| 491. |
|
|
| 492. |
- Jendle, Johan, 1963-, et al.
(författare)
-
Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes in a Swedish setting
- 2019
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Randomised controlled trials and observational studies have shown lower risk of hypoglycemia in patients with type 1-diabetes (T1D) and type 2-diabetes (T2D) on treatment with insulinde gludec (IDeg) vs insulin glargine 100 units/mL (IGlar). This study assessed cost-effectiveness (C/E) of IDeg vs insulin treatment before switch to IDeg in a Swedish real-world setting in people with T1D and T2D.Materials and methods: ReFLeCT is a prospective, observational study in T1D (n=566) and T2D (n=611) in seven European countries and comprised a four-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (IDeg). Data from ReFLeCT was used to assess C/E of IDeg compared with basal insulin treatment prior to switching to IDeg. Basal insulin unit costs were weighted to represent the basal insulin present at baseline (T1D: IGlar 63.8%, Insulin detemir (IDet) 22.7%, other/missing 13.5%. T2D: IGlar 59.1%, IDet 20.8%, other/missing 20.1%). The Swedish original IGlar price was used as base case. IGlar biosimilar price was used in a sensitivity analysis. Where information on basal insulin at baseline was missing, the lowest basal insulin price (insulin NPH) was used as a conservative approach. C/E was analysed over a 1-year time horizon from a Swedish societal perspective (price level 2019). Only differences with p<0.05 were included in the analysis.Results: Basal and bolus insulin doses at baseline were 25.0 IU and 27.3 IU (T1D) and 37.5 IU and 24.4 IU (T2D). At 12 months estimated basal and bolus insulin dose ratios were 0.91 (95% C.I. 0.83-0.91) and 0.87 (0.83-0.91) for T1D and 0.98 (0.95-1.01) and 0.96 (0.94-1.01) for T2D. For T1D riskratios (RR) for non-severe daytime hypoglycaemia was 0.85 (0.78-0.93), non-severe nocturnal hypoglycaemia 0.63 (0.52-0.76) and severe hypoglycaemia 0.28 (0.14-0.56). Corresponding RR for T2D were 0.56 (0.46-0.69), 0.38 (0.22-0.64) and 2.87 (0.33-24.65). In T1D IDeg was cost-saving compared to previous basal therapy (Table 1). In T2D, IDeg was highly cost-effective, with a cost per quality-adjusted life-year (QALY) of SEK 15,000-24,000 (Table 1). A treatment is considered cost-effective in Sweden if cost/QALY is below SEK 500,000. Sensitivity analyses showed that the results were robust to changes in efficacy and cost parameters in both T1D and T2D.Conclusion: In this C/E-analysis, treatment with IDeg was cost-saving (T1D) or highly cost-effective (T2D) relative to the treatment used before switch in a Swedish setting after one year. C/E of IDeg in clinical practice is driven by lower insulin doses (T1D) and reduced risk of hypoglycaemia (T1D and T2D).
|
|
| 493. |
- Jendle, Johan, 1963-, et al.
(författare)
-
Switching to insulin degludec is a cost-saving therapy for patients with type 1 and type 2 diabetes in the Swedish setting based on real world data
- 2019
-
Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 22:Suppl. 3, s. 575-576
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of thesefindings on long-term cost-effectiveness outcomes in the Swedish setting.Methods: Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK).Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cos tsavings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D.Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.
|
|
| 494. |
|
|
| 495. |
- Khalkar, P, et al.
(författare)
-
Novel Methylselenoesters Induce Programed Cell Death via Entosis in Pancreatic Cancer Cells
- 2018
-
Ingår i: International journal of molecular sciences. - : MDPI AG. - 1422-0067. ; 19:10
-
Tidskriftsartikel (refereegranskat)abstract
- Redox active selenium (Se) compounds have gained substantial attention in the last decade as potential cancer therapeutic agents. Several Se compounds have shown high selectivity and sensitivity against malignant cells. The cytotoxic effects are exerted by their biologically active metabolites, with methylselenol (CH3SeH) being one of the key executors. In search of novel CH3SeH precursors, we previously synthesized a series of methylselenoesters that were active (GI50 < 10 µM at 72 h) against a panel of cancer cell lines. Herein, we refined the mechanism of action of the two lead compounds with the additional synthesis of new analogs (ethyl, pentyl, and benzyl derivatives). A novel mechanism for the programmed cell death mechanism for Se-compounds was identified. Both methylseleninic acid and the novel CH3SeH precursors induced entosis by cell detachment through downregulation of cell division control protein 42 homolog (CDC42) and its downstream effector β1-integrin (CD29). To our knowledge, this is the first time that Se compounds have been reported to induce this type of cell death and is of importance in the characterization of the anticancerogenic properties of these compounds.
|
|
| 496. |
- Kimberg, Victor, et al.
(författare)
-
Phase-sensitive wave-packet dynamics caused by a breakdown of the rotating-wave approximation
- 2006
-
Ingår i: Physical Review A. Atomic, Molecular, and Optical Physics. - 1050-2947 .- 1094-1622. ; 73:2
-
Tidskriftsartikel (refereegranskat)abstract
- The water dimer driven by strong infrared field is studied in the two-vibrational mode approximation. A pump pulse excites the OH vibrational modes and creates a coherent superposition of vibrational states of the low-frequency OO mode. The solution of the Schrodinger equation in the adiabatic approximation shows a strong sensitivity of the OO vibrational wave-packet dynamics to the absolute phase of the pump field. This effect appears due to a break down of the rotating-wave approximation when the Rabi frequency of the OH vibrational transition approaches the frequency of the OH mode. The violation of the rotating wave approximation modifies considerably the interaction of the probe radiation with the laser-driven molecule.
|
|
| 497. |
- Ko, Jong Mi, et al.
(författare)
-
Differential impact of physical activity type on depression in adults with congenital heart disease : A multi-center international study
- 2019
-
Ingår i: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 124
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to examine the association between physical activity (PA) and depression in a large international cohort of adults with congenital heart disease (ACHD) as data about the differential impact of PA type on depression in this population are lacking.METHODS: In 2018, we conducted a cross-sectional assessment of 3908 ACHD recruited from 24 ACHD-specialized centers in 15 countries between April 2013 to March 2015. The Hospital Anxiety and Depression Scale was used to assess self-reported depressive symptoms and the Health-Behavior Scale-Congenital Heart Disease was used to collect PA information. Cochran-Armitage tests were performed to assess trends between depressive symptom levels and PA participation. Chi-Square and Wilcoxon Rank Sum tests were utilized to examine relations between depressive symptom levels and patient characteristics. Stepwise multivariable models were then constructed to understand the independent impact of PA on depressive symptoms.RESULTS: The overall prevalence of elevated depressive symptoms in this sample was 12% with significant differences in rates between countries (p < .001). Physically active individuals were less likely to be depressed than those who were sedentary. Of the 2 PA domains examined, sport participation rather than active commute was significantly associated with reduced symptoms of depression. After adjustment in multivariable analysis, sport participation was still significantly associated with 38% decreased probability of depressive symptoms (p < .001).CONCLUSIONS: Sport participation is independently associated with reduced depressive symptoms. The development and promotion of sport-related exercise prescriptions uniquely designed for ACHD may improve depression status in this unique population.
|
|
| 498. |
- Ko, Jong Mi, et al.
(författare)
-
Physical Activity-Related Drivers of Perceived Health Status in Adults With Congenital Heart Disease
- 2018
-
Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 122:8, s. 1437-1442
-
Tidskriftsartikel (refereegranskat)abstract
- Data on the differential impact of physical activity on perceived health status (PHS) in a large adult congenital heart disease (ACHD) patient population are lacking. We conducted a cross-sectional assessment of 4,028 ACHD patients recruited from 24 ACHD-specialized centers in 15 countries across 5 continents to examine the association between physical activity and PHS in a large international cohort of ACHD patients. A linear analog scale of the EuroQol-5D 3 level version and the 12-item Short Form Health Survey-version 2 were used to assess self-reported health status and the Health-Behavior Scale-Congenital Heart Disease was used as a subjective measurement of physical activity type, participation, and level. Correlation analyses and Wilcoxon Rank Sum tests examined bivariate relations between sample characteristics and PHS scores. Then, multivariable models were constructed to understand the impact of physical activity on PHS. Only 30% of our sample achieved recommended physical activity levels. Physically active patients reported better PHS than sedentary patients; however, the amount of physical activity was not associated with PHS. Further statistical analyses demonstrated that specifically sport participation regardless of physical activity level was a predictor of PHS. In conclusion, the majority of ACHD patients across the world are physically inactive. Sport participation appears to be the primary physical activity-related driver of PHS. By promoting sport-related exercise ACHD specialists thus may improve PHS in ACHD patients.
|
|
| 499. |
|
|
| 500. |
|
|
