bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP339 A Budget Impact Model Of The EluviaTM Drug-Eluting Stent from The Australian Public Hospital And National Payer Perspective
Authors: Altaf Nishath , Ariyaratne Thathya V. , Peacock Adrian , Deltetto Irene , El-Hoss Jad , Thomas Shannon , Taylor Colman , Mwipatayi Patrice 
Published: December 2020

IntroductionImproving long-term outcomes like target lesions revascularizations (TLRs) is a focus for endovascular interventions aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a paclitaxel-eluting drug-eluting stent (DES) was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent in the IMPERIAL trial, a global, randomized controlled study. This budget-impact evaluation investigated cost-savings from Eluvia-use when compared with Zilver PTX, relying on the 12- to 24-month outcomes from the IMPERIAL trial.MethodsA budget-impact model comparing Eluvia and Zilver PTX was developed from the Australian public healthcare payer, and an individual hospital perspective, with a 5-year time-horizon. Observed trial results were applied to each year's incident population and associated costs, and no extrapolation was conducted. The analysis used publicly available Australian national hospital cost data, population estimates, procedural statistics, epidemiological literature, and data from public hospital audits to verify eligible population for endovascular procedures (EVP) including DES. All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020).ResultsAssuming 80-percent EVP eligibility, and a DES-use range of 10–28 percent, the 5-year model estimated potential national savings of AUD 4.3–12.1 million (M) [USD 3–8.3M] to the public healthcare payer, driven by reduced TLRs from Eluvia-use compared with Zilver-PTX. The model projected potential national savings of AUD 33.1–92.6M (USD 22.8–63.9M) to individual hospitals through reduced hospital bed days for adverse events (AE). The model forecasted 14,428–40,399 treated patients; 1,499–4,198 fewer TLRs; and 16,515–46,243 fewer hospital days for AE. At a state level, projected hospital savings were: New South Wales AUD 10.9–30.7M [USD 7.5–21.1M]; Victoria AUD 8.4–23.4M [USD 5.8–16.1M]; Queensland AUD 6.5–18.3M [USD 4.5–12.6M]; Western Australia AUD 3.4–9.5M [USD 2.3–6.5M]; South Australia AUD 2.3–6.4M [USD 1.6–4.4M].ConclusionsTreatment of symptomatic lower-limb PAD with the Eluvia DES could lead to potential savings for the Australian healthcare system, at the national, state, and the local hospital level, based on improved patient outcomes.
PP400 Cost-Effectiveness Analysis Of Adding Bedaquiline To Drug Regimens For Multidrug-Resistant Tuberculosis Treatment In China
Authors: Zhang Fan , Liu Yuehua , Liu Zhao , Guo Zining , Yang Junting , Zhao Kun 
Published: December 2020

IntroductionAccording to the World Health Organization, there were approximately 0.5 million new cases of rifampicin-resistant tuberculosis in 2018, of which 78 percent were multidrug-resistant tuberculosis (MDR-TB), and China has one of the largest shares of the global burden (14%). In recent years, the Chinese government has made progress in TB control and prevention, but for MDR-TB, treatment options are still limited and expensive, and novel drugs are not always available. This research aims to evaluate the cost-effectiveness of adding bedaquiline to a background regimen (BR) of drugs for MDR-TB treatment in China, and to provide evidence for government to improve public health policies.MethodsA cohort-based Markov model was developed to evaluate the incremental cost-effectiveness ratio (ICER) of bedaquiline plus BR (BBR) versus BR alone in MDR-TB treatment, over a 10-year time horizon. Data were sourced from a phase II clinical trial, real-world data in China, published literature, and expert opinion. Outcomes were evaluated in quality-adjusted life years (QALYs) and life-years gained (LYG). The discount rate was 3.5%. Probabilistic and deterministic sensitivity analyses were conducted.ResultsThe discounted costs per person for BBR was CNY 135,706 [USD 19,172], compared with CNY 92,465 [USD 13,063] for BR. The discounted utility per person for BBR was also higher than that for BR (3.943 QALYs versus 3.193 QALYs). The ICER of BBR was CNY 58,096 [USD 8,208]/QALY, which was lower than the willingness-to-pay threshold of CNY 212,676 [USD 30,046] (three-times the gross domestic product per capita). Therefore, BBR was considered to be cost-effective. The sensitivity analysis confirmed the robustness of the results. BBR remained cost-effective in the sensitivity analysis, with a 77.2 percent probability of being cost-effective versus BR.ConclusionsIn China, bedaquiline is not included in the National Reimbursement Medicine List, which results in a heavy financial burden for MDR-TB patients. From this study, BBR was cost-effective by significantly reducing time to sputum culture conversion and increasing QALYs and LYGs, which offset the higher drug costs.
PP445 Mapping The Trend Of The Da Vinci Surgical System Use In China
Authors: Zhao Jin , Zhong Min , Hu Min 
Published: December 2020

IntroductionA robotically assisted surgical system, the da Vinci surgical system (DVSS), is a sophisticated surgical platform equipped with immersive 3D visualization and dexterous articulating endoscopic instruments. Surgeons can intuitively control the surgical system to perform delicate surgical tasks. Robotic surgery has gained popularity globally ever since its birth and was approved to market by the China Food and Drug Administration in 2006. This study aims to map the current use of DVSSs in mainland China and the trends from 2009 to 2019.MethodsA full-sample survey of all hospitals equipped with DVSSs was conducted in mainland China, collecting data on hospitals and surgical departments using DVSSs, operation volume, and time of installation. Disease classification was standardized to obtain DVSS use in each department. EXCEL software was used for logging and cleaning the data. The analysis focused on descriptive analysis to map trends of DVSS use in China and present geographical and department distribution.ResultsThe DVSSs installed have grown from seven in 2009 to 135 in 2019. By the end of 2019, twenty-eight provinces in China have been equipped with the DVSSs, among which eighty-seven in the eastern regions, twenty-seven in the central regions, and twenty-one in the western regions. The annual volume of operations grew from 339 in 2009 to 38,991 in 2019, at an annual rate of 60.7 percent. The average workload conducted by a single robot is much higher than that of their counterparts in other countries. The largest share of the volume is in department of urology (48%), followed by general surgery (25%) and thoracic surgery (13%).ConclusionsThe use of DVSSs in China has been growing rapidly and extensively, with certain differences between geographical regions and surgical departments. We need to further explore the factors affecting its use and operation efficiency and to evaluate the effectiveness as well as cost-effectiveness in real-world clinical practice to inform public policies on application of DVSS, for example, license and insurance.
PP455 Cost-effectiveness Of Ixazomib-Based Regimen Compared With Bortezomib-Based Regimen In Chinese Patients With Relapsed/Refractory Multiple Myeloma: A Retrospective Study
Authors: Wang Pei , Li Jing , Yang Yang , Liu Peng 
Published: December 2020

IntroductionThe treatment of relapsed/refractory multiple myeloma (RRMM), a common hematological malignancy, remains a great challenge in China, partially due to the limited accessibility to novel agents and inadequate public health insurance coverage. Ixazomib, a novel oral proteasome inhibitor (PI), was approved by the China Food and Drug Administration (CFDA) for RRMM in 2018. While bortezomib, a traditional PI, is the recommended agent in the clinical guideline for MM. Here, we compared their costs and effectiveness.MethodsRRMM patients who has received an ixazomib-based regimen (at least 2 cycles) were analyzed. Using a propensity score matching method, we generated a control group of RRMM patients who received the bortezomib-based regimen. The criteria included the number of treatment lines, age, and the revised international staging system stage (R-ISS) which representing the disease stage for myeloma, and paired at a ratio of 1:2 (allowing one control to match multiples). The difference in hospitalization stay, grade 3/4 adverse events rates, overall response rate (ORR), mortality during treatment, and treatment costs was then compared.ResultsNineteen patients received ixazomib and twenty-seven that received bortezomib were included. The ixazomib-group demonstrated a shorter hospital stay (9 days versus 27 days, p < 0.001), lower grade 3–4 adverse events rates (42.1% versus 55.6%, p < 0.001), higher ORR (63.2% versus 48.1%, p = 0.228), and lower mortality rate during treatment (0% versus 7.4%, p = 0.169) than that of bortezomib-group. The ixazomib group had lower total costs (127,620CNY versus 156,424CNY [18,033USD versus 22,103USD], p > 0.05), lower drug costs (98,376CNY versus 103,307CNY [13,901USD versus 14,598USD], p > 0.05), and the lower costs of supportive treatment (5,507CNY versus 14,701 CNY [778USD versus 2,077USD], p < 0.001). Only in terms of self-funded costs, the bortezomib-based regimen was significantly lower (37,127CNY versus 11,521CNY [5,246USD versus 1,628USD], p < 0.001).ConclusionsCompared with the bortezomib-based regimen, the ixazomib-based regimen has better therapeutic effects on MM patients while saving costs. Hence, it may be preferable for use in the treatment of RRMM in China.
PP538 Burden Of Disease For Patients With Acute Myocardial Infarction Combining Dyslipidemia In China
Authors: Zhang Mengran , Li Hongchao , Ma Aixia , Chen Pingyu 
Published: December 2020

IntroductionPrevalence of dyslipidemia in Chinese adults is increasing rapidly. Dyslipidemia is one of the most important risk factors for acute myocardial infarction (AMI), which represents a serious disease burden to the country. However, there is no published research on the costs of Chinese patients diagnosed with AMI combining dyslipidemia. This study aimed to report key findings of the disease burden in China, including direct medical costs and direct non-medical costs.MethodsSix hospitals from different geographic areas were selected in China for data collection. Patients who were hospitalized due to AMI combining dyslipidemia from January 1 2016 to December 31 2016 in the six sites were enrolled. Direct medical costs including inpatient and outpatient costs were extracted through electronic medical records; medical costs occurred in other healthcare institutions and direct non-medical costs were collected by a face-to-face questionnaire survey. Results were analyzed with descriptive statistics.ResultsData of 900 patients were analyzed. There were more males (78.40%) than females. The mean age was 62.1 (SD: 11.5). The times of inpatient and outpatient per year were 0.57 and 8.67, respectively. Medium direct medical costs and medium direct non-medical costs were 31,440 RMB (Interquartile range (IQR): 21,533–48,202) (4,443 USD: 3043–6812) and 665 RMB (IQR: 351–1328) (94 USD: 50–188), respectively; while corresponding medium indirect costs per year were 659 RMB (IQR: 226–1579) (93 USD: 32–223).ConclusionsThis is the first study comprehensively analyzing the disease burden of patients diagnosed with AMI combining dyslipidemia in China. The results suggested that the medical cost of this population is still high. Hospitalization cost accounted for 81 percent of the total cost, which was around 1.3 times of the annual per capita disposable income over the same period. Therefore, the importance of providing effective clinical management as well as dyslipidemia prevention and control intervention should be highlighted, especially for middle-aged and elderly males with dyslipidemia.
Projected effects on salt purchases following implementation of a national salt reduction policy in South Africa
Authors: Ndanuko Rhoda N , Shahid Maria , Jones Alexandra , Harris Terry , Maboreke Joel , Walker Adele , Raubenheimer David , Simpson Stephen J , Neal Bruce , Wu Jason HY , Peters Sanne AE , Woodward Mark 
Published: December 2020

AbstractObjective:To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with.Design:This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content.Setting:South Africa.Participants:The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018.Results:Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels.Conclusions:A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
Pre-pregnancy BMI is associated with offspring body composition in adulthood before adiposity-related disorders: a retrospective cohort
Authors: Eshriqui Ilana , Valente Angélica Marques Martins , Folchetti Luciana Dias , de Almeida-Pititto Bianca , Ferreira Sandra Roberta G 
Published: December 2020

AbstractObjective:To investigate the association between maternal pre-pregnancy BMI and offspring body composition in adulthood.Design:Retrospective cohort. Undergraduates of nutrition or nutritionists were recruited at the baseline of the Nutritionists’ Health Study between 2014 and 2017. Maternal pre-pregnancy BMI and current life aspects were self-reported through online questionnaires. Three body compartments were dual-energy x-ray absorptiometry-determined. The following variables were obtained: body fat (%), fat mass index (FMI) (kg/m2), android-to-gynoid fat ratio, visceral adipose tissue (VAT) (cm3), appendicular skeletal muscle mass index (ASMI) (kg/m2), total bone and femur mineral content (g) and density (g/cm2). Linear regression adjusted according to directed acyclic graphs recommendation was performed.Setting:São Paulo, Brazil.Participants:Healthy non-pregnant women (aged 20–45 years) (n 150).Results:Median age and BMI were 22 years (IQR = 20, 29) and 22·3 kg/m2 (IQR = 20·4, 25·3), respectively. Pre-pregnancy BMI ≥ 25 kg/m2 was reported by 14·7 % of mothers. In fully adjusted models, maternal pre-pregnancy BMI was associated with their daughters’ body fat % (β = 0·31; 95 % CI 0·0004, 0·63), FMI (β = 0·17; 95 % CI 0·03, 0·30), android-to-gynoid ratio (β = 0·01; 95 % CI 0·004, 0·02) and VAT (β = 0·09; 95 % CI 0·02, 0·16), but not with total bone density (β = 0·001; 95 % CI –0·003, 0·006) and content (β = 7·13; 95 % CI –4·19, 18·46). Direct association with ASMI was also detected, but lost statistical significance when participants whose mothers were underweight were excluded.Conclusions:Maternal pre-pregnancy BMI was directly associated with offspring general and visceral adiposity but seems not to be associated with bone mass. Results reinforce importance of avoiding excess of maternal adiposity, as an attempt to break the vicious cycle of obesity transmission.
The global politics paradigm: guide to the future or only the recent past?
Authors: Keohane Robert O. 
Published: December 2020

AbstractMichael Zürn's A Theory of Global Governance is a major theoretical statement. The first section of this essay summarizes Zürn's argument, pointing out that his Global Politics Paradigm views contestation as generated endogenously from the dilemmas and contradictions of reflexive authority relationships. Authoritative international institutions, he maintains, have difficulty maintaining their legitimacy in a world suffused with democratic values. The second section systematically compares Zürn's Global Politics Paradigm with both Realism and Cooperation Theory, arguing that the three paradigms have different scope conditions and are therefore as much complementary as competitive. The third section questions the relevance of Zürn's argument to contemporary reality. Great power conflict and authoritarian populism in formerly democratic countries generate existential threats to multilateralism and global institutions that are more serious than Zürn's legitimacy deficits.
Unsettling times for human rights: remarks on ‘The politics of rights’
Authors: Welsh Jennifer M. 
Published: December 2020

AbstractThis commentary focuses on Kratochwil's observation about the gap between the pervasiveness of human rights language and its susceptibility to perverse effects and abuse. After demonstrating that Kratochwil shares much of the contemporary skepticism about the alleged foundations and legitimacy of human rights, the comment elaborates on his claims that human rights were and are particularistic and that ‘rights talk’ produces unintended consequences for the individuals whose autonomy was meant to flourish. He questions but ultimately does not answer whether the broader anthropocentric ethos that underpins Western societies, and legal systems, may one day be superseded by ‘non-rightist’ approaches.
Estimating Greenhouse Gas Emissions From Peat Combustion in Wildfires on Indonesian Peatlands, and Their Uncertainty
Authors: Rodríguez Vásquez M. J. , Benoist A. , Roda J.‐M. , Fortin M. 
Published: December 2020

AbstractPeatlands play an important role as carbon pools, storing a third of the world's soil carbon. However, peatlands in Southeast Asia have suffered from depletion due to economic pressure and the demand for natural resources, often caused by land use changes and fires. Usually, land preparation requires drainage and fires, resulting in major greenhouse gas (GHG) emissions into the atmosphere. In this work, we propose a general equation to estimate GHG emissions from fires on peatlands. The contribution of each parameter to the variance of the estimated GHG emissions was also evaluated. We used Monte Carlo simulation, meta‐analyses, and an analytical expression of variance. GHG emissions of a single fire episode were estimated at 842 Mg ha−1 CO2 eq. with a standard deviation of 466 Mg ha−1 CO2 eq. The parameter contributing most to variance was the depth of burn, at 94.2%, followed by bulk density, at 5.5%, and emission factors, at 0.3%. Our estimated GHG emissions were close to the amount estimated from the default values provided by the IPCC, strengthening confidence in the IPCC methodology. When the depth of burn was assessed by remote sensing, the parameter that most contributed to variance became the fire‐damaged area, followed by the depth of burn. The contribution of each parameter to variance, as estimated in this study, made it possible to prioritize the effort in uncertainty reduction. Combining Monte Carlo simulation and an analytical expression of variance could be a promising way of obtaining more reliable confidence intervals.
A Mechanism‐Based Model for the Impact Response of Quartz
Authors: Zeng Qinglei , McCauley J. W. , Ramesh K. T. 
Published: December 2020

AbstractThe mechanical response of geomaterials to extreme dynamic conditions is essential to understanding planetary impacts, other geological and seismic events, and underground explosions. In this study, we present a multimechanism constitutive model to describe the dynamic response of polycrystalline quartz (e.g., nonporous quartzite), and implement it using a large scale computational analysis to simulate impact events. The active deformation mechanisms within quartz under dynamic loading consist of amorphization, fracture and granular flow. All of these mechanisms are integrated within the model in terms of their competition, evolution, and interaction during a complex loading history. A generalized amorphization model is introduced within a thermodynamically consistent framework on the basis of earlier work in Zeng et al. (2019a, https://doi.org/10.1016/j.jmps.2019.06.012), and accounts for the kinematics of finite deformation inside amorphization bands and the distinct physical properties of the amorphous phase. Fracture in the form of microcracking emanating from internal defects is also considered. Once the material is fully fragmented, the behavior transitions to granular flow. After determining the model parameters for polycrystalline quartz, we illustrate the model response using a representative volume element, where the competition of mechanisms is revealed under several typical loadings. Plate impact experiments and dynamic compression on a polycrystalline quartz foil are then simulated. The simulation results are compared with experiments to prove the predictive capability of the model in capturing the key features of quartz during impact events.
Atlantic Ocean Ventilation Changes Across the Last Deglaciation and Their Carbon Cycle Implications
Authors: Skinner L. C. , Freeman E. , Hodell D. , Waelbroeck C. , Vazquez Riveiros N. , Scrivner A. E. 
Published: December 2020

AbstractChanges in ocean ventilation, controlled by both overturning rates and air‐sea gas exchange, are thought to have played a central role in atmospheric CO2 rise across the last deglaciation. Here, we constrain the nature of Atlantic Ocean ventilation changes over the last deglaciation using radiocarbon and stable carbon isotopes from two depth transects in the Atlantic basin. Our findings broadly cohere with the established pattern of deglacial Atlantic overturning change, and underline the existence of active northern sourced deep‐water export at the Last Glacial Maximum (LGM). We find that the western Atlantic was less affected by incursions of southern‐sourced deep water, as compared to the eastern Atlantic, despite both sides of the basin being strongly influenced by the air‐sea equilibration of both northern and southern deep‐water end‐members. Ventilation at least as strong as modern is observed throughout the Atlantic during the Bølling‐Allerød (BA), implying a “flushing” of the entire Atlantic water column that we attribute to the combined effects of Atlantic meridional overturning circulation (AMOC) reinvigoration and increased air‐sea equilibration of southern sourced deep‐water. This ventilation “overshoot” may have counteracted a natural atmospheric CO2 decline during interstadial conditions, helping to make the BA a “point of no return” in the deglacial process. While the collected data emphasize a predominantly indirect AMOC contribution to deglacial atmospheric CO2 rise, via far field impacts on convection in the Southern Ocean and/or North Pacific during Heinrich Stadial 1 and the Younger Dryas, the potential role of the AMOC in centennial CO2 pulses emerges as an important target for future work.