No abstract available.
Comparative Effectiveness Research

No abstract available.
Comparative Effectiveness Research

Introduction: Well-differentiated thyroid carcinoma (WDTC) is the most common type of thyroid cancer with a notable increasing incidence worldwide. It is prevalent among Filipino descent as compared to other nationalities. Its good prognosis and high survival rate predispose patients to lifetime surveillance with incomplete response, instead of death, as outcome measure. This eventually leads to increase in cost of care, utilization, and allocation of medical resources for the survivors of the disease. Thyroglobulin immunoradiometric assay (Tg IRMA) and I-131 diagnostic whole-body scan (dWBS) are two nuclear medicine procedures that are part of WDTC surveillance. Due to their varied availability in Asia-Pacific, most clinicians measure thyroglobulin (Tg) alone due to perceived cost-effectiveness. Objective: This study aims to analyze the cost-effectiveness of two nuclear medicine procedures used in WDTC surveillance, namely thyroglobulin immunoradiometric assay and I-131 diagnostic whole-body scan, in detecting incomplete response. Methodology: Three clinical guidelines on WDTC management were reviewed to identify frequency, total number and expenditure for surveillance, namely from the University of the Philippines-Philippine General Hospital in 2008 (PGH 2008), American Thyroid Association in 2015 (ATA 2015), and the Department of Health (DOH 2021). A Markov model was constructed to simulate a 36-month surveillance with complete and incomplete response to treatment as disease states. Parameter values like rate of incomplete response in WDTC patients, prognostic values per each surveillance test, and other relevant data were collected from literature search and established data. The cost of surveillance was based on the rates offered by Philippine General Hospital (PGH) Radioisotope Laboratory as of November 2022. One-way sensitivity was done to check robustness of results. Results: ATA 2015 incurs the most expenses, amounting to PHP 14,600.00 to 20,450.00 ($ 254.19 – 356.04) for three years of surveillance, followed by DOH 2021 (PHP 11,700.00 – 15,600.00 or $ 203.74 – 271.65), and PGH 2008 (PHP 3,900.00 – 6,825.00 or $ 67.91 – 118.85). The thyroglobulin IRMA arm costs lower (PHP 17,784.00 or $ 309.74) than I-131 dWBS (PHP 271,875.00 or $ 4,735.13) in detecting incomplete response. I-131 dWBS should cost around PHP 570.00 (or $ 9.92) to be as cost-effective as the thyroglobulin IRMA. Conclusion This study has identified that thyroglobulin IRMA is more cost-effective than I-131 diagnostic whole-body scan in detecting incomplete response in WDTC patients. This supports the perceived cost-effectiveness of thyroglobulin measurement in surveillance, even without diagnostic whole body-scans. This study also identified that the new DOH 2021 guidelines will incur lesser expenditure in using nuclear medicine procedures for surveillance as compared to ATA 2015 guidelines. Local clinicians may also find it easier to follow as it is more suitable to the Philippine setting.
Cost-Effectiveness Analysis

Background: Cost-effectivenessstudiesareimportant for chronic diseases such as psoriasis, which may cause significant financial burden and negatively affect the patient's quality of life. Objectives: This study evaluated which among the treatment options, namely topicals phototherapy (TP), topicals + systemic (TS), and topicals + biologics (TB), is the most cost-effective for the management of moderate to severe psoriasis at the Rizal Medical Center's Psoriasis Center Methods: A total of 65 moderate to severe psoriasis patients seen at the Rizal Medical Center's Psoriasis Center in 2021 were included in this retrospective cross-sectional study. Chart review was conducted to account all direct costs of treatment. The effectiveness in relation to the overall cost was assessed using the psoriasis area severity index (PASI) and the dermatological life quality index (DLQI). Results: Our study showed that TS is the most cost-effective treatment for moderate to severe psoriasis with the lowest cost per PASI75 and DLQI<5 improvement valued at Php335.36, followed by TP valued at Php 762.87, and lastly by TB at Php 19,058.03. Despite TB incurring the highest cost, all patients in this treatment group showed the highest mean difference of PASI and DLQI. Conclusions Our findings suggest that topical with systemic medication is the most cost-effective treatment for moderate to severe psoriasis
Psoriasis ; Cost-Effectiveness Analysis

Synthesis research and test on biological activities of some azomethines from vanilline and 5-Nitro vanilline. 10 azomethines can be obtained by condensing vanilline and 5-Nitro Vanilline with aromatic amines such as aniline, pAB, p.Bromoe aniline, or.Toluidin, anthraniclic acid. The structures of obtained products have been characterized by element analyses and IR, UV spectroscopy. The compounds have been tested for antibacterial activities on positive gram bacteria rather than on negative ones. Azomethines of 5-Nitro vanillin have great effect in antibacterial and antifungal activities.
Pharmaceutical Preparations ; Relative Biological Effectiveness

By the condensation of azometines, 5-bromovalline with azomatic ketones, six beta-aminoketones was formed. All compounds was tested on 10 strains of bacteria and candida albicans in vitro. The results showed that synthesized compounds had strong antibacterial and antifungal activities.
Pharmaceutical Preparations ; Relative Biological Effectiveness

BACKGROUND: In 2000, the World Health Organization recommended implementation of universal hearing screening. The Philippines enacted this policy into law in 2009 as it was found to be cost-effective for the Philippines. The model at the time used a hospital-based approached to screening. This paper examines the cost-effectiveness and budget impact of implementing a community-based universal hearing screening program.
METHODS: A model was developed following a community-based hearing screening program. Parameters were obtained through literature review, secondary data analysis, and consultation with experts. Cost-effectiveness was assessed for a single birth cohort from a public payer and societal perspective.
RESULTS: A community-based universal hearing screening program was found to be cost-saving. One-way sensitivity analysis showed that results were sensitive only to treatment rate and follow-up rate. The program is also a high budget impact program.
CONCLUSION: A community-based hearing screening program is cost-saving for the Philippines. Ensuring treatment and good follow-up in testing will ensure cost-effectiveness.

Comparative effectiveness research (CER) now is a very popular concept in the field of international heath care reformation. Although its contents are not essentially changed, it advocates a new medical idea, a policy orientation at the national medical system level. The European countries and America hope CER could initiate the construction of a new historical milestone. Although there are already some guidelines for the design and report of CER by authorized international organizations, its assessment standards have not been involved. Therefore, good research for comparative effectiveness (GRACE) was signed by International Society Pharmacoepidemiology. A series of standard rules were formulated on how to assess the observational studies. In this article by analyzing the GRACE, we hope to provide the referential standards for enforcing observational studies by introducing CER in the clinical studies of Chinese medicine.
Comparative Effectiveness Research ; Research Design ; standards

A thermal neutron beam facility utilizing a typical tangential beam port for Neutron Capture Therapy was installed at the HANARO, 30 MW multi-purpose research reactor. Mixed beams with different physical characteristics and relative biological effectiveness would be emitted from the BNCT irradiation facility, so a quantitative analysis of each component of the mixed beams should be performed to determine the accurate delivered dose. Thus, various techniques were applied including the use of activation foils, TLDs and ionization chambers. All the dose measurements were performed with the water phantom filled with distilled water. The results of the measurement were compared with MCNP4B calculation. The thermal neutron fluxes were 1.02E9 n/cm2 s and 6.07E8 n/cm2 s at 10 and 20 mm depth respectively, and the fast neutron dose rate was insignificant as 0.11 Gy/hr at 10 mm depth in water. The gamma-ray dose rate was 5.10 Gy/hr at 20 mm depth in water. Good agreement within 5%, has been obtained between the measured dose and the calculated dose using MCNP for neutron and gamma component and discrepancy with 14% for fast neutron flux. Considering the difficulty of neutron detection, the current study support the reliability of these results and confirmed the suitability of the thermal neutron beam as a dosimetric data for BNCT clinical trials.
Fast Neutrons ; Neutron Capture Therapy* ; Neutrons* ; Relative Biological Effectiveness ; Water

The dose response of the number of micronuclei in cytokinesis-blocked (CB) lymphocytes after in vitro irradiation with -rays and neutrons in the 5 dose ranges was studied for a heterogeneous population of 4 donors. One thousand binucleated cells were systematically scored for micronuclei. Measurements performed after irradiation showed a dose-dependent increase in micronuclei(MN) frequency in each of the doctors studied. The dose-response curves were analyzed by a linear-quadratic model, frequencies per 1000 CB cells were (0.31+/-0.049) D+(0.0022+/-0.0002) D2+(13.19+/-1.854) (r2=1.000, X2=0.7074, p=0.95) following irradiation, and (0.99+/-0.528) D+(0.0093+/-0.0047) D2+(13.31+/-7.309) (r2=0.996, X2=7.6834, p=0.11) following neutrons irradiation (D is irradiation dose in cGy). The relative biological effectiveness (RBE) of neutrons compared with -rays was estimated by best fitting linear-quadratic model. In the micronuclei frequency between 0.05 and 0.8 per cell, the RBE of neutrons was 2.37+/-0.17. Since the MN assay is simple and rapid, it may be a good tool for evaluating the y-ray and neutron response.
Humans ; Lymphocytes* ; Neutrons ; Relative Biological Effectiveness ; Tissue Donors