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Parmar A, Dai WF, Dionne F, Geirnaert M, Denburg A, Ahuja T, Beca J, Bouchard S, Chambers C, Hunt MJ, Husereau D, Lungu E, McDonald V, Mercer RE, Mitera G, Muñoz C, Naipaul R, Peacock S, Potashnik T, Tadrous M, Takhar P, Taylor M, Trudeau M, Wasney D, Gavura S, Chan KKW. Development of a Multi-Criteria Decision Analysis Rating Tool to Prioritize Real-World Evidence Questions for the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration. Curr Oncol 2023; 30:3776-3786. [PMID: 37185399 PMCID: PMC10137247 DOI: 10.3390/curroncol30040286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
The Canadian Real-world Evidence for Value of Cancer Drugs (CanREValue) collaboration developed an MCDA rating tool to assess and prioritize potential post-market real-world evidence (RWE) questions/uncertainties emerging from public drug funding decisions in Canada. In collaboration with a group of multidisciplinary stakeholders from across Canada, the rating tool was developed following a three-step process: (1) selection of criteria to assess the importance and feasibility of an RWE question; (2) development of rating scales, application of weights and calculating aggregate scores; and (3) validation testing. An initial MCDA rating tool was developed, composed of seven criteria, divided into two groups. Group A criteria assess the importance of an RWE question by examining the (1) drug’s perceived clinical benefit, (2) magnitude of uncertainty identified, and (3) relevance of the uncertainty to decision-makers. Group B criteria assess the feasibility of conducting an RWE analysis including the (1) feasibility of identifying a comparator, (2) ability to identify cases, (3) availability of comprehensive data, and (4) availability of necessary expertise and methodology. Future directions include partnering with the Canadian Agency for Drugs and Technology in Health’s Provincial Advisory Group for further tool refinement and to gain insight into incorporating the tool into drug funding deliberations.
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Dai WF, Arciero V, Craig E, Fraser B, Arias J, Boehm D, Bosnic N, Caetano P, Chambers C, Jones B, Lungu E, Mitera G, Potashnik T, Reiman A, Ritcher T, Beca JM, Denburg A, Mercer RE, Parmar A, Tadrous M, Takhar P, Chan KKW. Considerations for Developing a Reassessment Process: Report from the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's Reassessment and Uptake Working Group. Curr Oncol 2021; 28:4174-4183. [PMID: 34677272 PMCID: PMC8534602 DOI: 10.3390/curroncol28050354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
The Canadian Real-world Evidence for Value in Cancer Drugs (CanREValue) Collaboration was established to develop a framework for generating and using real-world evidence (RWE) to inform the reassessment of cancer drugs following initial health technology assessment (HTA). The Reassessment and Uptake Working Group (RWG) is one of the five established CanREValue Working Groups. The RWG aims to develop considerations for incorporating RWE for HTA reassessment and strategies for using RWE to reassess drug funding decisions. Between February 2018 and December 2019, the RWG attended four teleconferences (with follow-up surveys) and two in-person meetings to discuss recommendations for the development of a reassessment process and potential barriers and facilitators. Modified Delphi methods were used to gather input. A draft report of recommendations (to December 2018) was shared for public consultation (December 2019 to January 2020). Initial considerations for developing a reassessment process were proposed. Specifically, reassessment can be initiated by diverse stakeholders, including decision makers from public drug plans or industry stakeholders. The reassessment process should be modelled after existing deliberation and recommendation frameworks used by HTA agencies. Proposed reassessment outcome categories include maintaining status quo, revisiting funding criteria, renegotiating price, or disinvesting. Overall, these initial considerations will serve as the basis for future advancements by the Collaboration.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
| | - Vanessa Arciero
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
| | - Erica Craig
- New Brunswick Cancer Network, Saint John, NB E2J 3S4, Canada;
| | - Brent Fraser
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (T.R.)
| | - Jessica Arias
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada;
| | - Nevzeta Bosnic
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | | | | | | | - Elena Lungu
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | - Gunita Mitera
- Canadian Association of Provincial Cancer Agencies, Toronto, ON M5H 1J9, Canada;
| | - Tanya Potashnik
- Patented Medicine Prices Review Board, Ottawa, ON K1P 1C1, Canada; (N.B.); (E.L.); (T.P.)
| | - Anthony Reiman
- Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
- Department of Biology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada
- Department of Oncology, Saint John Regional Hospital, Saint John, NB E2L 42L, Canada
| | - Trevor Ritcher
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (T.R.)
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Avram Denburg
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (J.A.); (P.T.)
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada; (W.F.D.); (V.A.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
- Correspondence:
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Kaondera-Shava RF, Lungu E, Szomolay B. A novel mathematical model of AIDS-associated Kaposi's sarcoma: Analysis and optimal control. Biosystems 2020; 200:104318. [PMID: 33309554 DOI: 10.1016/j.biosystems.2020.104318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022]
Abstract
Kaposi's sarcoma (KS) has been the most common HHV-8 virus-induced neoplasm associated with HIV-1 infection. Although the standard KS therapy has not changed in 20 years, not all cases of KS will respond to the same therapy. The goal of current AIDS-KS treatment modalities is to reconstitute the immune system and suppress HIV-1 replication, but newer treatment modalities are on horizon. There are very few mathematical models that have included HIV-1 viral load (VL) measures, despite VL being a key determinant of treatment outcome. Here we introduce a mathematical model that consolidates the effect of both HIV-1 and HHV-8 VL on KS tumor progression by incorporating low or high VLs into the proliferation terms of the immune cell populations. Regulation of HIV-1/HHV-8 VL and viral reservoir cells is crucial for restoring a patient to an asymptomatic stage. Therefore, an optimal control strategy given by a combined antiretroviral therapy (cART) is derived. The results indicate that the drug treatment strategies are capable of removing the viral reservoirs faster and consequently, the HIV-1 and KS tumor burden is reduced. The predictions of the mathematical model have the potential to offer more effective therapeutic interventions based on viral and virus-infected cell load and support new studies addressing the superiority of VL over CD4+ T-cell count in HIV-1 pathogenesis.
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Affiliation(s)
- R F Kaondera-Shava
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana.
| | - E Lungu
- Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Private Bag 16, Palapye, Botswana.
| | - B Szomolay
- Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, CF14 4XN, United Kingdom.
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Dahl W, Lungu E. Dietary Intake of Malawian Children Aged 6-36 Months. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lungu E, Vendittoli PA, Desmeules F. Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review. Open Orthop J 2016; 10:213-31. [PMID: 27398109 PMCID: PMC4920971 DOI: 10.2174/1874325001610010213] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/06/2016] [Accepted: 05/05/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA. METHOD A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. RESULTS Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). CONCLUSION Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required.
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Affiliation(s)
- E Lungu
- Department of Biomedical Sciences, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - P-A Vendittoli
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, 5415 Boul. L'Assomption, Montreal, Québec, Canada, H1T 2M4; Surgery Department, Maisonneuve-Rosemont Hospital, University of Montréal Affiliated Research Center, 5415 Boul. L'Assomption, Montréal, Québec, Canada, H1T 2M4
| | - F Desmeules
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, 5415 Boul. L'Assomption, Montreal, Québec, Canada, H1T 2M4; School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
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Lungu E, Maftoon S, Vendittoli PA, Desmeules F. A systematic review of preoperative determinants of patient-reported pain and physical function up to 2 years following primary unilateral total hip arthroplasty. Orthop Traumatol Surg Res 2016; 102:397-403. [PMID: 27026499 DOI: 10.1016/j.otsr.2015.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 02/02/2023]
Abstract
UNLABELLED Although generally considered successful, total hip arthroplasty (THA) can yield suboptimal results in terms of pain and function in up to one forth of patients suffering from hip osteoarthritis (OA). A thorough understanding of the determinants of patient-reported pain and function following THA can help plan interventions directed at improving surgical results. Previously published systematic reviews do not permit to confidently identify the determinants of THA outcomes because of unsatisfactory methodological designs. Therefore, we aimed to answer: (1) which preoperative factors are most consistently associated with postoperative patient-reported pain and function up to 2 years following primary unilateral THA for hip OA. Medline, Pubmed, Embase and CINAHL were screened from their respective inception dates until April 2015 using a combination of keywords and MESH terms. Criteria for inclusion were: (1) participants with primary unilateral THA for hip OA followed for at least 3 months with a maximal follow-up of 2 years; (2) validated disease-specific patient-reported outcome measures assessing pain and/or disability; (3) identification of determinants obtained via multivariate analyses. Methodological quality was assessed using a modified version of the methodology checklist for prognostic studies. Twenty-two manuscripts were included. Mean score of the methodological quality was 81.0±10.3% (66.7% to 100%). Among socioeconomic determinants, a lower educational level was significantly related to worse pain and function (3 out of 3 studies evaluating the relationship). Clinical determinants of poor outcomes included preoperative levels of pain and physical function (9 out of 12 studies), higher body mass index (6 out of 10 studies), presence/greater level of comorbidities (7 out of 8), worse general health (4 out of 4 studies) and lower radiographic OA severity (3 out of 4 studies). Study heterogeneity limited the pooled assessment of the strength of associations between the preoperative variables and THA outcomes. Studies with moderate-to-high methodological quality allowed to identify 6 preoperative variables consistently associated with medium term pain and function following THA. This knowledge may assist the management of patients at risk of poor results. Further research is required to clarify the force of associations between determinants and THA outcomes. LEVEL OF EVIDENCE Level II. Systematic review of cohort studies.
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Affiliation(s)
- E Lungu
- Department of biomedical sciences, faculty of medicine, university of Montreal, Montreal, QC, Canada; Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada.
| | - S Maftoon
- Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada
| | - P-A Vendittoli
- Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada; Surgery department, Maisonneuve-Rosemont hospital, university of Montreal affiliated research center, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada
| | - F Desmeules
- Centre de recherche, hôpital Maisonneuve-Rosemont, 5415, boulevard de L'Assomption, H1T 2M4 Montreal, QC, Canada; School of rehabilitation, faculty of medicine, university of Montréal, Montreal, QC, Canada
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Triandaf I, Mardare G, Lungu I, Pandele G, Triandaf N, Terek C, Lungu E, Foişor P. [Clinico-morpho-biological correlations useful in diagnosis of chronic hepatitis]. Rev Med Chir Soc Med Nat Iasi 1978; 82:27-30. [PMID: 674949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lungu I, Mardare G, Stanciu C, Triandaf N, Lungu E, Săndulescu E, Untu A, Leibovici M, Mihailovici MS. [Criteria of appraisal of the evolution and prognosis of chronic hepatitis]. Rev Med Chir Soc Med Nat Iasi 1976; 80:519-22. [PMID: 16296531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Strat C, Boingeanu A, Drăgan M, Ardeleanu G, Rusu G, Mardare G, Lungu E, Wasserman L, Miron E. [Comparative value of methods of early diagnosis of gastric cancer]. Med Interna (Bucur) 1970; 22:153-61. [PMID: 4910483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Russu G, Stanciu C, Drăgan M, Dumitrescu A, Lungu E. [Dyshormonism of the adrenal glands in gastroduodenal ulcer]. Rev Med Chir Soc Med Nat Iasi 1969; 73:53-9. [PMID: 5808189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Lungu I, Strat C, Russu G, Dragan M, Lungu E, Solomon M, Cobeţ I, Stanciu C. [Value and limitations of complex functional examinations of the liver in chromic postiviral hepatitis]. Rev Med Chir Soc Med Nat Iasi 1968; 72:621-4. [PMID: 5686782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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