The National Institute for Health and Care Excellence in England has implemented severity-of-disease modifiers that give greater weight to health benefits accruing to patients who experience a larger ...shortfall in quality-adjusted life-years (QALYs) under current standard of care than healthy individuals. This requires an estimate of quality-adjusted life expectancy (QALE) of the general population based on age and sex. Previous QALE population norms are based on nearly 30-year-old assessments of health-related quality of life in the general population. This study provides updated QALE estimates for the English population based on age and sex.
5-level version of EQ-5D data for 14 412 participants from the Health Survey for England (waves 2017 and 2018) were pooled, and health-related quality of life population norms were calculated. These norms were combined with official life tables from the Office for National Statistics for 2017 to 2019 using the Sullivan method to derive QALE estimates based on age and sex. Values were discounted using 0%, 1.5%, and 3.5% discount rates.
QALE at birth is 68.24 QALYs for men and 68.21 QALYs for women. These values are significantly lower than previously published QALE population norms based on the older 3-level version of EQ-5D data.
This study provides new QALE population norms for England that serve to establish absolute and relative QALY shortfalls for the purpose of health technology assessments.
•In 2022, the National Institute for Health and Care Excellence (NICE) introduced quality-adjusted life-year (QALY) weighting based on the QALY shortfall associated with a condition. Shortfall calculations require estimates of the quality-adjusted life expectancy of healthy individuals.•We provide up-to-date estimates of the quality-adjusted life expectancy of the English population by combining national mortality statistics with 5-level version of EQ-5D data from the Health Survey for England mapped to 3-level version of EQ-5D utility values using NICE’s preferred mapping algorithm. We also publish an online tool that enables the QALY shortfall associated with a condition to be simply calculated: https://shiny.york.ac.uk/shortfall.•These up-to-date results and the associated tool have the potential to inform NICE appraisals conducted under the new methods.
Patients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy, although fewer than 50% could receive postoperative chemotherapy. We examined the value of ...purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines.
Patients with locally advanced adenocarcinoma of the stomach or esophagogastric junction (AEG II and III) were randomly assigned to preoperative chemotherapy followed by surgery or to surgery alone. To detect with 80% power an improvement in median survival from 17 months with surgery alone to 24 months with neoadjuvant, 282 events were required.
This trial was stopped for poor accrual after 144 patients were randomly assigned (72:72); 52.8% patients had tumors located in the proximal third of the stomach, including AEG type II and III. The International Union Against Cancer R0 resection rate was 81.9% after neoadjuvant chemotherapy as compared with 66.7% with surgery alone (P = .036). The surgery-only group had more lymph node metastases than the neoadjuvant group (76.5% v 61.4%; P = .018). Postoperative complications were more frequent in the neoadjuvant arm (27.1% v 16.2%; P = .09). After a median follow-up of 4.4 years and 67 deaths, a survival benefit could not be shown (hazard ratio, 0.84; 95% CI, 0.52 to 1.35; P = .466).
This trial showed a significantly increased R0 resection rate but failed to demonstrate a survival benefit. Possible explanations are low statistical power, a high rate of proximal gastric cancer including AEG and/or a better outcome than expected after radical surgery alone due to the high quality of surgery with resections of regional lymph nodes outside the perigastic area (celiac trunc, hepatic ligament, lymph node at a. lienalis; D2).
Purpose of Review
This review brings a major, previously under-recognized dental and general health problem to the attention of the medical and scientific community. The goals are to help clinicians ...make early diagnoses, thereby improving treatment outcomes, and to stimulate increasing research efforts to understand the etiology and ultimately prevention.
Recent Findings
There are two recent systematic reviews of molar incisor hypomineralization (MIH). One reveals the global burden of the condition; mean global prevalence is 13% with 878 million people affected, with 4.8 million cases per year requiring treatment. The review into etiology found a lack of definitive knowledge, but that it is likely to be multifactorial, with childhood illness including fever possibly implicated.
Summary
The review presents details of MIH sufficient to enable clinicians to recognize it and understand its impact on affected children, its management, and the importance of early intervention. Much further research is needed.
The increasing intelligence of products and systems, their intra-company cross-linking and their cross-company integration into value creation networks is referred to as Industry 4.0. Academics and ...practitioners, largely agreeing on the global importance of this proclaimed industrial revolution, have published many contributions on the topic. Research, however, is rather focused on investigating single technologies in quite specific application domains and largely neglects the profound managerial challenges underlying Industry 4.0. Given the recent plea for a more active contribution from the management science community, we strive to establish Industry 4.0 as a challenging but promising field for management research, and aim to assist scholars in engaging with the topic. Therefore, we first gather and analyze extant contributions by means of a systematic literature review and synthesize the information gained into 18 managerial challenges of Industry 4.0 falling into six interrelated clusters: (1) strategy and analysis, (2) planning and implementation, (3) cooperation and networks, (4) business models, (5) human resources and (6) change and leadership. Considering that Industry 4.0 is still an emerging topic and publications may therefore not always be found in highly ranked journals, we aimed to increase the confidence in our findings and triangulated our data by conducting an online survey of industry experts and academics that allows us to qualify the identified challenges in terms of importance and future research need. On this basis, we present an empirically backed research agenda and suggest fruitful avenues for future research in three basic categories: practice-enhancing research, knowledge-enhancing research, and high-impact research.
Endoluminal vacuum therapy (EVT) has evolved as a promising option for endoscopic treatment of foregut wall injuries in addition to the classic closure techniques using clips or stents. To improve ...vacuum force and maintain esophageal passage, we combined endosponge treatment with a partially covered self-expandable metal stent (stent-over-sponge; SOS).
Twelve patients with infected upper gastrointestinal wall defects were treated with the SOS technique.
Indications for SOS were anastomotic leakage after surgery (n = 11) and chronic foregut fistula (n = 1). SOS treatment was used as a first-line treatment in seven patients with a success rate of 71.4 % (5/7) and as a second-line treatment after failed previous EVT treatment in five patients (success rate 80 %; 4/5). Overall, SOS treatment was successful in 75 % of patients (9/12). No severe adverse events occurred. CONCLUSION : SOS is an effective method to treat severely infected foregut wall defects in patients where EVT has failed, and also as a first-line treatment. Comparative prospective studies are needed to confirm our preliminary results.
OBJECTIVE:To define “best possible” outcomes in total minimally invasive transthoracic esophagectomy (ttMIE).
BACKGROUND:TtMIE, performed by experts in patients with low comorbidity, may serve as a ...benchmark procedure for esophagectomy.
PATIENTS AND METHODS:From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score ≤2, WHO/ECOG score ≤1, age ≤65 years, body mass index 19–29 kg/m). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results.
RESULTS:Benchmark patients were predominantly male (82.9%) with a median age of 58 years (53–62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0–2) and 12 (9–18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (≥grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were ≤55.7% and ≤30.8% for overall and major complications, ≤18.0% for readmission, ≤3.1% for positive resection margins, and ≥23 for lymph node yield. Benchmarks at 30 and 90 days were ≤1.0% and ≤4.6% for mortality, and ≤40.8 and ≤42.8 for the comprehensive complication index, respectively.
CONCLUSION:This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection.
Health economic evaluation models have traditionally been built in Microsoft Excel, but more sophisticated tools are increasingly being used as model complexity and computational requirements ...increase. Of all the programming languages, R is most popular amongst health economists because it has a plethora of user created packages and is highly flexible. However, even with an integrated development environment such as R Studio, R lacks a simple point and click user interface and therefore requires some programming ability. This might make the switch from Microsoft Excel to R seem daunting, and it might make it difficult to directly communicate results with decisions makers and other stakeholders. The R package Shiny has the potential to resolve this limitation. It allows programmers to embed health economic models developed in R into interactive web browser based user interfaces. Users can specify their own assumptions about model parameters and run different scenario analyses, which, in the case of regular a Markov model, can be computed within seconds. This paper provides a tutorial on how to wrap a health economic model built in R into a Shiny application. We use a four-state Markov model developed by the Decision Analysis in R for Technologies in Health (DARTH) group as a case-study to demonstrate main principles and basic functionality. A more extensive tutorial, all code, and data are provided in a GitHub repository.
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