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Laza C, Niño de Guzmán E, Gea M, Plazas M, Posso M, Rué M, Castells X, Román M. "For and against" factors influencing participation in personalized breast cancer screening programs: a qualitative systematic review until March 2022. Arch Public Health 2024; 82:23. [PMID: 38389068 PMCID: PMC10882761 DOI: 10.1186/s13690-024-01248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Personalized breast cancer screening is a novel strategy that estimates individual risk based on age, breast density, family history of breast cancer, personal history of benign breast lesions, and polygenic risk. Its goal is to propose personalized early detection recommendations for women in the target population based on their individual risk. Our aim was to synthesize the factors that influence women's decision to participate in personalized breast cancer screening, from the perspective of women and health care professionals. METHODS Systematic review of qualitative evidence on factors influencing participation in personalized Breast Cancer Screening. We searched in Medline, Web of science, Scopus, EMBASE, CINAHL and PsycINFO for qualitative and mixed methods studies published up to March 2022. Two reviewers conducted study selection and extracted main findings. We applied the best-fit framework synthesis and adopted the Multilevel influences on the cancer care continuum model for analysis. After organizing initial codes into the seven levels of the selected model, we followed thematic analysis and developed descriptive and analytical themes. We assessed the methodological quality with the Critical Appraisal Skills Program tool. RESULTS We identified 18 studies published between 2017 and 2022, conducted in developed countries. Nine studies were focused on women (n = 478) and in four studies women had participated in a personalized screening program. Nine studies focused in health care professionals (n = 162) and were conducted in primary care and breast cancer screening program settings. Factors influencing women's decision to participate relate to the women themselves, the type of program (personalized breast cancer screening) and perspective of health care professionals. Factors that determined women participation included persistent beliefs and insufficient knowledge about breast cancer and personalized screening, variable psychological reactions, and negative attitudes towards breast cancer risk estimates. Other factors against participation were insufficient health care professionals knowledge on genetics related to breast cancer and personalized screening process. The factors that were favourable included the women's perceived benefits for themselves and the positive impact on health systems. CONCLUSION We identified the main factors influencing women's decisions to participate in personalized breast cancer screening. Factors related to women, were the most relevant negative factors. A future implementation requires improving health literacy for women and health care professionals, as well as raising awareness of the strategy in society.
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Affiliation(s)
- Celmira Laza
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Ena Niño de Guzmán
- Cancer Prevention and Control Program, Institut Català d' Oncologia, Barcelona, Spain
| | - Montserrat Gea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
| | - Merideidy Plazas
- Cochrane Associated Center- University Foundation of Health Sciences, Bogotá, Colombia
| | - Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Montserrat Rué
- Biomedical Research Institute of Lleida Fundació Dr. Pifarré (IRBLleida), Lleida, Spain
- Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain.
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Louro J, Posso M, Perez-Leon D, Ejarque B, Arranz M, Arenas N, Román M, Alcántara R, Castells X. Patient-assisted versus standard compression in mammography screening: A randomized trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01433-2] [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: 11/19/2022]
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Arenas N, Alcantara R, Posso M, Louro J, Perez-Leon D, Ejarque B, Arranz M, Maiques J, Castells X, Macià F, Román M, Rodríguez-Arana A. Comparison of technical parameters and women's experience between self-compression and standard compression modes in mammography screening: a single-blind randomized clinical trial. Eur Radiol 2022; 32:7480-7487. [PMID: 35536390 DOI: 10.1007/s00330-022-08835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/19/2022] [Accepted: 03/29/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We compared the compression force, breast thickness, and glandular dose, as well as the severity of discomfort and women's experience between the patient-assisted compression (PAC) and standard compression (SC) modes. MATERIALS AND METHODS We conducted a prospective randomized controlled study at Hospital del Mar in Barcelona, Spain. We included 448 asymptomatic women aged 50 to 69 years old, attending their screening round from December 2017 to December 2019. Mammograms included the two bilateral views. In each woman, one breast was studied with SC and the other with PAC. The mode used in each breast was selected following a randomized list. Compression force, breast thickness, and average glandular dose were obtained for each of the 1792 images. We also recorded the degree of discomfort and women's experience, after mammogram acquisitions, using a predefined survey. RESULTS Higher compression forces were obtained with PAC than with SC (99.27 N vs 83.25 N, p < 0.001). Breast thickness mode (56.11 mm vs 57.52 mm, p = 0.015) and glandular dose (1.34 mGy vs 1.37 mGy, p = 0.018) were lower in PAC. The discomfort score was slightly higher with PAC (mean 3.94 vs 3.69, p = 0.042), but in the satisfaction survey, more women reported that PAC caused less discomfort. Additionally, 63.2% of women (289/448) preferred PAC. CONCLUSION PAC achieved higher compression forces without impairing the other technical imaging parameters and enhanced women's experience of screening mammography. We believe there were no clinically significant differences in the severity of discomfort between the two modes. KEY POINTS • Self-compression allows higher compression forces than the standard compression mode. • Self-compression does not affect technical imaging parameters. • Self-compression improved women's experience of screening mammography when standard compression was used on one breast and self-compression on the other.
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Affiliation(s)
- Natalia Arenas
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Daniela Perez-Leon
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Belén Ejarque
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Mónica Arranz
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Jose Maiques
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Maritím 25-29, 08003, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Ana Rodríguez-Arana
- Radiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Checa C, Canelo-Aybar C, Suclupe S, Ginesta-López D, Berenguera A, Castells X, Brotons C, Posso M. Effectiveness and Cost-Effectiveness of Case Management in Advanced Heart Failure Patients Attended in Primary Care: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:13823. [PMID: 36360704 PMCID: PMC9656967 DOI: 10.3390/ijerph192113823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
AIMS Nurse-led case management (CM) may improve quality of life (QoL) for advanced heart failure (HF) patients. No systematic review (SR), however, has summarized its effectiveness/cost-effectiveness. We aimed to evaluate the effect of such programs in primary care settings in advanced HF patients. We examined and summarized evidence on QoL, mortality, hospitalization, self-care, and cost-effectiveness. METHODS AND RESULTS The MEDLINE, CINAHL, Embase, Clinical Trials, WHO, Registry of International Clinical Trials, and Central Cochrane were searched up to March 2022. The Consensus Health Economic Criteria instrument to assess risk-of-bias in economic evaluations, Cochrane risk-of-bias 2 for clinical trials, and an adaptation of Robins-I for quasi-experimental and cohort studies were employed. Results from nurse-led CM programs did not reduce mortality (RR 0.78, 95% CI 0.53 to 1.15; participants = 1345; studies = 6; I2 = 47%). They decreased HF hospitalizations (HR 0.79, 95% CI 0.68 to 0.91; participants = 1989; studies = 8; I2 = 0%) and all-cause ones (HR 0.73, 95% CI 0.60 to 0.89; participants = 1012; studies = 5; I2 = 36%). QoL improved in medium-term follow-up (SMD 0.18, 95% CI 0.05 to 0.32; participants = 1228; studies = 8; I2 = 28%), and self-care was not statistically significant improved (SMD 0.66, 95% CI -0.84 to 2.17; participants = 450; studies = 3; I2 = 97%). A wide variety of costs ranging from USD 4975 to EUR 27,538 was observed. The intervention was cost-effective at ≤EUR 60,000/QALY. CONCLUSIONS Nurse-led CM reduces all-cause hospital admissions and HF hospitalizations but not all-cause mortality. QoL improved at medium-term follow-up. Such programs could be cost-effective in high-income countries.
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Affiliation(s)
- Caterina Checa
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Primary Healthcare Centre Dreta de l’Eixample, 08013 Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025 Barcelona, Spain
| | - Stefanie Suclupe
- Department of Clinical Epidemiology and Public Health, de la Santa Creu i Sant Pau (IIB Sant Pau) University Hospital, 08041 Barcelona, Spain
| | | | - Anna Berenguera
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
| | - Xavier Castells
- Doctoral Program in Methodology of Biomedical Research, Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Spain
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Carlos Brotons
- Biomedical Research Institute (IBB Sant Pau), Sardenya Primary Health Care Center, 08025 Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
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Merchán-Galvis A, Posso M, Canovas E, Jordán M, Aguilera X, Martinez-Zapata MJ. Quality of life and cost-effectiveness analysis of topical tranexamic acid and fibrin glue in femur fracture surgery. BMC Musculoskelet Disord 2022; 23:827. [PMID: 36045358 PMCID: PMC9429462 DOI: 10.1186/s12891-022-05775-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background We assessed quality of life (QoL) of patients undergoing surgery for proximal femur fracture and performed a cost-effectiveness analysis of haemostatic drugs for reducing postoperative bleeding. Methods We analysed data from an open, multicentre, parallel, randomized controlled clinical trial (RCT) that assessed the efficacy and safety of tranexamic acid (TXA group) and fibrin glue (FG group) administered topically prior to surgical closure, compared with usual haemostasis methods (control group). For this study we conducted a cost-effectiveness analysis of these interventions from the Spanish Health System perspective, using a time horizon of 12 months. The cost was reported in $US purchasing power parity (USPPP). We calculated the incremental cost-effectiveness ratio (ICER) per QALY (quality-adjusted life-year). Results We included 134 consecutive patients from February 2013 to March 2015: 42 patients in the TXA group, 46 in the FG group, and 46 in the control group. Before the fracture, EuroQol visual analogue scale (EQ-VAS) health questionnaire score was 68.6. During the 12 months post-surgery, the intragroup EQ-VAS improved, but without reaching pre-fracture values. There were no differences between groups for EQ-VAS and EuroQol 5 dimensions 5 levels (EQ-5D-5L) health questionnaire score, nor in hospital stay costs or medical complication costs. Nevertheless, the cost of one FG treatment was significantly higher (399.1 $USPPP) than the cost of TXA (12.9 $USPPP) or usual haemostasis (0 $USPPP). When comparing the cost-effectiveness of the interventions, FG was ruled out by simple dominance since it was more costly (13,314.7 $USPPP) than TXA (13,295.2 $USPPP) and less effective (utilities of 0.0532 vs. 0.0734, respectively). TXA compared to usual haemostasis had an ICER of 15,289.6 $USPPP per QALY). Conclusions There were no significant differences between the intervention groups in terms of postoperative changes in QoL. However, topical TXA was more cost-effective than FG or usual haemostasis. Trial registration ClinicalTrials.gov: NCT02150720. Date of registration 30/05/2014. Retrospectively registered.
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Velásquez-Rimachi V, Chachaima-Mar J, Cárdenas-Baltazar EC, Loayza-Vidalon A, Morán-Mariños C, Pacheco-Barrios K, Posso M, Alva-Díaz C. Greater occipital nerve block for chronic migraine patients: A meta-analysis. Acta Neurol Scand 2022; 146:101-114. [PMID: 35726455 DOI: 10.1111/ane.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/20/2022] [Revised: 04/05/2022] [Accepted: 05/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM. METHODS We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE. RESULTS We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were 'high risk' or 'some concerns'. GONB reduced the intensity of headaches at the end of the first month (MD: -1.35, 95% CI: -2.12 to -0.59) and the second month (MD: -2.10, CI 95%: -2.94 to -1.26) as well as the frequency of headaches (first month: MD: -4.45 days, 95% CI: -6.56 to -2.34 days; second month: MD: -5.49, 95% CI -8.94 to -2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: -1.1 days, 95% CI: -4.1 to 1.8, p = .45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision. CONCLUSION The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.
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Affiliation(s)
- Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Jorge Chachaima-Mar
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kevin Pacheco-Barrios
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carlos Alva-Díaz
- Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
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Bosch G, Posso M, Louro J, Roman M, Porta M, Castells X, Macià F. Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study. eLife 2022; 11:77434. [PMID: 35686727 PMCID: PMC9212994 DOI: 10.7554/elife.77434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. Methods: We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012–2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84–0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59–0.67] and aOR = 0.95 [95% CI = 0.86–1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01–1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56–0.99] and aOR = 0.80 [95% CI = 0.68–0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66–1.28] and incident aOR = 0.72 [95% CI = 0.59–0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76–2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69–1.18]), or cancer stages. Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. Funding: This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Roman
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Miquel Porta
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital del Mar Institute of Medical Research (IMIM PSMar), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
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Canelo-Aybar C, Taype-Rondan A, Zafra-Tanaka JH, Rigau D, Graewingholt A, Lebeau A, Gómez EP, Rossi PG, Langendam M, Posso M, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. Correction to: Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Eur Radiol 2022; 32:4333. [PMID: 34994847 PMCID: PMC9123054 DOI: 10.1007/s00330-021-08489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | | | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | | | - Annette Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Miranda Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Margarita Posso
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP127, I-21027, Ispra, VA, Italy.
| | - Zuleika Saz-Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP127, I-21027, Ispra, VA, Italy
| | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
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Leis A, Casadevall D, Albanell J, Posso M, Macià F, Castells X, Ramírez-Anguita JM, Martínez Roldán J, Furlong LI, Sanz F, Ronzano F, Mayer MA. Exploring the Association of Cancer and Depression in Electronic Health Records: Combining Encoded Diagnosis and Mining Free Text Clinical Notes (Preprint). JMIR Cancer 2022; 8:e39003. [PMID: 35816382 PMCID: PMC9315897 DOI: 10.2196/39003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background A cancer diagnosis is a source of psychological and emotional stress, which are often maintained for sustained periods of time that may lead to depressive disorders. Depression is one of the most common psychological conditions in patients with cancer. According to the Global Cancer Observatory, breast and colorectal cancers are the most prevalent cancers in both sexes and across all age groups in Spain. Objective This study aimed to compare the prevalence of depression in patients before and after the diagnosis of breast or colorectal cancer, as well as to assess the usefulness of the analysis of free-text clinical notes in 2 languages (Spanish or Catalan) for detecting depression in combination with encoded diagnoses. Methods We carried out an analysis of the electronic health records from a general hospital by considering the different sources of clinical information related to depression in patients with breast and colorectal cancer. This analysis included ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes and unstructured information extracted by mining free-text clinical notes via natural language processing tools based on Systematized Nomenclature of Medicine Clinical Terms that mentions symptoms and drugs used for the treatment of depression. Results We observed that the percentage of patients diagnosed with depressive disorders significantly increased after cancer diagnosis in the 2 types of cancer considered—breast and colorectal cancers. We managed to identify a higher number of patients with depression by mining free-text clinical notes than the group selected exclusively on ICD-9-CM codes, increasing the number of patients diagnosed with depression by 34.8% (441/1269). In addition, the number of patients with depression who received chemotherapy was higher than those who did not receive this treatment, with significant differences (P<.001). Conclusions This study provides new clinical evidence of the depression-cancer comorbidity and supports the use of natural language processing for extracting and analyzing free-text clinical notes from electronic health records, contributing to the identification of additional clinical data that complements those provided by coded data to improve the management of these patients.
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Affiliation(s)
- Angela Leis
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Casadevall
- Cancer Research Program, Hospital del Mar Research Institute, Barcelona, Spain
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Albanell
- Cancer Research Program, Hospital del Mar Research Institute, Barcelona, Spain
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology, Hospital del Mar Research Institute, Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Laura I Furlong
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Francesco Ronzano
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel A Mayer
- Research Programme on Biomedical Informatics, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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10
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Rodríguez-Campello A, Hidalgo-Benítez V, Posso M, Pascual-Barbero E, Revert-Barbera A, Estragués-Gazquez I, Núñez-Pedrosa R, Zafra M, Ros-Roig J, López-Mesa S, Cuadrado-Godia E, Roquer J, Iglesias-Villanueva D. [Cross-cultural adaptation to Spanish of the Signs of Depression Scale (SODS) to the early assessment of mood in patients admitted to a Stroke Unit]. Rev Neurol 2022; 74:175-180. [PMID: 35275393 DOI: 10.33588/rn.7406.2021420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Stroke hospitalization negatively affects mood. Clinical guidelines recommend early evaluation of mood disorders. However, there is no consensus on the most appropriate scale in Spanish language. AIM The objective of the study is the cross-cultural adaptation of the Signs of Depression Scale (SODS) in patients admitted to the stroke unit of the Hospital del Mar. MATERIALS AND METHODS The work scheme for transcultural adaptation into Spanish was: a) direct translation; b) reconciliation and synthesis of translations; c) reverse translation into English; d) consensus of the back-translated version with original author; e) cognitive interrogation; f) revision and consensus version in Spanish; g) reading test, spelling, and grammar check; h) final version. Analysis and descriptive summary of the adaptation process was performed. RESULTS There were no differences between direct translation versions. The back-translation version was accepted by the author of the original questionnaire. A convenience sample of patients with/without aphasia (n = 22) was included for cognitive interview from which no major problems were identified in the implementation of the questionnaire. Inclusive language was used in the final version. CONCLUSION The transcultural adaptation of the scale allows in a simple and early way the evaluation mood in patients admitted to the stroke unit. The Spanish version is equivalent to the original instrument. This adaptation can be incorporated into care in the Stroke Unit and is extrapolated to other Spanish-speaking centres.
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Affiliation(s)
- A Rodríguez-Campello
- Hospital del Mar, Barcelona, España
- Universitat Pompeu Fabra, Barcelona, España
- Universitat Autònoma de Barcelona, Bellaterra, España
| | | | - M Posso
- Hospital del Mar, Barcelona, España
| | | | | | | | | | - M Zafra
- Hospital del Mar, Barcelona, España
| | | | | | - E Cuadrado-Godia
- Hospital del Mar, Barcelona, España
- Universitat Pompeu Fabra, Barcelona, España
| | - J Roquer
- Hospital del Mar, Barcelona, España
- Universitat Autònoma de Barcelona, Bellaterra, España
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11
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Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. Int J Environ Res Public Health 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
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Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
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12
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Montero-Moraga JM, Posso M, Román M, Burón A, Sala M, Castells X, Macià F. Effect of an information leaflet on breast cancer screening participation: A cluster randomized controlled trial. BMC Public Health 2021; 21:1301. [PMID: 34217258 PMCID: PMC8254065 DOI: 10.1186/s12889-021-11360-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate the impact of an information leaflet about the risk-benefit balance of breast cancer screening on women’s participation. Methods This cluster randomized controlled trial was conducted within a population-based breast cancer screening program and included women from the catchment areas of two hospitals in Barcelona, Spain. We evaluated women aged 50–69 years invited to screening between September 2019 and January 2020. The intervention group received an information leaflet on the benefits and harms of mammography screening. The control group received the usual invitation letter. The clusters consisted of the processing days of the invitation letter, assigned to the intervention with a simple random allocation scheme. We compared the participation rate at the individual level between groups, stratified by hospital and by per-protocol and intention-to-treat analyses. Results We included 11,119 women (137 clusters): 5416 in the intervention group (66 clusters) and 5703 in the control group (71 clusters). A total of 36% (1964/5393) of the women in the intervention group and 37% (2135/5694) of those in the control group attended screening, respectively. Overall, we found no differences in participation among groups (difference in participation − 1.1%; 95%CI; − 2.9 to 0.7%). In a hospital attending a population with a low socioeconomic status, attendance was lower in the intervention group (− 1.4, 95%CI: − 5.7% to − 0.03%). Conclusions Overall participation in our program was unaffected by a new information leaflet on the risk-benefit balance of breast cancer screening. However, participation was lower in certain populations with lower socioeconomic status Trial registration Trial registration number ISRCTN13848929. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11360-0.
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Affiliation(s)
- Jose Maria Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain. .,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Andrea Burón
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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13
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Canelo-Aybar C, Taype-Rondan A, Zafra-Tanaka JH, Rigau D, Graewingholt A, Lebeau A, Pérez Gómez E, Rossi PG, Langedam M, Posso M, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Eur Radiol 2021; 31:5880-5893. [PMID: 34052881 PMCID: PMC8270803 DOI: 10.1007/s00330-021-07873-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07873-2.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.
| | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | | | - David Rigau
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
| | | | - Annette Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Miranda Langedam
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands
| | - Margarita Posso
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP127, I-21027, Ispra, VA, Italy.
| | - Zuleika Saz-Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi, 2749. TP127, I-21027, Ispra, VA, Italy
| | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, 08025, Barcelona, Spain
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14
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Louro J, Román M, Posso M, Vázquez I, Saladié F, Rodriguez-Arana A, Quintana MJ, Domingo L, Baré M, Marcos-Gragera R, Vernet-Tomas M, Sala M, Castells X. Developing and validating an individualized breast cancer risk prediction model for women attending breast cancer screening. PLoS One 2021; 16:e0248930. [PMID: 33755692 PMCID: PMC7987139 DOI: 10.1371/journal.pone.0248930] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several studies have proposed personalized strategies based on women's individual breast cancer risk to improve the effectiveness of breast cancer screening. We designed and internally validated an individualized risk prediction model for women eligible for mammography screening. METHODS Retrospective cohort study of 121,969 women aged 50 to 69 years, screened at the long-standing population-based screening program in Spain between 1995 and 2015 and followed up until 2017. We used partly conditional Cox proportional hazards regression to estimate the adjusted hazard ratios (aHR) and individual risks for age, family history of breast cancer, previous benign breast disease, and previous mammographic features. We internally validated our model with the expected-to-observed ratio and the area under the receiver operating characteristic curve. RESULTS During a mean follow-up of 7.5 years, 2,058 women were diagnosed with breast cancer. All three risk factors were strongly associated with breast cancer risk, with the highest risk being found among women with family history of breast cancer (aHR: 1.67), a proliferative benign breast disease (aHR: 3.02) and previous calcifications (aHR: 2.52). The model was well calibrated overall (expected-to-observed ratio ranging from 0.99 at 2 years to 1.02 at 20 years) but slightly overestimated the risk in women with proliferative benign breast disease. The area under the receiver operating characteristic curve ranged from 58.7% to 64.7%, depending of the time horizon selected. CONCLUSIONS We developed a risk prediction model to estimate the short- and long-term risk of breast cancer in women eligible for mammography screening using information routinely reported at screening participation. The model could help to guiding individualized screening strategies aimed at improving the risk-benefit balance of mammography screening programs.
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Affiliation(s)
- Javier Louro
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- * E-mail:
| | - Margarita Posso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | | | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | | | - M. Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Domingo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Marisa Baré
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Sabadell, Spain
| | - Rafael Marcos-Gragera
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Department of Health, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
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15
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Canelo-Aybar C, Carrera L, Beltrán J, Posso M, Rigau D, Lebeau A, Gräwingholt A, Castells X, Langendam M, Pérez E, Giorgi Rossi P, Van Engen R, Parmelli E, Saz-Parkinson Z, Alonso-Coello P. Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Cancer Med 2021; 10:2191-2204. [PMID: 33675147 PMCID: PMC7982617 DOI: 10.1002/cam4.3803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. Objective To evaluate the replacement of DxMM with DBT in women recalled at screening. Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%–3%) and a pooled difference for the specificity of 6% (95%CI 2%–11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2–6) more BC cases and has 47 (95%CI 16–87) fewer false‐positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. Conclusion The evidence in the assessment of screen‐recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false‐positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Jessica Beltrán
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Rigau
- Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Annette Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Elsa Pérez
- University Hospital Dr. Josep Trueta, Girona, Spain
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ruben Van Engen
- LRCB, Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Elena Parmelli
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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16
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Canelo-Aybar C, Ferreira DS, Ballesteros M, Posso M, Montero N, Solà I, Saz-Parkinson Z, Lerda D, Rossi PG, Duffy SW, Follmann M, Gräwingholt A, Alonso-Coello P. Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: A systematic review for the European Commission Initiative on Breast Cancer. J Med Screen 2021; 28:389-404. [PMID: 33632023 DOI: 10.1177/0969141321993866] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. METHODS We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (<50, 50-69 and 70-74). GRADE (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the certainty of evidence. RESULTS We identified 10 RCTs including 616,641 women aged 38-75. Mammography reduced BC mortality in women aged 50-69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66-0.90, high certainty) and 70-74 (RR 0.77, 95%CI 0.54-1.09, high certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76-1.02, moderate certainty). Mammography reduced stage IIA+ in women 50-69 (RR 0.80, 95%CI 0.64-1.00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI 18-27%) and 17% (95%CI 15-20%) in under 50s and 50-69, respectively (moderate certainty). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes (low certainty). CONCLUSIONS For women 50-69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.
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Affiliation(s)
- Carlos Canelo-Aybar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Diogenes S Ferreira
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mónica Ballesteros
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Nadia Montero
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Donata Lerda
- European Commission, Joint Research Centre (JRC), Ispra, VA, Italy
| | - Paolo G Rossi
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, RE, Italy
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | | | - Pablo Alonso-Coello
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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17
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Giorgi Rossi P, Lebeau A, Canelo-Aybar C, Saz-Parkinson Z, Quinn C, Langendam M, Mcgarrigle H, Warman S, Rigau D, Alonso-Coello P, Broeders M, Graewingholt A, Posso M, Duffy S, Schünemann HJ. Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative. Br J Cancer 2021; 124:1503-1512. [PMID: 33597715 PMCID: PMC8076250 DOI: 10.1038/s41416-020-01247-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question “Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?” Methods The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS). Results Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests. Conclusions The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).
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Affiliation(s)
- Paolo Giorgi Rossi
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annette Lebeau
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, and Public Health, PhD Programme in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Zuleika Saz-Parkinson
- European Commission, Joint Research Centre (JRC), Ispra, Italy. .,Instituto de Salud Carlos III, Health Technology Assessment Agency, Avenida Monforte de Lemos 5, Madrid, Spain.
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | | | - Sue Warman
- Havyatt Lodge, Havyatt Road, Langford, North Somerset, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Mireille Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.,Dutch Expert Centre for Screening, Nijmegen, the Netherlands
| | | | - Margarita Posso
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Stephen Duffy
- Centre for Cancer Prevention, Queen Mary University of London, Charterhouse Square, London, UK
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres; Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
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18
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Kifer D, Bugada D, Villar-Garcia J, Gudelj I, Menni C, Sudre C, Vučković F, Ugrina I, Lorini LF, Posso M, Bettinelli S, Ughi N, Maloberti A, Epis O, Giannattasio C, Rossetti C, Kalogjera L, Peršec J, Ollivere L, Ollivere BJ, Yan H, Cai T, Aithal GP, Steves CJ, Kantele A, Kajova M, Vapalahti O, Sajantila A, Wojtowicz R, Wierzba W, Krol Z, Zaczynski A, Zycinska K, Postula M, Lukšić I, Čivljak R, Markotić A, Brachmann J, Markl A, Mahnkopf C, Murray B, Ourselin S, Valdes AM, Horcajada JP, Castells X, Pascual J, Allegri M, Primorac D, Spector TD, Barrios C, Lauc G. Effects of Environmental Factors on Severity and Mortality of COVID-19. Front Med (Lausanne) 2021; 7:607786. [PMID: 33553204 PMCID: PMC7855590 DOI: 10.3389/fmed.2020.607786] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented. Methods: We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application. Findings: Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973-0.988, p < 0.001) and per increase in ambient temperature of 1°C to be 0.854 (0.773-0.944, p = 0.007). Statistically significant decreases of comparable magnitude in median hospital stay, probability of transfer to the intensive care unit, and need for mechanical ventilation were also observed in most, but not all hospitals. The analysis of individually reported symptoms of 37,187 individuals in the UK also showed the decrease in symptom duration and disease severity with time. Interpretation: Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation.
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Affiliation(s)
- Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Dario Bugada
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Judit Villar-Garcia
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ivan Gudelj
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Carole Sudre
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | | | - Ivo Ugrina
- Faculty of Science, University of Split, Split, Croatia
| | - Luca F. Lorini
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Margarita Posso
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Silvia Bettinelli
- Emergency and Intensive Care Department, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Nicola Ughi
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Maloberti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Oscar Epis
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Cristina Giannattasio
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Rossetti
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livije Kalogjera
- Department of Otolaryngology-Head and Neck Surgery, Zagreb School of Medicine, University Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
| | - Jasminka Peršec
- Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava Zagreb, Zagreb, Croatia
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Luke Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Benjamin J. Ollivere
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Huadong Yan
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Ting Cai
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Department of Infectious Diseases, Hwamei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Guruprasad P. Aithal
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Anu Kantele
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mikael Kajova
- Inflammation Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Olli Vapalahti
- Department of Virology, Helsingin ja Uudenmaan Sairaanhoitopiiri Diagnostic Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rafal Wojtowicz
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Waldemar Wierzba
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Zbigniew Krol
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Artur Zaczynski
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
| | - Katarina Zycinska
- Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
- Medical University of Warsaw, Warsaw, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Center for Preclinical Research and Technology CEPT, Medical University of Warsaw, Warsaw, Poland
| | - Ivica Lukšić
- University of Zagreb School of Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital for Infectious Diseases “Fran Mihaljević”, Catholic University of Croatia, Zagreb, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Fran Mihaljević”, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Johannes Brachmann
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | | | | | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ana M. Valdes
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Juan P. Horcajada
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Xavier Castells
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Julio Pascual
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Massimo Allegri
- Pain Therapy Service Policlinico of Monza Hospital, Monza, Italy
| | - Dragan Primorac
- REGIOMED Kliniken, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
- St. Catharine Hospital, Zagreb, Croatia
- Eberly College of Science, Penn State University, University Park, PA, United States
- University of Osijek School of Medicine, Osijek, Croatia
- Faculty of Dental Medicine and Health, University of Rijeka School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Clara Barrios
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Gordan Lauc
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
- Genos Glycoscience Research Laboratory, Zagreb, Croatia
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19
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Agache I, Song Y, Posso M, Alonso‐Coello P, Rocha C, Solà I, Beltran J, Akdis CA, Akdis M, Brockow K, Chivato T, Giacco S, Eiwegger T, Eyerich K, Giménez‐Arnau A, Gutermuth J, Guttman‐Yassky E, Maurer M, Ogg G, Ong PY, O’Mahony L, Schwarze J, Werfel T, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of dupilumab for moderate-to-severe atopic dermatitis: A systematic review for the EAACI biologicals guidelines. Allergy 2021; 76:45-58. [PMID: 32691892 DOI: 10.1111/all.14510] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 07/14/2020] [Indexed: 12/14/2022]
Abstract
This systematic review evaluates the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled moderate-to-severe atopic dermatitis (AD). Pubmed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important AD-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Seven RCTs including 1845 subjects >12 years treated with dupilumab 16 to 52 weeks were evaluated. For adults, there is high certainty that dupilumab decreases SCORAD (MD -30,72; 95% CI -34,65% to -26,79%) and EASI-75 (RR 3.09; 95% CI 2.45 to 3.89), pruritus (RR 2.96; 95% CI 2.37 to 3.70), rescue medication (RR 3.46; 95% CI 2.79 to 4.30), sleep disturbance (MD -7.29; 95% CI -8.23 to -6.35) and anxiety/depression (MD -3.08; 95% CI -4.41 to -1.75) and improves quality of life (MD -4.80; 95% CI -5.55 to -4.06). The efficacy for adolescents is similar. Dupilumab-related adverse events (AEs) slightly increase (low certainty). The evidence for dupilumab-related serious AE is uncertain. The incremental cost-effectiveness ratio ranged from 28 500 £ (low certainty) to 124 541 US$ (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population. Registration: PROSPERO (CRD42020153645).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Yang Song
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Margarita Posso
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- Department of Epidemiology and Evaluation IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
| | - Pablo Alonso‐Coello
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Madrid Spain
| | - Claudio Rocha
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Ivan Solà
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Jessica Beltran
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein Technical University of Munich Munich Germany
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Stefano Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto Canada
| | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar‐ Institut Mar d'Investigacions Mèdiques Universitat Autònoma de Barcelona Bellaterra Spain
| | - Jan Gutermuth
- Department of Dermatology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Emma Guttman‐Yassky
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Graham Ogg
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford NIHR Biomedical Research Centre Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Peck Y. Ong
- Division of Clinical Immunology & Allergy Children’s Hospital Los Angeles Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Liam O’Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Jürgen Schwarze
- Centre for Inflammation Research Child Life and Health The University of Edinburgh Edinburgh UK
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Carlos Canelo‐Aybar
- Department of Clinical Epidemiology and Public Health Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Madrid Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wroclaw Poland
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20
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Agache I, Rocha C, Pereira A, Song Y, Alonso‐Coello P, Solà I, Beltran J, Posso M, Akdis CA, Akdis M, Brockow K, Chivato T, del Giacco S, Eiwegger T, Eyerich K, Giménez‐Arnau A, Gutermuth J, Guttman‐Yassky E, Maurer M, Ogg G, Ong P, O’Mahony L, Schwarze J, Werfel T, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with omalizumab for chronic spontaneous urticaria: A systematic review for the EAACI Biologicals Guidelines. Allergy 2021; 76:59-70. [PMID: 32767573 DOI: 10.1111/all.14547] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) -5; 95%CI -7.75 to -2.25), and the itch severity score (ISS)7 (MD -2.15; 95% CI -3.2 to -1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD -2.01; 95%CI -3.22 to -0.81) and decreases (moderate certainty) rescue medication use (MD -1.68; 95%CI -2.95 to -0.4). Omalizumab 300 mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD -11.05; 95%CI -12.87 to -9.24), the ISS7 (MD -4.45; 95%CI -5.39 to -3.51), and QoL (high certainty) (DLQI; MD -4.03; 95% CI -5.56 to -2.5) and decreases (moderate certainty) rescue medication use (MD -2.04; 95%CI -3.19 to -0.88) and drug-related serious AEs (RR 0.77; 95%CI 0.20 to 2.91).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Claudio Rocha
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Ana Pereira
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Yang Song
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Pablo Alonso‐Coello
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein Technical University of Munich Munich Germany
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Stefano del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program, The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada
| | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein Technical University of Munich Munich Germany
| | - Ana Giménez‐Arnau
- Department of Dermatology Hospital del Mar‐ Institut Mar d'Investigacions Mèdiques Universitat Autònoma de Barcelona Barcelona Spain
| | - Jan Gutermuth
- Department of Dermatology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Emma Guttman‐Yassky
- Department of Dermatology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Marcus Maurer
- Dermatological Allergology, Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Graham Ogg
- MRC Human Immunology Unit Department of Medicine Weatherall Institute of Molecular Medicine University of Oxford Radcliffe, Oxford UK
| | - Peck Ong
- Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Liam O’Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Jürgen Schwarze
- Centre for Inflammation Research Child Life and Health The University of Edinburgh Edinburgh UK
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - Carlos Canelo‐Aybar
- Iberoamerican Cochrane Centre ‐ Department of Clinical Epidemiology and Public Health Biomedical Research Institute Sant Pau (IIB Sant Pau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wroclaw Poland
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Vernet-Tomás M, Louro J, Román M, Saladié F, Posso M, Prieto M, Vázquez I, Baré M, Peñalva L, Vidal C, Bargalló X, Sánchez M, Ferrer J, A Espinàs J, Quintana MJ, Rodríguez-Arana A, Castells X. Risk of breast cancer two years after a benign biopsy depends on the mammographic feature prompting recall. Maturitas 2020; 144:53-59. [PMID: 33358209 DOI: 10.1016/j.maturitas.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/01/2019] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to explore whether the type of mammographic feature prompting a false-positive recall (FPR) during mammography screening influences the risk and timing of breast cancer diagnosis, particularly if assessed with invasive procedures. STUDY DESIGN We included information on women screened and recalled for further assessment in Spain between 1994 and 2015, with follow-up until 2017, categorizing FPRs by the assessment (noninvasive or invasive) and mammographic feature prompting the recall. MAIN OUTCOME MEASURES Breast cancer rates in the first two years after FPR (first period) and after two years (second period). RESULTS The study included 99,825 women with FPRs. In both periods, the breast cancer rate was higher in the invasive assessment group than in the noninvasive group (first period 12 ‰ vs 1.9 ‰, p < 0.001; second period 4.4‰ vs 3.1‰, p < 0.001). During the first period, the invasive assessment group showed diverse breast cancer rates for each type of mammographic feature, with a higher rate for asymmetric density (31.9‰). When the second period was compared with the first, the breast cancer rate decreased in the invasive assessment group (from 12‰ to 4.4‰, p < 0.001) and increased in the noninvasive assessment group (from 1.9‰ to 3.1‰, p < 0.001). CONCLUSION In the context of mammography screening, the risk of breast cancer diagnosis during the first two years after FPR was particularly high for women undergoing invasive assessment; importantly, the risk was modified by type of mammographic feature prompting the recall. This information could help to individualize follow-up after exclusion of malignancy.
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Affiliation(s)
- Maria Vernet-Tomás
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain.
| | - Javier Louro
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francina Saladié
- Fundació Lliga per a La Investigació i Prevenció del Càncer (FUNCA), Avinguda Josep Laporte, 2, 43204, Reus, Spain
| | - Margarita Posso
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Miguel Prieto
- Consejería de Sanidad, Gobierno de Asturias. Calle Ciriaco Miguel Vigil, 9, 33005, Oviedo, Spain
| | - Ivonne Vázquez
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Marisa Baré
- Consorci Corporació Sanitaria Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Spain
| | - Lupe Peñalva
- Hospital General de Granollers, Av. Francesc Ribas, s/n, 08402, Granollers, Spain
| | - Carmen Vidal
- Programa de Prevenció i Control del Càncer de l'Institut Català d'Oncologia, Gran Via de l'Hospitalet, 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Xavier Bargalló
- Centro de Diagnóstico por la Imagen Clínic (CDIC) del Hospital Clínic de Barcelona. Calle Villarroel 170, 08036, Barcelona, Spain
| | - Mar Sánchez
- Dirección General de Salud Pública del Gobierno de Cantabria, C/ Federico Vial 13, 39009, Santander, Spain
| | - Joana Ferrer
- Hospital de Santa Caterina, Carrer del Dr. Castany, s/n, 17190, Salt, Girona, Spain
| | - Josep A Espinàs
- Pla Director d'Oncologia del Departament de Salut de la Generalitat de Catalunya, Travessera de les Corts, 131-159, 08028, Barcelona, Spain
| | - M Jesús Quintana
- Departament d'Epidemiologia de l'Hospital de la Santa Creu i Sant Pau, c/ San Antoni M. Claret 167, 08025, Barcelona, Spain
| | - Ana Rodríguez-Arana
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Xavier Castells
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Dr. Aiguader 88, 08003, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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22
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Posso M, Comas M, Román M, Domingo L, Louro J, González C, Sala M, Anglès A, Cirera I, Cots F, Frías VM, Gea J, Güerri-Fernández R, Masclans JR, Noguès X, Vázquez O, Villar-García J, Horcajada JP, Pascual J, Castells X. Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain. Arch Bronconeumol 2020; 56:756-758. [PMID: 33994638 PMCID: PMC7657606 DOI: 10.1016/j.arbr.2020.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Cristina González
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Albert Anglès
- Medical Documentation Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Isabel Cirera
- Emergency Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Víctor-Manuel Frías
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar-IMIM, DCEXS, UPF, CIBERES, ISCiii, Barcelona, Spain
| | | | | | - Xavier Noguès
- Department of Internal Medicine, Hospital del Mar. IMIM, CIBERFES, Barcelona, Spain
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Juan Pablo Horcajada
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Louro J, Román M, Posso M, Comerma L, Vidal C, Saladié F, Alcantara R, Sanchez M, Quintana MJ, Del Riego J, Ferrer J, Peñalva L, Bargalló X, Prieto M, Sala M, Castells X. Differences in breast cancer risk after benign breast disease by type of screening diagnosis. Breast 2020; 54:343-348. [PMID: 33023825 PMCID: PMC7770442 DOI: 10.1016/j.breast.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction We aimed to assess differences in breast cancer risk across benign breast disease diagnosed at prevalent or incident screens. Materials and methods We conducted a retrospective cohort study with data from 629,087 women participating in a long-standing population-based breast cancer screening program in Spain. Each benign breast disease was classified as non-proliferative, proliferative without atypia, or proliferative with atypia, and whether it was diagnosed in a prevalent or incident screen. We used partly conditional Cox hazard regression to estimate the adjusted hazard ratios of the risk of breast cancer. Results Compared with women without benign breast disease, the risk of breast cancer was significantly higher (p-value = 0.005) in women with benign breast disease diagnosed in an incident screen (aHR, 2.67; 95%CI: 2.24–3.19) than in those with benign breast disease diagnosed in a prevalent screen (aHR, 1.87; 95%CI: 1.57–2.24). The highest risk was found in women with a proliferative benign breast disease with atypia (aHR, 4.35; 95%CI: 2.09–9.08, and 3.35; 95%CI: 1.51–7.40 for those diagnosed at incident and prevalent screens, respectively), while the lowest was found in women with non-proliferative benign breast disease (aHR, 2.39; 95%CI: 1.95–2.93, and 1.63; 95%CI: 1.32–2.02 for those diagnosed at incident and prevalent screens, respectively). Conclusion Our study showed that the risk of breast cancer conferred by a benign breast disease differed according to type of screen (prevalent or incident). To our knowledge, this is the first study to analyse the impact of the screening type on benign breast disease prognosis. Breast cancer risk after a benign breast disease varied with the screening type. Incident benign breast disease had a higher breast cancer risk than prevalent. The risk remained increased regardless of benign breast disease subtype.
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Affiliation(s)
- Javier Louro
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain; European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Margarita Posso
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Laura Comerma
- Servei de Patologia, Hospital Del Mar, Barcelona, Spain
| | - Carmen Vidal
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut D'Investigació Sanitària Pere Virgili, Universitat Rovira I Virgili, Reus, Spain
| | - Rodrigo Alcantara
- Servei de Diagnòstic per La Imatge, Hospital Del Mar, Barcelona, Spain
| | - Mar Sanchez
- Direction General of Public Health, Cantabria, Spain
| | - M Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de La Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Javier Del Riego
- Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - Joana Ferrer
- Radiology Department, Hospital de Santa Caterina, Salt, Girona, Spain
| | - Lupe Peñalva
- Vallés Oriental Breast Cancer Early Detection Program, Spain
| | | | - Miguel Prieto
- Breast Cancer Screening Program, Principality of Asturias, Spain
| | - María Sala
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain.
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Louro J, Román M, Posso M, Vidal C, Prieto M, Saladié F, Baré M, Sánchez M, Quintana M, Bargalló X, Ferrer J, Peñalva L, Sala M, Castells X. Differences in breast cancer risk after a benign breast disease according to the screening type. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30552-9] [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: 11/26/2022]
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Sanabria AJ, Pardo-Hernandez H, Ballesteros M, Canelo-Aybar C, McFarlane E, Niño de Guzman E, Penman K, Posso M, Roqué i Figuls M, Selva A, Vernooij RW, Alonso-Coello P, Martínez García L, Agarwal A, Blanchard S, Brereton L, Brouwers M, Etxeandia-Ikobaltzeta I, Flórez ID, Haynes C, Ibargoyen Roteta N, James R, Kwong J, Minister C, Nolan K, Qaseem A, Rotaeche del Campo R, Shaw B, Shin ES, Tam I, Thornton J, Vandvik Per O. The UpPriority tool was developed to guide the prioritization of clinical guideline questions for updating. J Clin Epidemiol 2020; 126:80-92. [DOI: 10.1016/j.jclinepi.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
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26
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Brozek JL, Canelo-Aybar C, Akl EA, Bowen JM, Bucher J, Chiu WA, Cronin M, Djulbegovic B, Falavigna M, Guyatt GH, Gordon AA, Hilton Boon M, Hutubessy RCW, Joore MA, Katikireddi V, LaKind J, Langendam M, Manja V, Magnuson K, Mathioudakis AG, Meerpohl J, Mertz D, Mezencev R, Morgan R, Morgano GP, Mustafa R, O'Flaherty M, Patlewicz G, Riva JJ, Posso M, Rooney A, Schlosser PM, Schwartz L, Shemilt I, Tarride JE, Thayer KA, Tsaioun K, Vale L, Wambaugh J, Wignall J, Williams A, Xie F, Zhang Y, Schünemann HJ. GRADE Guidelines 30: the GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making. J Clin Epidemiol 2020; 129:138-150. [PMID: 32980429 DOI: 10.1016/j.jclinepi.2020.09.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The objective of the study is to present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modeling studies (i.e., certainty associated with model outputs). STUDY DESIGN AND SETTING Expert consultations and an international multidisciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modeling community. Feedback from experts in a broad range of modeling and health care disciplines addressed the content validity of the approach. RESULTS Workshop participants agreed that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose-response relation, and the direction of residual confounding) also apply when assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo, a model specific to the situation of interest, 2) identifying an existing model, the outputs of which provide the highest certainty evidence for the situation of interest, either "off-the-shelf" or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modeling and health care disciplines. CONCLUSION This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care-related disciplines (e.g., therapeutic decision-making, toxicology, environmental health, and health economics).
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Affiliation(s)
- Jan L Brozek
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Canelo-Aybar
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, and Public Health. PhD Programme in Methodology of Biomedical Research and Public Health. Universitat Autònoma de Barcelona, Bellaterra, Spain; Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - James M Bowen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
| | - John Bucher
- National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Weihsueh A Chiu
- Department of Veterinary Integrative Biosciences, Texas A&M University, College Station, TX, USA
| | - Mark Cronin
- School of Pharmacy and Chemistry, Liverpool John Moores University, Liverpool, UK
| | - Benjamin Djulbegovic
- Center for Evidence-Based Medicine and Health Outcome Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Raymond C W Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Manuela A Joore
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | | | - Judy LaKind
- LaKind Associates, LLC, Catonsville, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Veena Manja
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Surgery, University of California Davis, Sacramento, CA, USA; Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | | | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, University Hospital of South Manchester, University of Manchester, Manchester, UK
| | - Joerg Meerpohl
- Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg-am-Breisgau, Germany; Cochrane Germany, Freiburg-am-Breisgau, Germany
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Roman Mezencev
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Rebecca Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gian Paolo Morgano
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
| | - Reem Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin O'Flaherty
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Grace Patlewicz
- National Center for Computational Toxicology, U.S. Environmental Protection Agency, Durham, NC, USA
| | - John J Riva
- McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margarita Posso
- Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Andrew Rooney
- National Toxicology Program, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Paul M Schlosser
- National Center for Environmental Assessment, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ian Shemilt
- EPPI-Centre, Institute of Education, University College London, London, UK
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Programs for Assessment of Technology in Health, McMaster University, Hamilton, Ontario, Canada
| | - Kristina A Thayer
- Department of Medicine, Department of Veterans Affairs, Northern California Health Care System, Mather, CA, USA
| | - Katya Tsaioun
- Evidence-Based Toxicology Collaboration, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - John Wambaugh
- National Center for Computational Toxicology, U.S. Environmental Protection Agency, Durham, NC, USA
| | | | | | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Health Quality Ontario, Toronto, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster GRADE Centre & Michael DeGroote Cochrane Canada Centre, McMaster University, Hamilton, Ontario, Canada
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Posso M, Comas M, Román M, Domingo L, Louro J, González C, Sala M, Anglès A, Cirera I, Cots F, Frías VM, Gea J, Güerri-Fernández R, Masclans JR, Noguès X, Vázquez O, Villar-García J, Horcajada JP, Pascual J, Castells X. Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain. Arch Bronconeumol 2020; 56:756-758. [PMID: 32782092 PMCID: PMC7365099 DOI: 10.1016/j.arbres.2020.06.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Margarita Posso
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Cristina González
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Albert Anglès
- Medical Documentation Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Isabel Cirera
- Emergency Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar-IMIM, Barcelona, Spain
| | - Víctor-Manuel Frías
- Institute of Neuropsychiatry and Addictions (INAD), Hospital del Mar, Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar-IMIM, DCEXS, UPF, CIBERES, ISCiii, Barcelona, Spain
| | | | | | - Xavier Noguès
- Department of Internal Medicine, Hospital del Mar. IMIM, CIBERFES, Barcelona, Spain
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Juan Pablo Horcajada
- Infection Control Program, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Department of Infectious Diseases, Hospital del Mar-IMIM, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar-IMIM, Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.
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28
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Agache I, Song Y, Rocha C, Beltran J, Posso M, Steiner C, Alonso‐Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park H, Pérez de Llano L, Quirce S, Sastre J, Shamji M, Schwarze J, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines-Recommendations on the use of biologicals in severe asthma. Allergy 2020; 75:1058-1068. [PMID: 32154939 DOI: 10.1111/all.14268] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
Dupilumab, a fully human monoclonal antibody against interleukin-4 receptor α, is approved as add-on maintenance treatment for inadequately controlled type 2 severe asthma. This systematic review evaluated the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled severe asthma. PubMed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. Three RCTs including 2735 subjects >12 years old and 24-52 weeks of follow-up were included. Dupilumab reduced with high certainty severe asthma exacerbations (Incidence rate ratio 0.51; 95% CI 0.45-0.59) and the percentage use of oral corticosteroid use (mean difference (MD) -28.2 mg/d; 95% CI -40.7 to -15.7). Asthma control (ACQ-5), quality of life (AQLQ) and rescue medication use [puffs/d] improved, without reaching the minimal important clinical difference: ACQ-5 MD -0.28 (95% CI -0.39 to -0.17); AQLQ MD +0.28 (95% CI 0.20-0.37); and rescue medication MD -0.35 (95% CI -0.73 to +0.02). FEV1 increased (MD +0.15; 95% CI +0.11 to +0.18) (moderate certainty). There was an increased rate of dupilumab-related adverse events (AEs) (moderate certainty) and of drug-related serious AEs (low certainty). The incremental cost-effectiveness ratio of dupilumab versus standard therapy was 464 000$/QALY (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population.
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29
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Agache I, Rocha C, Beltran J, Song Y, Posso M, Solà I, Alonso‐Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park H, Pérez de Llano L, Quirce S, Sastre J, Shamji M, Schwarze J, Canelo‐Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma: A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020; 75:1043-1057. [PMID: 32064642 DOI: 10.1111/all.14235] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [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: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 01/01/2023]
Abstract
Allergic asthma is a frequent asthma phenotype. Both IgE and type 2 cytokines are increased, with some degree of overlap with other phenotypes. Systematic reviews assessed the efficacy and safety of benralizumab, dupilumab and omalizumab (alphabetical order) vs standard of care for patients with uncontrolled severe allergic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. All three biologicals reduced with high certainty the annualized asthma exacerbation rate: benralizumab incidence rate ratios (IRR) 0.63 (95% CI 0.50 - 0.81); dupilumab IRR 0.58 (95%CI 0.47 - 0.73); and omalizumab IRR 0.56 (95%CI 0.42 - 0.73). Benralizumab and dupilumab improved asthma control with high certainty and omalizumab with moderate certainty; however, none reached the minimal important difference (MID). Both benralizumab and omalizumab improved QoL with high certainty, but only omalizumab reached the MID. Omalizumab enabled ICS dose reduction with high certainty. Benralizumab and omalizumab showed an increase in drug-related adverse events (AEs) with low to moderate certainty. All three biologicals had moderate certainty for an ICER/QALY value above the willingness to pay threshold. There was high certainty that in children 6-12 years old omalizumab decreased the annualized exacerbation rate [IRR 0.57 (95%CI 0.45-0.72)], improved QoL [relative risk 1.43 (95%CI 1.12 -1.83)], reduced ICS [mean difference (MD) -0.45 (95% CI -0.58 to -0.32)] and rescue medication use [ MD -0.41 (95%CI -0.66 to -0.15)].
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30
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Agache I, Beltran J, Akdis C, Akdis M, Canelo‐Aybar C, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Hernández‐Martín I, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park H, Pérez de Llano L, Posso M, Rocha C, Quirce S, Sastre J, Shamji M, Song Y, Steiner C, Schwarze J, Alonso‐Coello P, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020; 75:1023-1042. [PMID: 32034960 DOI: 10.1111/all.14221] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [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: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Abstract
Five biologicals have been approved for severe eosinophilic asthma, a well-recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6-11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV1 , without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug-related adverse events (AE) and drug-related serious AE (low to very low certainty of evidence). The incremental cost-effectiveness ratio per quality-adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV1 . More data on long-term safety are needed together with more efficacy data in the paediatric population.
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31
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Agache I, Song Y, Rocha C, Beltran J, Posso M, Steiner C, Alonso-Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park HS, Pérez de Llano L, Quirce S, Sastre J, Shamji M, Schwarze J, Canelo-Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines-Recommendations on the use of biologicals in severe asthma. Allergy 2020. [PMID: 32154939 DOI: 10.1111/all.14268.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dupilumab, a fully human monoclonal antibody against interleukin-4 receptor α, is approved as add-on maintenance treatment for inadequately controlled type 2 severe asthma. This systematic review evaluated the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled severe asthma. PubMed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. Three RCTs including 2735 subjects >12 years old and 24-52 weeks of follow-up were included. Dupilumab reduced with high certainty severe asthma exacerbations (Incidence rate ratio 0.51; 95% CI 0.45-0.59) and the percentage use of oral corticosteroid use (mean difference (MD) -28.2 mg/d; 95% CI -40.7 to -15.7). Asthma control (ACQ-5), quality of life (AQLQ) and rescue medication use [puffs/d] improved, without reaching the minimal important clinical difference: ACQ-5 MD -0.28 (95% CI -0.39 to -0.17); AQLQ MD +0.28 (95% CI 0.20-0.37); and rescue medication MD -0.35 (95% CI -0.73 to +0.02). FEV1 increased (MD +0.15; 95% CI +0.11 to +0.18) (moderate certainty). There was an increased rate of dupilumab-related adverse events (AEs) (moderate certainty) and of drug-related serious AEs (low certainty). The incremental cost-effectiveness ratio of dupilumab versus standard therapy was 464 000$/QALY (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Yang Song
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Corinna Steiner
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Departments of Paediatrics and Immunology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - James E Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Alberto Papi
- Department of Medical Sciences, Research Center on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University, Suwon, South Korea
| | | | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, National Heart and Lung Institute, London, UK.,Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain
| | - Marek Jutel
- Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.,ALL-MED" Medical Research Institute, Wroclaw, Poland
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32
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Agache I, Rocha C, Beltran J, Song Y, Posso M, Solà I, Alonso-Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park HS, Pérez de Llano L, Quirce S, Sastre J, Shamji M, Schwarze J, Canelo-Aybar C, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab and omalizumab) for severe allergic asthma: A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020. [PMID: 32064642 DOI: 10.1111/all.14235.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Allergic asthma is a frequent asthma phenotype. Both IgE and type 2 cytokines are increased, with some degree of overlap with other phenotypes. Systematic reviews assessed the efficacy and safety of benralizumab, dupilumab and omalizumab (alphabetical order) vs standard of care for patients with uncontrolled severe allergic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. All three biologicals reduced with high certainty the annualized asthma exacerbation rate: benralizumab incidence rate ratios (IRR) 0.63 (95% CI 0.50 - 0.81); dupilumab IRR 0.58 (95%CI 0.47 - 0.73); and omalizumab IRR 0.56 (95%CI 0.42 - 0.73). Benralizumab and dupilumab improved asthma control with high certainty and omalizumab with moderate certainty; however, none reached the minimal important difference (MID). Both benralizumab and omalizumab improved QoL with high certainty, but only omalizumab reached the MID. Omalizumab enabled ICS dose reduction with high certainty. Benralizumab and omalizumab showed an increase in drug-related adverse events (AEs) with low to moderate certainty. All three biologicals had moderate certainty for an ICER/QALY value above the willingness to pay threshold. There was high certainty that in children 6-12 years old omalizumab decreased the annualized exacerbation rate [IRR 0.57 (95%CI 0.45-0.72)], improved QoL [relative risk 1.43 (95%CI 1.12 -1.83)], reduced ICS [mean difference (MD) -0.45 (95% CI -0.58 to -0.32)] and rescue medication use [ MD -0.41 (95%CI -0.66 to -0.15)].
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Claudio Rocha
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yang Song
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Margarita Posso
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Giorgio W Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy, Monserrato
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, ON, Canada
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Italy, Monserrato
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University, Suwon, South Korea
| | | | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- Universidad Autónoma de Madrid Facultad de Medicina, Madrid, Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.,Imperial College NIHR Biomedical Research Centre, UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre , Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain
| | - Marek Jutel
- University of Wroclaw, Department of Clinical Immunology, Wroclaw, Poland.,"ALL-MED" Medical Research Institute, Wroclaw, Poland
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33
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Agache I, Beltran J, Akdis C, Akdis M, Canelo-Aybar C, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Hernández-Martín I, Nair P, O'Mahony L, Papadopoulos NG, Papi A, Park HS, Pérez de Llano L, Posso M, Rocha C, Quirce S, Sastre J, Shamji M, Song Y, Steiner C, Schwarze J, Alonso-Coello P, Palomares O, Jutel M. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy 2020. [PMID: 32034960 DOI: 10.1111/all.14221.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five biologicals have been approved for severe eosinophilic asthma, a well-recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6-11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV1 , without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug-related adverse events (AE) and drug-related serious AE (low to very low certainty of evidence). The incremental cost-effectiveness ratio per quality-adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV1 . More data on long-term safety are needed together with more efficacy data in the paediatric population.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Jessica Beltran
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Thomas Casale
- Division of Allergy and Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Department of Immunology, University of Toronto, Toronto, ON, Canada.,Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Departments of Paediatrics and Immunology, University of Toronto, Toronto, Canada
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Eckard Hamelmann
- Klinik für Kinder- und Jugendmedizin Kinderzentrum Bethel, Bielefeld, Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Second Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Alberto Papi
- Research Center on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University, Suwon, Korea
| | | | - Margarita Posso
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Claudio Rocha
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, CIBER of Respiratory Diseases (CIBERES), Universidad Autónoma de Madrid, Madrid, Spain
| | - Joaquin Sastre
- Universidad Autónoma de Madrid Facultad de Medicina, Madrid, Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development, National Heart and Lung Institute, London, UK.,Imperial College NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Yang Song
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Corinna Steiner
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain
| | - Marek Jutel
- Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.,"ALL-MED" Medical Research Institute, Wroclaw, Poland
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Román M, Sala M, Domingo L, Posso M, Louro J, Castells X. Personalized breast cancer screening strategies: A systematic review and quality assessment. PLoS One 2019; 14:e0226352. [PMID: 31841563 PMCID: PMC6913984 DOI: 10.1371/journal.pone.0226352] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The effectiveness of breast cancer screening is still under debate. Our objective was to systematically review studies assessing personalized breast cancer screening strategies based on women's individual risk and to conduct a risk of bias assessment. METHODS We followed the standard methods of The Cochrane Collaboration and PRISMA declaration and searched the MEDLINE, EMBASE and Clinical Trials databases for studies published in English. The quality of the studies was assessed using the ISPOR-AMCP-NPC Questionnaire and The Cochrane Risk of Bias Tool. Two independent reviewers screened full texts and evaluated the risk of bias. RESULTS Out of the 1533 initially retrieved citations, we included 13 studies. Three studies were randomized controlled trials, while nine were mathematical modeling studies, and one was an observational pilot study. The trials are in the recruitment phase and have not yet reported their results. All three trials used breast density and age to define risk groups, and two of them included family history, previous biopsies, and genetic information. Among the mathematical modeling studies, the main risk factors used to define risk groups were breast density, age, family history, and previous biopsies. Six studies used genetic information to define risk groups. The most common outcome measures were the gain in quality-adjusted life years (QALY), absolute costs, and incremental cost-effectiveness ratio (ICER), while the main outcome in the observational study was the detection rate. In all models, personalized screening strategies were shown to be effective. The randomized trials were of good quality. The modeling studies showed moderate risk of bias but there was wide variability across studies. The observational study showed a low risk of bias but its utility was moderate due to its pilot design and its relatively small scale. CONCLUSIONS There is some evidence of the effectiveness of screening personalization in terms of QUALYs and ICER from the modeling studies and the observational study. However, evidence is lacking on feasibility and acceptance by the target population. REVIEW REGISTRATION PROSPERO: CRD42018110483.
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Affiliation(s)
- Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network on Health Services in Chronic Diseases (REDISSEC), Spain
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Recalde M, Manzano-Salgado CB, Díaz Y, Puente D, Garcia-Gil MDM, Marcos-Gragera R, Ribes-Puig J, Galceran J, Posso M, Macià F, Duarte-Salles T. Validation Of Cancer Diagnoses In Electronic Health Records: Results From The Information System For Research In Primary Care (SIDIAP) In Northeast Spain. Clin Epidemiol 2019; 11:1015-1024. [PMID: 31819655 PMCID: PMC6899079 DOI: 10.2147/clep.s225568] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Electronic health records are becoming an increasingly valuable resource for epidemiology but their data quality needs to be quantified. We aimed to validate twenty-five types of incident cancer cases in the Information System for Research in Primary Care (SIDIAP) in Catalonia with the population-based cancer registries of Girona and Tarragona as the gold-standard. Methods We calculated the sensitivity, positive predictive values (PPV), and the time-difference between the date of diagnosis entered into the SIDIAP and into the registries. We added hospital discharge cancer diagnoses to the SIDIAP to assess sensitivity changes. Results We identified 27,046 incident cancer diagnoses in the SIDIAP from 2009–2015 among the 949,841 residents of Girona and Tarragona. The cancer types with the highest sensitivity were breast (89%, 95% CI: 88–90%), colorectal (81%, 95% CI: 80–82%), and prostate (81%, 95% CI: 80–83%). Trachea, bronchus and lung cancers had the highest PPV (76%, 95% CI: 74%-78%) followed by stomach (72%, 95% CI: 68–75%) and pancreas (71%, 95% CI: 67–75%). Most cancer diagnoses were reported with less than three months of difference between the SIDIAP and the registries. More cases were registered first in the registries than in the SIDIAP. By adding cancer diagnoses based on hospital discharge data, sensitivity increased for all cancers, especially for gallbladder and biliary tract for which the sensitivity increased by 21%. Conclusion The SIDIAP includes 76% of the cancer diagnoses in the cancer registries but includes a considerable number of cases that are not in the registries. The SIDIAP reports most of the cancer diagnoses within a three-month period difference from the date of diagnosis in the cancer registries. Our results support the use of the SIDIAP cancer diagnoses for epidemiological research when cancer is the outcome of interest. We recommend adding hospital discharge data to the SIDIAP to increase data quality, particularly for less frequent cancer types.
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Affiliation(s)
- Martina Recalde
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Cyntia B Manzano-Salgado
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Yesika Díaz
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
| | - Diana Puente
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Cerdanyola del Vallès, Spain
| | - Maria Del Mar Garcia-Gil
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
| | - Rafael Marcos-Gragera
- Unitat d'Epidemiologia i Registre de Càncer de Girona (UERCG), Pla Director d'Oncologia, Institut Català d'Oncologia, Institut d'Investigació Biomèdica de Girona (IdIBGi), Universitat De Girona, Girona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josefa Ribes-Puig
- Catalan Cancer Plan, Department of Health of Catalonia, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona (UB), Barcelona, Spain
| | - Jaume Galceran
- Registre de Càncer de Tarragona, Fundació per a la Investigació i Prevenció del Càncer (FUNCA), IISPV, Reus, Spain
| | - Margarita Posso
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
| | - Francesc Macià
- Cancer Prevention Unit and Cancer Registry, Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGoL), Barcelona, Spain
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Murzi M, Gordillo J, Oblitas E, Soriano G, Pernas JC, Posso M, Garcia-Planella E. Spontaneous hepatic portal venous gas in a patient with ulcerative colitis. A case report and a review. Gastroenterol Hepatol 2019; 43:22-25. [PMID: 31640909 DOI: 10.1016/j.gastrohep.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Marianette Murzi
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Jordi Gordillo
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain.
| | - Elida Oblitas
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - German Soriano
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain; Centro de Investigaciones Biomédicas en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Pernas
- Radiology Department, Abdominal Section. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
| | - Margarita Posso
- Service of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Esther Garcia-Planella
- Gastroenterology and Hepatology Unit. Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Catalonia, Spain
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37
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Posso M, Canelo C, Niño de Guzman Quispe E, Rodriguez L, Pacheco K, Balbin Ramon G. CM1 EFECTIVIDAD Y SEGURIDAD DE LA RESECCIÃN MUCOSA ENDOSCÃPICA FRENTE A LA DISECCIÃN SUBMUCOSA EN PACIENTES CON CÃNCER GÃSTRICO TEMPRANO: REVISIÃN SISTEMÃTICA CON METANÃLISIS. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.010] [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: 10/25/2022]
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Martin-Sanchez M, Comas M, Posso M, Louro J, Domingo L, Tebé C, Castells X, Espallargues M. Cost-Effectiveness of the Screening for the Primary Prevention of Fragility Hip Fracture in Spain Using FRAX ®. Calcif Tissue Int 2019; 105:263-270. [PMID: 31172231 DOI: 10.1007/s00223-019-00570-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/30/2019] [Indexed: 12/17/2022]
Abstract
To assess the cost-effectiveness of the primary prevention of fragility hip fractures through opportunistic risk-based screening using FRAX® among women aged 70 to 89 years, and the subsequent treatment with alendronate in women at high-risk, from the Spanish national health system perspective. We performed a discrete-event simulation model. Women were categorized in low, intermediate and high-risk of fragility hip fracture through screening based on the FRAX® risk assessment tool score (Spanish version). Low-risk women received lifestyle recommendations whereas the high-risk group was assigned to alendronate treatment. For women at intermediate-risk, treatment decision was based on a recalculated score considering bone mineral density (BMD). The cost-effectiveness analysis tested six scenarios defined by different FRAX® cut-off values assessing the incremental costs per averted fracture in 20 years. Deterministic sensitivity analysis was performed. We included a random sample of 5146 women obtained from a Spanish cohort of women referred for BMD. The most cost-effective intervention had an Incremental Cost-effectiveness Ratio (ICER) of 57,390 € per averted hip fracture and consisted of using the FRAX® score without BMD and treating women with a score higher than 5%. The ICER exceeded the acceptability threshold of 25,000 € in all the scenarios. Sensitivity analysis based on time to fracture, treatment efficacy, adherence to treatment and cost of dependence resulted in ICERs ranging from 39,216 € to 254,400 €. An ICER of 24,970 € was obtained when alendronate cost was reduced to 1.13 € per month. The use of FRAX® as screening tool followed by alendronate treatment is not cost-effective in senior women in Spain. Other primary preventions strategies are advisable.
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Affiliation(s)
- Mario Martin-Sanchez
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Preventive Medicine and Public Health Training Unit PSMAR-UPF-ASPB (Parc de Salut Mar - Pompeu Fabra University-Public Health Agency of Barcelona), Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain.
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Cristian Tebé
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Mireia Espallargues
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
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Posso M, Quintana MJ, Bellmunt S, Martínez García L, Escudero JR, Viteri-García A, Valli C, Bonfill X. GRADE-Based Recommendations for Surgical Repair of Nonruptured Abdominal Aortic Aneurysm. Angiology 2019; 70:701-710. [PMID: 30961349 DOI: 10.1177/0003319719838892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to provide evidence-based recommendations for endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for patients with a nonruptured abdominal aortic aneurysm (AAA). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Both low- and high surgical risk patients treated with EVAR showed decreased 30-day mortality, but the low-risk group had no differences in 4-year mortality. Compared with friendly anatomy, patients with hostile anatomy had an increased risk of type I endoleak. Young patients may prefer OSR. Endovascular aneurysm repair was not cost-effective in Europe. Four conditional recommendations were formulated: (1) OSR for low-risk patients up to 80 years old, (2) EVAR for low-risk patients older than 80 years, (3) EVAR for high-risk patients as long as is anatomically feasible, and (4) OSR in patients in whom it is not anatomically feasible to perform EVAR. Based on GRADE criteria, either OSR or EVAR can be suggested to patients with nonruptured AAA taking into account their surgical risk, hostile anatomy, and age. Given the weakness of the recommendations, personal preferences are determinant.
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Affiliation(s)
- Margarita Posso
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - M Jesús Quintana
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Sergi Bellmunt
- 4 Department of Angiology, Vascular and Endovascular Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,5 Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - José R Escudero
- 6 Joint Service of Angiology, Vascular and Endovascular Surgery, Sant Pau-Dos de Mayo Hospital, Barcelona, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain.,8 CIBER of Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Andrés Viteri-García
- 9 Faculty of Health Sciences "Eugenio Espejo," Clinical Epidemiology and Public Health Research Centre (CISPEC), Universidad UTE, Quito, Ecuador
| | - Claudia Valli
- 2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain
| | - Xavier Bonfill
- 1 Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau IIB Sant Pau, Barcelona, Spain.,2 Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona, Spain.,3 CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,7 Autonomous University of Barcelona, Barcelona, Spain
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40
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Esteva M, Ruidíaz M, Sánchez MA, Pértega S, Pita-Fernández S, Macià F, Posso M, González-Luján L, Boscá-Wats MM, Leiva A, Ripoll J. Correction: Emergency presentation of colorectal patients in Spain. PLoS One 2018; 13:e0207143. [PMID: 30388189 PMCID: PMC6214565 DOI: 10.1371/journal.pone.0207143] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0203556.].
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Esteva M, Ruiz-Díaz M, Sánchez MA, Pértega S, Pita-Fernández S, Macià F, Posso M, González-Luján L, Boscá-Wats MM, Leiva A, Ripoll J. Emergency presentation of colorectal patients in Spain. PLoS One 2018; 13:e0203556. [PMID: 30273339 PMCID: PMC6166931 DOI: 10.1371/journal.pone.0203556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background Colorectal cancer (CRC) is the leading cause of cancer deaths in Europe. Survival is poorer in patients admitted to hospitals through the emergency department than in electively admitted patients. Knowledge of factors associated with a cancer diagnosis through presentation at an emergency department may reduce the likelihood of an emergency diagnosis. This study evaluated factors influencing the diagnosis of CRC in the emergency department. Methods and findings This is a cross-sectional study in 5 Spanish regions; subjects were incident cases of CRC diagnosed in 9 public hospitals, between 2006 and 2008. Data were obtained from patient interviews and primary care and hospital clinical records. We found that approximately 40% of CRC patients first contacted a hospital for CRC through an emergency service. Women were more likely than men to be emergency presenters. The type of symptom associated with emergency presentation differed between patients with colon cancer and those with rectal cancer, in that the frequency of “alarm symptoms” was significantly lower in colon than in rectal cancer patients who initially presented to emergency services. Soon after symptom onset, some patients went to a hospital emergency service, whereas others contacted their GP. Lack of contact with a GP for CRC-related symptoms was consistently related to emergency presentation. Among patients who contacted a GP, a higher number of consultations for CRC symptoms and any referral to outpatient consultations reduced the likelihood of emergency presentation. All diagnostic time intervals were shorter in emergency presenters than in elective patients. Conclusions Emergency presenters are not a uniform category and can be divided into categories according to their symptoms, help seeking behavior trajectory and interaction with their GPs. Time constraints for testing and delays in obtaining outpatient appointments led patients to visit a hospital service either on their own or after referral by their GP.
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Affiliation(s)
- Magdalena Esteva
- Primary Care Research Unit, Majorca Department of Primary Care; Baleares Health Service [IbSalut], Balearic Islands Health Research Institute (IdISBa), Majorca, Spain
- * E-mail:
| | | | - M. Antonia Sánchez
- Centro de Salud Fuentes Norte Zaragoza, Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Sonia Pértega
- Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, España
| | - Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, España
| | - Francesc Macià
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain
| | - Luis González-Luján
- Serreria II Primary Care Centre, Valencia Institute of Health, Valencia, Spain
| | - Marta M. Boscá-Wats
- Digestive Medicine Unit, Hospital Clinic Universitari de València, València, Spain
| | - Alfonso Leiva
- Primary Care Research Unit, Majorca Department of Primary Care; Baleares Health Service [IbSalut], Balearic Islands Health Research Institute (IdISBa), Majorca, Spain
| | - Joana Ripoll
- Primary Care Research Unit, Majorca Department of Primary Care; Baleares Health Service [IbSalut], Balearic Islands Health Research Institute (IdISBa), Majorca, Spain
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Rojas-Camayo J, Mejia CR, Callacondo D, Dawson JA, Posso M, Galvan CA, Davila-Arango N, Bravo EA, Loescher VY, Padilla-Deza MM, Rojas-Valero N, Velasquez-Chavez G, Clemente J, Alva-Lozada G, Quispe-Mauricio A, Bardalez S, Subhi R. Reference values for oxygen saturation from sea level to the highest human habitation in the Andes in acclimatised persons. Thorax 2017; 73:776-778. [DOI: 10.1136/thoraxjnl-2017-210598] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/06/2017] [Accepted: 09/25/2017] [Indexed: 11/04/2022]
Abstract
Oxygen saturation, measured by pulse oximetry (SpO2), is a vital clinical measure. Our descriptive, cross-sectional study describes SpO2 measurements from 6289 healthy subjects from age 1 to 80 years at 15 locations from sea level up to the highest permanent human habitation. Oxygen saturation measurements are illustrated as percentiles. As altitude increased, SpO2 decreased, especially at altitudes above 2500 m. The increase in altitude had a significant impact on SpO2 measurements for all age groups. Our data provide a reference range for expected SpO2 measurements in people from 1 to 80 years from sea level to the highest city in the world.
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Lafranconi A, Pylkkänen L, Deandrea S, Bramesfeld A, Lerda D, Neamțiu L, Saz-Parkinson Z, Posso M, Rigau D, Sola I, Alonso-Coello P, Martinez-Zapata MJ. Intensive follow-up for women with breast cancer: review of clinical, economic and patient's preference domains through evidence to decision framework. Health Qual Life Outcomes 2017; 15:206. [PMID: 29052503 PMCID: PMC5649085 DOI: 10.1186/s12955-017-0779-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 10/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Women treated for breast cancer are followed-up for monitoring of treatment effectiveness and for detecting recurrences at an early stage. The type of follow-up received may affect women's reassurance and impact on their quality of life. Anxiety and depression among women with breast cancer has been described, but little is known about how the intensity of the follow-up can affect women's psychological status. This study was undertaken to evaluate the effects of intensive vs. less-intensive follow-up on different health outcomes, to determine what are women's preferences and values regarding the follow-up received, and also assess the costs of these different types of follow-up. METHODS A systematic review following standard Cochrane Collaboration methods was carried out to assess the efficacy of intensive follow-up versus non-intensive follow-up in breast cancer patients. Two additional reviews on women's preferences and economic evidence were also carried out. The search was performed up to January 2016 in: MEDLINE, EMBASE, PDQ, McMaster Health Systems Evidence, CENTRAL, and NHS EED (through The Cochrane Library). The quality of evidence was assessed by GRADE (for quantitative studies) and CerQUAL (for qualitative studies). Several outcomes including mortality, breast cancer recurrences, quality of life, and patient satisfaction were evaluated. RESULTS Six randomised trials (corresponding to 3534 women) were included for the evaluation of health outcomes; three studies were included for women's values and preferences and four for an economic assessment. There is moderate certainty of evidence showing that intensive follow-up, including more frequent diagnostic tests or visits, does not have effects on 5- or 10-year overall mortality and recurrences in women with breast cancer, compared with less intensive follow-up. Regarding women's preferences and values, there was important variability among studies and within studies (low confidence due to risk of bias and inconsistency). Furthermore, intensive follow-up, as opposed to less intensive follow-up, is not likely to be cost-effective. CONCLUSIONS Less intensive follow-up appears to be justified and can be recommended over intensive follow-up. Resources could thus be mobilised to other aspects of breast cancer care, or other areas of healthcare.
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Affiliation(s)
- Alessandra Lafranconi
- CESP, School of Medicine, Università degli Studi Milano Bicocca, Monza, MB Italy
- Department of International Health, FHML, CAPHRI, Maastricht University, Maastricht, Netherlands
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Liisa Pylkkänen
- Cancer Society of Finland, Helsinki, Finland
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Silvia Deandrea
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Anke Bramesfeld
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Donata Lerda
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Luciana Neamțiu
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Zuleika Saz-Parkinson
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
| | - Margarita Posso
- Iberoamerican Cochrane Centre - Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - David Rigau
- Iberoamerican Cochrane Centre - Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ivan Sola
- CESP, School of Medicine, Università degli Studi Milano Bicocca, Monza, MB Italy
- Department of International Health, FHML, CAPHRI, Maastricht University, Maastricht, Netherlands
- Cancer Society of Finland, Helsinki, Finland
- European Commission, Directorate General Joint Research Centre (JRC), Directorate F - Health, Consumers and Reference Materials, Ispra, VA Italy
- Iberoamerican Cochrane Centre - Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre - Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Posso M, Puig T, Carles M, Rué M, Canelo-Aybar C, Bonfill X. Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis. Eur J Radiol 2017; 96:40-49. [PMID: 29103474 DOI: 10.1016/j.ejrad.2017.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 04/24/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Double reading is the strategy of choice for mammogram interpretation in screening programmes. It remains, however, unknown whether double reading is still the strategy of choice in the context of digital mammography. Our aim was to determine the effectiveness and cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes. METHODS We performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases up to April 2017. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist to assess the methodological quality of the diagnostic studies and economic evaluations, respectively. A proportion's meta-analysis approach, 95% Confidence Intervals (95% CI) and test of heterogeneity (P values) were used for pooled results. Costs are expressed US$ PPP (United States Dollar purchasing power parities). The PROSPERO ID of this Systematic Review's protocol is CRD42014013804. RESULTS Of 1473 potentially relevant hits, four high-quality studies were included. The pooled cancer detection rate of double reading was 6.01 per 1000 screens (CI: 4.47‰-7.77‰), and it was 5.65 per 1000 screens (CI: 3.95‰-7.65‰) for single reading (P=0.76). The pooled proportion of false-positives of double reading was 47.03 per 1000 screens (CI: 39.13‰-55.62‰) and it was 40.60 per 1000 screens (CI: 38.58‰-42.67‰) for single reading (P=0.12). One study reported, for double reading, an ICER (Incremental Cost-Effectiveness Ratio) of 16,684 Euros (24,717 US$ PPP; 2015 value) per detected cancer. Single reading+CAD (computer-aided-detection) was cost-effective in Japan. CONCLUSION The evidence of benefit for double reading compared to single reading for digital mammography interpretation is scarce. Double reading seems to increase operational costs, have a not significantly higher false-positive rate, and a similar cancer detection rate.
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Affiliation(s)
- Margarita Posso
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Iberoamerican Cochrane Centre, Barcelona, Spain.
| | - Teresa Puig
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | | | - Montserrat Rué
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Universitat de Lleida, Lleida, Spain.
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Barcelona, Spain; School of Medicine, Peruvian University of Applied Sciences, Lima, Peru.
| | - Xavier Bonfill
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Iberoamerican Cochrane Centre, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain.
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Martínez García L, Pardo-Hernandez H, Niño de Guzman E, Superchi C, Ballesteros M, McFarlane E, Penman K, Posso M, Roqué i Figuls M, Sanabria AJ, Selva A, Vernooij RWM, Alonso-Coello P. Development of a prioritisation tool for the updating of clinical guideline questions: the UpPriority Tool protocol. BMJ Open 2017; 7:e017226. [PMID: 28775194 PMCID: PMC5724084 DOI: 10.1136/bmjopen-2017-017226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to a continuous emergence of new evidence, clinical guidelines (CGs) require regular surveillance of evidence to maintain their trustworthiness. The updating of CGs is resource intensive and time consuming; therefore, updating may include a prioritisation process to efficiently ensure recommendations remain up to date. The objective of our project is to develop a pragmatic tool to prioritise clinical questions for updating within a CG. METHODS AND ANALYSIS To develop the tool, we will use the results and conclusions of a systematic review of methodological research on prioritisation processes for updating and will adopt a methodological approach we have successfully implemented in a previous experience.We will perform a multistep process including (1) generation of an initial version of the tool, (2) optimisation of the tool (feasibility test of the tool, semistructured interviews, Delphi consensus survey, external review by CG methodologists and users and pilot test of the tool) and (3) approval of the final version of the tool.At each step of the process, we will (1) calculate absolute frequencies and proportions (quantitative data), (2) use content analysis to summarise and draw conclusions (qualitative data) and (3) draft a final report, discuss results and refine the previous versions of the tool. Finally, we will calculate intraclass coefficients with 95% CIs for each item and overall as indicators of agreement among reviewers. ETHICS AND DISSEMINATION We have obtained a waiver of approval from the Clinical Research Ethics Committee at the Hospital de la Santa Creu i Sant Pau (Barcelona). The results of the study will be published in peer-reviewed journal and communicated to interested stakeholders.The tool could support the standardisation of prioritisation processes for updating CGs and therefore have important implications for a more efficient use of resources in the CG field.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Manchester, UK
| | - Katrina Penman
- National Institute for Health and Care Excellence, Manchester, UK
| | - Margarita Posso
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué i Figuls
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening. Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Clinical Epidemiology and Biostatistics Department, McMaster University, Hamilton, Canada
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Posso M, Corominas JM, Serrano L, Román M, Torá‐Rocamora I, Domingo L, Romero A, Quintana MJ, Vernet‐Tomas M, Baré M, Vidal C, Sánchez M, Saladié F, Natal C, Ferrer J, Servitja S, Sala M, Castells X. Biomarkers expression in benign breast diseases and risk of subsequent breast cancer: a case-control study. Cancer Med 2017; 6:1482-1489. [PMID: 28470951 PMCID: PMC5463091 DOI: 10.1002/cam4.1080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022] Open
Abstract
Women with benign breast diseases (BBD) have a high risk of breast cancer. However, no biomarkers have been clearly established to predict cancer in these women. Our aim was to explore whether estrogen receptor (ER), progesterone receptor (PR), and Ki67 expression stratify risk of breast cancer in screened women with BBD. We conducted a nested case-control study. Women with breast cancer and prior BBDs (86 cases) were matched to women with prior BBDs who were free from breast cancer (172 controls). The matching factors were age at BBD diagnosis, type of BBD, and follow-up time since BBD diagnosis. ER, PR, and Ki67 expression were obtained from BBDs' specimens. Conditional logistic regression was used to estimate odds ratios (ORs), and 95% confidence intervals (CIs) of breast cancer risk according to ER, PR, and Ki67 expression. Women with >90% of ER expression had a higher risk of breast cancer (OR = 2.63; 95% CI: 1.26-5.51) than women with ≤70% of ER expression. Similarly, women with >80% of PR expression had a higher risk of breast cancer (OR = 2.22; 95% CI: 1.15-4.27) than women with ≤40% of PR expression. Women with proliferative disease and ≥1% of Ki67 expression had a nonsignificantly increased risk of breast cancer (OR = 1.16; 95% CI: 0.46-2.90) than women with <1% of Ki67 expression. A high expression of ER and PR in BBD is associated with an increased risk of subsequent breast cancer. In proliferative disease, high Ki67 expression may also have an increased risk. This information is helpful to better characterize BBD and is one more step toward personalizing the clinical management of these women.
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Affiliation(s)
- Margarita Posso
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Department of Clinical Epidemiology and Public HealthHospital de la Santa Creu i Sant Pau (IIB Sant Pau)BarcelonaSpain
| | - Josep M. Corominas
- Pathology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Laia Serrano
- Pathology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Marta Román
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Isabel Torá‐Rocamora
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Laia Domingo
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
- Agency for Health Quality and Assessment of Catalonia (AQuAS)BarcelonaSpain
| | - Anabel Romero
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public HealthHospital de la Santa Creu i Sant Pau (IIB Sant Pau)BarcelonaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)BarcelonaSpain
| | - María Vernet‐Tomas
- Obstetrics and Gynecology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - Marisa Baré
- Clinical Epidemiology and Cancer ScreeningParc Taulí University HospitalBarcelonaSpain
| | - Carmen Vidal
- Cancer Prevention and Control ProgramCatalan Institute of OncologyBarcelonaSpain
| | - Mar Sánchez
- Direction General of Public HealthDepartment of HealthGovernment of CantabriaSantanderSpain
| | - Francina Saladié
- Breast Cancer Screening Program of TarragonaThe Foundation League for the Research and Prevention of CancerTarragonaSpain
| | - Carmen Natal
- Principality of Asturias Breast Cancer Screening ProgramPrincipality of AsturiasOviedoSpain
| | - Joana Ferrer
- Radiology DepartmentHospital de Santa CaterinaGironaSpain
| | - Sònia Servitja
- Oncology DepartmentIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
| | - María Sala
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Xavier Castells
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Research Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
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Martínez García L, Pardo-Hernandez H, Superchi C, Niño de Guzman E, Ballesteros M, Ibargoyen Roteta N, McFarlane E, Posso M, Roqué I Figuls M, Rotaeche Del Campo R, Sanabria AJ, Selva A, Solà I, Vernooij RWM, Alonso-Coello P. Methodological systematic review identifies major limitations in prioritization processes for updating. J Clin Epidemiol 2017; 86:11-24. [PMID: 28549931 DOI: 10.1016/j.jclinepi.2017.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/04/2016] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of the study was to identify and describe strategies to prioritize the updating of systematic reviews (SRs), health technology assessments (HTAs), or clinical guidelines (CGs). STUDY DESIGN AND SETTING We conducted an SR of studies describing one or more methods to prioritize SRs, HTAs, or CGs for updating. We searched MEDLINE (PubMed, from 1966 to August 2016) and The Cochrane Methodology Register (The Cochrane Library, Issue 8 2016). We hand searched abstract books, reviewed reference lists, and contacted experts. Two reviewers independently screened the references and extracted data. RESULTS We included 14 studies. Six studies were classified as descriptive (6 of 14, 42.9%) and eight as implementation studies (8 of 14, 57.1%). Six studies reported an updating strategy (6 of 14, 42.9%), six a prioritization process (6 of 14, 42.9%), and two a prioritization criterion (2 of 14, 14.2%). Eight studies focused on SRs (8 of 14, 57.1%), six studies focused on CGs (6 of 14, 42.9%), and none were about HTAs. We identified 76 prioritization criteria that can be applied when prioritizing documents for updating. The most frequently cited criteria were as follows: available evidence (19 of 76, 25.0%), clinical relevance (10 of 76; 13.2%), and users' interest (10 of 76; 13.2%). CONCLUSION There is wide variability and suboptimal reporting of the methods used to develop and implement processes to prioritize updating of SRs, HTAs, and CGs.
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Affiliation(s)
- Laura Martínez García
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain.
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Cecilia Superchi
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Monica Ballesteros
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Nora Ibargoyen Roteta
- Department of Health and Consumer Affairs, Basque Office for Health Technology Assessment (Osteba), Basque Government, Calle Donostia 1, Vitoria-Gasteiz ES-01010, Spain
| | - Emma McFarlane
- National Institute for Health and Care Excellence, Level 1A City Tower, Piccadilly Plaza, Manchester M1 4BT, UK
| | - Margarita Posso
- Service of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Marta Roqué I Figuls
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Rafael Rotaeche Del Campo
- Alza Health Centre, Osakidetza-Basque Health Service, Avda Larratxo s/n, Donostia-San Sebastián 20013, Spain
| | - Andrea Juliana Sanabria
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí de Sabadell, Parc Taulí s/n, Sabadell 08208, Spain
| | - Anna Selva
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret 167, Pavelló 18 - planta 0, Barcelona 08025, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Castells X, Torá-Rocamora I, Posso M, Román M, Vernet-Tomas M, Rodríguez-Arana A, Domingo L, Vidal C, Baré M, Ferrer J, Quintana MJ, Sánchez M, Natal C, Espinàs JA, Saladié F, Sala M. Risk of Breast Cancer in Women with False-Positive Results according to Mammographic Features. Radiology 2016; 280:379-86. [DOI: 10.1148/radiol.2016151174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Posso M, Carles M, Rué M, Puig T, Bonfill X. Cost-Effectiveness of Double Reading versus Single Reading of Mammograms in a Breast Cancer Screening Programme. PLoS One 2016; 11:e0159806. [PMID: 27459663 PMCID: PMC4961365 DOI: 10.1371/journal.pone.0159806] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The usual practice in breast cancer screening programmes for mammogram interpretation is to perform double reading. However, little is known about its cost-effectiveness in the context of digital mammography. Our purpose was to evaluate the cost-effectiveness of double reading versus single reading of digital mammograms in a population-based breast cancer screening programme. METHODS Data from 28,636 screened women was used to establish a decision-tree model and to compare three strategies: 1) double reading; 2) double reading for women in their first participation and single reading for women in their subsequent participations; and 3) single reading. We calculated the incremental cost-effectiveness ratio (ICER), which was defined as the expected cost per one additionally detected cancer. We performed a deterministic sensitivity analysis to test the robustness of the ICER. RESULTS The detection rate of double reading (5.17‰) was similar to that of single reading (4.78‰; P = .768). The mean cost of each detected cancer was €8,912 for double reading and €8,287 for single reading. The ICER of double reading versus single reading was €16,684. The sensitivity analysis showed variations in the ICER according to the sensitivity of reading strategies. The strategy that combines double reading in first participation with single reading in subsequent participations was ruled out due to extended dominance. CONCLUSIONS From our results, double reading appears not to be a cost-effective strategy in the context of digital mammography. Double reading would eventually be challenged in screening programmes, as single reading might entail important net savings without significantly changing the cancer detection rate. These results are not conclusive and should be confirmed in prospective studies that investigate long-term outcomes like quality adjusted life years (QALYs).
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Affiliation(s)
- Margarita Posso
- Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Montserrat Rué
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Universitat de Lleida, Lleida, Spain
| | - Teresa Puig
- Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Xavier Bonfill
- Service of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Burón A, Posso M, Sivilla J, Grau J, Guayta R, Castells X, Castells A, Macià F. Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. Gastroenterol Hepatol 2016; 40:265-275. [PMID: 27292268 DOI: 10.1016/j.gastrohep.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents' opinion and satisfaction with each step of the screening process. MATERIAL AND METHOD Telephone survey using an ad hoc questionnaire (see annex) administered to a final sample of 1189 people: 310 non-participants in the programme (NoP), 553 participants with a negative test result (PNeg), and 326 participants with a positive result (PPos). RESULTS High scores were obtained for the clarity of the information provided by the programme (mean 8.9 on a scale 0-10), and for the accessibility and attention at the pharmacy as well as its role as the point for collection and return of FOB test cards (mean >9.3). Aspects that were not so highly rated were: preparation for the colonoscopy (41.6% reported quite a lot or a lot of discomfort), and to a lesser extent telephone accessibility (27.1% reported some difficulties). Participants also expressed concern about receiving a positive test result by telephone (78.9% reported some concern). CONCLUSIONS Respondents' opinion of the programme was positive overall, and supports the pharmacy as the point for distributing and collecting FOB test cards, as well as the role of the pharmacist in the context of the programme. Some aspects of the screening process will be reviewed in order to improve participant satisfaction and eventually increase uptake.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España.
| | - Margarita Posso
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Judit Sivilla
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Jaume Grau
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Rafael Guayta
- Direcció de Projectes i Recerca. Consell de Col·legis Farmacèutics de Catalunya, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
| | - Antoni Castells
- Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universitat de Barcelona, Barcelona, España
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
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