study (pregabalin-containing treatments, n = 138; usual care, n = 211). Cost inputs included medical costs and productivity losses. QALYs were calculated using the EuroQol five-dimensional, five-level questionnaire. The cost-effectiveness was evaluated using incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to assess the robustness of results.Results: From the payer’s perspective, pregabalin-containing treatments were more costly (JPY 61,779 versus JPY 26,428) but also more effective (0.763 QALYs versus 0.727 QALYs) than the usual care, with an ICER of JPY 970,314 per QALY gained. From the societal perspective, which also included productivity losses, the ICER reduced to JPY 458,307 per QALY gained. One-way sensitivity analyses demonstrated the robustness of the results. Given a hypothetical threshold value of one additional QALY of JPY 5,000,000, the probability of pregabalin-containing treatments being cost-effective was 100%.Conclusion: Compared with using other analgesics alone, the use of pregabalin, alone or in addition to other analgesics, was cost-effective for the treatment of chronic cervical pain with a neuropathic pain component in Japan.Keywords: neuropathic pain, quality-adjusted life-year, incremental cost-effectiveness ratio, health economics

Ataru Igarashi,1 Manabu Akazawa,2 Tatsunori Murata,3 Toshihiko Taguchi,4 Alesia Sadosky,5 Nozomi Ebata,6 Richard Willke,5 Koichi Fujii,6 Jim Doherty,5 Makoto Kobayashi3 1Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan; 2Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan; 3CRECON Medical Assessment Inc., Tokyo, Japan; 4Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; 5Pfizer Inc., New York, NY, USA; 6Pfizer Japan, Inc., Tokyo, Japan Objective: To assess the cost-effectiveness of pregabalin for the treatment of chronic low back pain with accompanying neuropathic pain (CLBP-NeP) from the health care payer and societal perspectives. Methods: The cost-effectiveness of pregabalin versus usual care for treatment of CLBP-NeP was evaluated over a 12-month time horizon using the incremental cost-effectiveness ratio (ICER). Quality-adjusted life years (QALYs), derived from the five-dimension, five-level EuroQol (EQ-5D-5L) questionnaire, was the measure of effectiveness. Medical costs and productivity losses were both calculated. Expected costs and outcomes were estimated via cohort simulation using a state-transition model, which mimics pain state transitions among mild, moderate, and severe pain. Distributions of pain severity were obtained from an 8-week noninterventional study. Health care resource consumption for estimation of direct medical costs for pain severity levels was derived from a physician survey. The ICER per additional QALY gained was calculated and sensitivity analyses were performed to evaluate the robustness of the assumptions across a range of values. Results: Direct medical costs and hospitalization costs were both lower in the pregabalin arm compared with usual care. The estimated ICERs in the base case scenarios were approximately ¥2,025,000 and ¥1,435,000 per QALY gained with pregabalin from the payer and societal perspectives, respectively; the latter included indirect costs related to lost productivity. Sensitivity analyses using alternate values for postsurgical pain scores (0 and 5), initial pain severity levels (either all moderate or all severe), and the actual EQ-5D-5L scores from the noninterventional study showed robustness of results, with ICERs that were similar to the base case. Development of a cost-effectiveness acceptability curve showed high probability (≥75%) of pregabalin being cost-effective. Conclusion: Using data and assumptions from routine clinical practice, pregabalin is cost-effective for the treatment of CLBP-NeP in Japan. Keywords: usual care, neuropathic pain, Markov model, quality-adjusted life-year, willingness to pay, health economics

A down-scattered neutron detector operating in the multichannel counting mode was developed for areal density (ρR) measurement. Equipped with a newly developed 6Li glass scintillator (APLF80), the detector was tested in a fusion experiment at the GEKKO XII facility, Osaka University, Osaka, Japan. For a low-ρR fusion shot, the detector clearly discriminated the γ-rays, primary neutrons, γ-rays produced via (n, γ) reactions from the target chamber, and neutrons scattered by the target chamber. Furthermore, the observed signal was in good agreement with predictions made by Monte Carlo simulation.

This article discusses a case study of a patient with Keratitis-Ichthyosis-Deafness (KID) syndrome, a congenital skin disease. The patient had chronic cutaneous candidiasis, which led to the emergence of multiple revertant keratinocyte clones with a reversal of the skin phenotype. The study used whole-exome sequencing to analyze samples from different regions of the patient's skin and identified somatic mutations, including second-site mutations in the GJB2 gene. The findings suggest that chronic cutaneous candidiasis may promote the emergence of independent keratinocyte clones with second-site mutations, and this phenomenon could potentially be used to develop treatments for KID syndrome. [Extracted from the article]