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Tamlyn Anne R, Downes M, Simoncini T, Yu Q, Ren M, Wang Y, Graziano CM, Kim K. Evaluating the cost utility of estradiol plus dydrogesterone for the treatment of menopausal women in China. J Med Econ 2024; 27:16-26. [PMID: 38037348 DOI: 10.1080/13696998.2023.2289297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
AIM Evaluate the cost utility of menopausal hormone therapy for women in China. MATERIALS AND METHODS A bespoke Markov cost utility model was developed to evaluate a cohort of symptomatic perimenopausal women (>45 years) with intact uterus in China in accordance with China's Pharmacoeconomic guideline. Short (5-year) and long (10-year) treatment durations were evaluated over a lifetime model time horizon with 12-month cycle duration. Societal and healthcare payer perspectives were evaluated in the context of a primary care provider/prescriber, outpatient setting with inpatient care for patients with chronic conditions. Disease risk and mortality parameters were derived from focused literature searches, and China Diagnosis-related Group cost data was included. Comprehensive scenario, univariate and probabilistic sensitivity analysis were undertaken along with independent validation. This is the first model to include MHT-related disease risks. RESULTS According to base case results, the total cost for MHT was 22,516$ (150,106¥) and total quality adjusted life years 12.32 versus total cost of no MHT 30,824$ (205,495¥) and total quality adjusted life years 11.16 resulting in a dominant incremental cost effectiveness ratio of -7,184$ (-47,898¥) per QALY. Results hold true over a range of univariate deterministic sensitivity and scenario analyses. Probabilistic analysis showed a 91% probability of being cost effective at a willingness to pay threshold of three times Gross Domestic Product per capita in China. CONCLUSION Contingent on the structure and assumptions of the model, combination of estradiol plus dydrogesterone MHT is potentially cost saving in symptomatic women over the age of 45 years in China.
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Affiliation(s)
| | - Martin Downes
- Centre for Applied Health Economics, Griffith University, Griffith, Australia
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Molecular and Cellular Gynaecological Endocrinology Laboratory (MCGEL), University of Pisa, , Pisa, Italy
- European Menopause and Andropause Society, Geneva, Switzerland
| | - Qi Yu
- Centre of Gynaecological Endocrinology and Reproduction, Peking Union Medical College Hospital, Peking, China
- Asia Pacific Menopause Federation, Devon, United Kingdom of Great Britain and Northern Ireland
| | - Mulan Ren
- Department of Obstetrics and Gynaecology, Southeast University School of Medicine, Nanjing, Jiangsu, China
- Reproductive Centre, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
- Gynaecologic Endocrinologist Training Base of Chinese Medical Doctor Association, Beijing, China
- Menopause Group, Obstetrics and Gynaecology Society of Chinese Medical Association, Beijing, China
- Jiangsu Obstetrics and Gynaecology Quality Control Centre, Nanjing, Jiangsu, China
- Osteoporosis and Bone Mineral Salt Disease, Nanjing Medical Association, Nanjing, China
- Reproductive Medicine, Jiangsu Association of Integrative Medicine, Nanjing, Jiangsu, China
| | - Yaping Wang
- Centre for Reproductive Endocrinology and Infertility, Peking Union Medical College Hospital, Peking, China
| | | | - Kyoo Kim
- Abbott Products Operations AG, Basel-Landschaft, Switzerland
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Du M, Chen S, Chen Y, Yuan X, Dong H. Testicular fat deposition attenuates reproductive performance via decreased follicle-stimulating hormone level and sperm meiosis and testosterone synthesis in mouse. Anim Biosci 2024; 37:50-60. [PMID: 37641828 PMCID: PMC10766465 DOI: 10.5713/ab.23.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/10/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Testicular fat deposition has been reported to affect animal reproduction. However, the underlying mechanism remains poorly understood. The present study explored whether sperm meiosis and testosterone synthesis contribute to mouse testicular fat depositioninduced reproductive performance. METHODS High fat diet (HFD)-induced obesity CD1 mice (DIO) were used as a testicular fat deposition model. The serum hormone test was performed by agent kit. The quality of sperm was assessed using a Sperm Class Analyzer. Testicular tissue morphology was analyzed by histochemical methods. The expression of spermatocyte marker molecules was monitored by an immuno-fluorescence microscope during meiosis. Analysis of the synthesis of testosterone was performed by real-time polymerase chain reaction and reagent kit. RESULTS It was found that there was a significant increase in body weight among DIO mice, however, the food intake showed no difference compared to control mice fed a normal diet (CTR). The number of offspring in DIO mice decreased, but there was no significant difference from the CTR group. The levels of follicle-stimulating hormone were lower in DIO mice and their luteinizing hormone levels were similar. The results showed a remarkable decrease in sperm density and motility among DIO mice. We also found that fat accumulation affected the meiosis process, mainly reflected in the cross-exchange of homologous chromosomes. In addition, overweight increased fat deposition in the testis and reduced the expression of testosterone synthesis-related enzymes, thereby affecting the synthesis and secretion of testosterone by testicular Leydig cells. CONCLUSION Fat accumulation in the testes causes testicular cell dysfunction, which affects testosterone hormone synthesis and ultimately affects sperm formation.
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Affiliation(s)
- Miao Du
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109,
China
| | - Shikun Chen
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109,
China
- College of Veterinary Medicine, Murdoch University, Murdoch, Western Australia 6150,
Australia
| | - Yang Chen
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109,
China
| | - Xinxu Yuan
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA 23284,
USA
| | - Huansheng Dong
- College of Animal Science and Technology, Qingdao Agricultural University, Qingdao 266109,
China
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Quiroga Gutierrez AC, Lindegger DJ, Taji Heravi A, Stojanov T, Sykora M, Elayan S, Mooney SJ, Naslund JA, Fadda M, Gruebner O. Reproducibility and Scientific Integrity of Big Data Research in Urban Public Health and Digital Epidemiology: A Call to Action. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1473. [PMID: 36674225 PMCID: PMC9861515 DOI: 10.3390/ijerph20021473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
The emergence of big data science presents a unique opportunity to improve public-health research practices. Because working with big data is inherently complex, big data research must be clear and transparent to avoid reproducibility issues and positively impact population health. Timely implementation of solution-focused approaches is critical as new data sources and methods take root in public-health research, including urban public health and digital epidemiology. This commentary highlights methodological and analytic approaches that can reduce research waste and improve the reproducibility and replicability of big data research in public health. The recommendations described in this commentary, including a focus on practices, publication norms, and education, are neither exhaustive nor unique to big data, but, nonetheless, implementing them can broadly improve public-health research. Clearly defined and openly shared guidelines will not only improve the quality of current research practices but also initiate change at multiple levels: the individual level, the institutional level, and the international level.
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Affiliation(s)
| | | | - Ala Taji Heravi
- CLEAR Methods Center, Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel and University of Basel, 4031 Basel, Switzerland
| | - Thomas Stojanov
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, 4031 Basel, Switzerland
| | - Martin Sykora
- School of Business and Economics, Centre for Information Management, Loughborough University, Loughborough LE11 3TU, UK
| | - Suzanne Elayan
- School of Business and Economics, Centre for Information Management, Loughborough University, Loughborough LE11 3TU, UK
| | - Stephen J. Mooney
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Marta Fadda
- Institute of Public Health, Università Della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Oliver Gruebner
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
- Department of Geography, University of Zurich, 8057 Zurich, Switzerland
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Schwander B, Kaier K, Hiligsmann M, Evers S, Nuijten M. Does the Structure Matter? An External Validation and Health Economic Results Comparison of Event Simulation Approaches in Severe Obesity. PHARMACOECONOMICS 2022; 40:901-915. [PMID: 35771486 PMCID: PMC9363367 DOI: 10.1007/s40273-022-01162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES As obesity-associated events impact long-term survival, health economic (HE) modelling is commonly applied, but modelling approaches are diverse. This research aimed to compare the events simulation and the HE outcomes produced by different obesity modelling approaches. METHODS An external validation, using the Swedish obesity subjects (SOS) study, of three main structural event modelling approaches was performed: (1) continuous body mass index (BMI) approach; (2) risk equation approach; and (3) categorical BMI-related approach. Outcomes evaluated were mortality, cardiovascular events, and type 2 diabetes (T2D) for both the surgery and the control arms. Concordance between modelling results and the SOS study were investigated by different state-of-the-art measurements, and categorized by the grade of deviation observed (grades 1-4 expressing mild, moderate, severe, and very severe deviations). Furthermore, the costs per quality-adjusted life-year (QALY) gained of surgery versus controls were compared. RESULTS Overall and by study arm, the risk equation approach presented the lowest average grade of deviation (overall grade 2.50; control arm 2.25; surgery arm 2.75), followed by the continuous BMI approach (overall 3.25; control 3.50; surgery 3.00) and by the categorial BMI approach (overall 3.63; control 3.50; surgery 3.75). Considering different confidence interval limits, the costs per QALY gained were fairly comparable between all structural approaches (ranging from £2,055 to £6,206 simulating a lifetime horizon). CONCLUSION None of the structural approaches provided perfect external event validation, although the risk equation approach showed the lowest overall deviations. The economic outcomes resulting from the three approaches were fairly comparable.
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Affiliation(s)
- Björn Schwander
- Department of Health Services Research, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- AHEAD GmbH-Agency for Health Economic Assessment and Dissemination, Wilhelm-Leibl-Str. 7, D-74321 Bietigheim-Bissingen, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics (IMBI), University of Freiburg, Freiburg im Breisgau, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI-Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Trimbos Institute-Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Mark Nuijten
- a2m-Ars Accessus Medica, Amsterdam, the Netherlands
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