Cost-utility Analysis of Atezolizumab Combined with Standard Chemotherapy Regimen in the First-line Treatment of Extensive-stage Small-cell Lung Cancer / 中国药房

OBJECTIVE：To evaluate the economics of atezolizumab combined with stardard chemotherapy regimens versus chemotherapy regimens alone as first-line treatment for extensive-stage small-cell lung cancer （ES-SCLC）from the healthcare system perspective. METHODS ：A partitioned survival model was constructed using published phase Ⅲ clinical trial data （IMpower133）and literature data to evaluate the economics of atezolizumaba combined with standard chemotherapy regimens versus chemotherapy regimens alone as first-line treatment for ES-SCLC. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the stability of the results. RESULTS ：The results of cost-utility analysis showed that the cost of atezolizumab combined with chemotherapy group was 489 598.52 yuan，with utility of 0.70 QALYs；the cost of chemotherapy alone group was 126 276.80 yuan，with utility of 0.55 QALYs；the incremental cost-utility ratio （ICUR）between the two groups was 2 361 709.05 yuan/QALY，far exceeding the willingness-to-pay （WTP）in China （3 times of GDP per capita in 2019，212 676 yuan）. One-way sensitivity analysis showed that progression-free utility value of atezolizumab combined with chemotherapy had the greatest impact on the results of cost-utility analysis ；probabilistic sensitivity analysis suggested that the atezolizumab combined with chemotherapy regimen was not economical within the WTP range of 0-500 000 yuan/QALY. CONCLUSIONS ：Atezolizumab combined with chemotherapy regimen has no cost-utility advantage versus chemotherapy alone in the first-line treatment of ES-CLC under the current economic level of China.

Cost-utility Analysis of Osimertinib in the First-line Treatment of EGFR Mutation-positive Locally Advanced or Metastatic Non-small Cell Lung Cancer / 中国药房

OBJECTIVE：To evaluate the economic s of osimertinib versus first-generation EGFR-TKIs in the first-line treatment of EGFR mutation-positive locally advanced or metastatic non-small cell lung cancer （NSCLC），and to provide evidence-based reference for medical and healthy decision-making in China. METHODS ：From respective of health care system ，Markov model was developed by using patientsurvival data and published literature datato simulate 10 years of direct medical costs and quality-adjusted life years （QALY）for EGFR mutation-positive locally advanced or metastatic NSCLC patients ，with a model cycle length of 3 weeks，and the discount rate of 5％. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the effects of parameter changes on the stability of the model results. RESULTS ：In the base-case analysis ，compared with the first-generation EGFR-TKIs ，osimertinib could obtain 0.40 QALYs more ，with an incremental cost of 163 531.55 yuan and an incremental cost-utility ratio （ICER）of 409 321.54 yuan/QALY，which was higher than the willingness-to-pay （WTP）threshold in China（3 times per capita GDP in China in 2019 of 212 676 yuan/QALY）. The results of one-way sensitivity analysis showed that the utility value of progression-free survival status and the price of osimertinib had the greatest impact on ICER. The results of probability sensitivity analysis showed that the probability of osimertinib to be cost-effective was 11.00％ at the WTP threshold in China. When the price of osimertinib decreased by 30％，50％ and 70％，the probability of osimertinib to be cost-effective was 26.20％，47.40％，and 74.30％ at the WTP threshold of 212 676 yuan/QALY，respectively. CONCLUSIONS ：When Chinese 3 times per capita GDP in 2019 is used as the criterion for judgment ，osimertinib is not economical compared with the first-generation EGFR-TKIs in first-line treatment of locally advanced or metastatic NSCLC with EGFR mutation-positive. Appropriate price reduction can improve its economy.

Pharmacoeconomic Evaluation of Pembrolizumab in First-line Treatment of Advanced Non-small Cell Lung Cancer with High PD-L 1 Expression / 中国药房

OBJECTIVE：To ev aluate the economics of pembrolizumab versus first-line chemotherapy in the treatment of advanced non-small cell lung cancer with high programmed cell death protein ligand 1（PD-L1）expression from the perspective of Chinese healthcare system. METHODS ：Published KEYNOTE- 042 clinical trial data and relevant literature data were used to establish a Markov model to evaluate the economics of pembrolizumab versus first-line chemotherapy with a 20-years horizon and a 3-week cycle length ，discounting costs and utilities using a discount rate of 5％. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the stability of the model results. RESULTS ：The base-case results showed that pembrolizumab yield additional 1.62 QALYs more than first-line chemotherapy ，with an incremental cost of 54 648 yuan；the incremental cost-utility ratio was 33 686 yuan/QALY，which was lower than the willingness-to-pay threshold （WTP）in China. The results of one-way sensitivity analysis showed that the price of nivolumab ，the price of pembrolizumab and the proportion of patients who received second-line immunotherapy in first-line chemotherapy group had the greatest impact on the results. The results of probabilistic sensitivity analysis showed that the probability of pembrolizumab to be cost-effective gradually increased within the WTP of 0-140 000/QALY. When WTP was 70 892 yuan/QALY（one time of the per capita GDP of China in 2019），the probability of pembrolizumab to be cost-effective was 95％. When WTP beyond 100 000 yuan/QALY，the probability of pembrolizumab to be cost-effective was 100％. CONCLUSIONS ：Pembrolizumab has economic advantages than first-line chemotherapy in the first-line treatment of non-small cell lung cancer with high PD-L 1 expression in China.

Pharmacoeconomic Evaluation of Ixekizumab in the Treatment of Moderate-to-severe Plaque Psoriasis / 中国药房

OBJECTIVE：To evaluate the drug economy of ixekizumab in the treatment of moderate-to-severe plaque psoriasis. METHODS： Literatures were retrieved from PubMed ， Embase， The Cochrane Library ， CNKI and Wanfang database ， supplemented by manual search ，search time from the database establishment to Oct. 31st，2019，using Chinese and English search terms included “Ixekizumab”“Taltz”“Psoriasis”“Pharmacoeconomics”“Cost-benifit analysis ”“Cost-effectiveness analysis ” “Cost-utility analysis ”，etc. The literatures were screened according to inclusion and exclusion criteria. Relevant pharmacoeconomic studies about ixekizumab in the treatment of moderate-to-severe plaque psoriasis were collected ，and the study methods and pharmacoeconomic evaluation results were summarized. RESULTS ：A total of 8 literatures were included ，involving 9 studies. The overall quality of the studies was high. All the studies were distributed in foreign countries such as Canada ，the United States and the United Kingdom. All the studies adopted Markov model. The health outcomes showed that ixekizumab could bring more quality-adjusted life years. Compared with methotrexate combined with phototherapy ，infliximab，ustekinumab and secukinumab ， the incremental cost-utility ratio （ICUR）of ixekizumab was different in different studies. CONCLUSIONS ：Ixekizumab has certain economic advantages for the treatment of moderate-to-severe plaque psoriasis ，but there is still a lack of relevant research in China and it is urgent to carry out relevant research suitable for Chinese.

Clinical Characteristics of Alien Hand Syndrome:Eight Cases Report / 中国康复理论与实践

Objective To report the clinical characteristics of alien hand syndrome(AHS). Methods Eight AHS inpatients from July,2015 to July,2017 were reviewed from the etiology,clinical manifestations, imaging characteristics and outcome. Results The etiology of the patients was cerebrovascular disease. The clinical features included alien hand (8 cases), movement disorder(8 cases),cognitive disorder(5 cases),speech disorder(4 cases)and affective disorder(3 cas-es).Imaging indicated the lesions involved callosum(8 cases),frontal lobe(2 cases),parietal lobe(3 cases),tem-poral lobe(2 cases)and basal ganglial region(1 case).There were four cases healing,two improving,two of re-mission after medicine and rehabilitation. Conclusion ASH is mainly resulted from cerebrovascular disease, in which callosum and frontal lobe are mostly in-volved,features in different forms,and prognoses well.

Purification and characterization of an aspartic protease from the Rhizopus oryzae protease extract, Peptidase R

Background Aspartic proteases are a subfamily of endopeptidases that are useful in a variety of applications, especially in the food processing industry. Here we describe a novel aspartic protease that was purified from Peptidase R, a commercial protease preparation derived from Rhizopus oryzae. Results An aspartic protease sourced from Peptidase R was purified to homogeneity by anion exchange chromatography followed by polishing with a hydrophobic interaction chromatography column, resulting in a 3.4-fold increase in specific activity (57.5 × 10³ U/mg) and 58.8% recovery. The estimated molecular weight of the purified enzyme was 39 kDa. The N-terminal sequence of the purified protein exhibited 63-75% identity to rhizopuspepsins from various Rhizopus species. The enzyme exhibited maximal activity at 75°C in glycine-HCl buffer, pH 3.4 with casein as the substrate. The protease was stable at 35°C for 60 min and had an observed half-life of approximately 30 min at 45°C. Enzyme activity was not significantly inhibited by chelation with ethylenediamine tetraacetic acid (EDTA), and the addition of metal ions to EDTA-treated protease did not significantly change enzyme activity, indicating that proteolysis is not metal ion-dependent. The purified enzyme was completely inactivated by the aspartic protease inhibitor Pepstatin A. Conclusion Based on the observed enzyme activity, inhibition profile with Pepstatin A, and sequence similarity to other rhizopuspepsins, we have classified this enzyme as an aspartic protease.