Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China: a CR-HepB-based real-world study / 中华肝脏病杂志

Objective: To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.

Análisis retrospectivo de pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina / Retrospective analysis of patients with locally advanced or metastatic gastric cancer in Argentina

OBJETIVO Describir las características clínicas, los patrones de tratamiento y los costos asociados en pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina, en los sectores público y privado. MÉTODOS Una cohorte histórica de pacientes que recibieron tratamiento de quimioterapia de primera línea (análogo de platino y/o una fluoropirimidina) y fueron seguidos durante al menos tres meses después de la última administración de un agente citotóxico de primera línea fueron elegibles. Se extrajeron los datos a través de un cuestionario estructurado a partir de los registros médicos de cuatro hospitales argentinos. Las estimaciones de los costos de tratamiento también se calcularon utilizando los costos unitarios de los hospitales participantes. RESULTADOS Entre los 101 pacientes, más de tres cuartas partes (79,2%) eran hombres, 41,6% fueron diagnosticados con enfermedad metastásica en estadio IV, la edad media fue de 57,7 años y el 27,7% tenían antecedentes de tabaquismo. Antes del diagnóstico de cáncer gástrico metastásico, el 42,4% de los pacientes habían recibido gastrectomía total. El 97% de los pacientes recibió una terapia doble o triplete, de los cuales el tratamiento más frecuente fue la epirubicina en combinación con oxaliplatino y capecitabina (38%), seguida de capecitabina + oxaliplatino (29%). Alrededor del 36% de los pacientes respondieron al tratamiento de primera línea (respuesta completa y parcial). Del 76,2% de los pacientes que siguieron un tratamiento de segunda línea, al 37,7% todavía se les administró un análogo de platino y/o fluoropirimidina. Durante el período de seguimiento, el 50% de los pacientes progresó y el 32,8% tenía enfermedad estable. La terapia de apoyo consistió principalmente en visitas ambulatorias después de la última línea de quimioterapia (16,8%), radioterapia paliativa (16,8%) y cirugía (30,7%). Se observaron diferencias significativas entre los costos de los hospitales públicos y privado. CONCLUSIONES Comprender los patrones de tratamiento en pacientes con cáncer gástrico localmente avanzado o metastásico puede ayudar a abordar las necesidades médicas no satisfechas para un mejor manejo del paciente y la mejora de sus resultados clínicos en Argentina.

AIM To assess patient and disease characteristics, treatment patterns and associated costs in patients with locally advanced or metastatic gastric cancer in Argentina, in the public and private sectors. METHODS A historic cohort of patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed-up for at least three months after the last administration of a first-line cytotoxic agent were eligible. Case-report forms were prepared based on medical records from four Argentinian hospitals. Estimates of treatment costs were also calculated using the unit costs of the participating hospitals. RESULTS Of 101 patients, more than three quarters (79.2%) were male, 41.6% were diagnosed with metastatic stage IV disease (mean age, 57.7years), and 27.7 % had a smoking history. Before locally advanced or metastatic gastric cancer diagnosis, 42.4% of the patients had received total gastrectomy. Ninety-seven percent of the patients received a doublet or triplet therapy, of which epirubicin in combination with oxaliplatin and capecitabine was the most common treatment (38%), followed by capecitabine plus oxaliplatin (29%). Around 36% of the patients responded to first-line treatment (complete and partial response). Out of the 76.2% of the patients who followed a second-line treatment, 37.7% were still administered a platinum analog and/or fluoropyrimidine. During the reported follow-up period, 50% of the patients progressed, and 32.8% had stable disease. The best supportive care consisted mostly of outpatient visits after last-line therapy (16.8%), palliative radiotherapy (16.8%), and surgery (30.7%). We observed significant differences between public and private hospital costs. CONCLUSIONS Understanding treatment patterns in patients with locally advanced or metastatic gastric cancer may help address unmet medical needs for better patient management and improvement of their clinical outcome in Argentina.

Real-World Treatment Patterns among Patients with Advanced Gastric Cancer in South Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to understand patient treatment patterns, outcomes, and healthcare resource use in cases of metastatic and/or locally recurrent, unresectable gastric cancer (MGC) in South Korea. MATERIALS AND METHODS: Thirty physicians reviewed charts of eligible patients to collect de-identified data. Patients must have received platinum/fluoropyrimidine first-line therapy followed by second-line therapy or best supportive care, had no other primary cancer, and not participated in a clinical trial following MGC diagnosis. Data were summarized using descriptive statistics. Kaplan-Meier analysis was used to describe survival. RESULTS: Of 198 patients, 73.7% were male, 78.3% were diagnosed with MGC after age 55 (mean, 61.3 years), and 47.0% were current or former smokers. The majority of tumorswere located in the antrum/pylorus (51.5%). Metastatic sites most often occurred in the peritoneum (53.5%), lymph nodes (47.5%), and liver (38.9%). At diagnosis, the mean Charlson comorbidity indexwas 0.4 (standard deviation, 0.6). The most common comorbidities were chronic gastritis (22.7%) and cardiovascular disease (18.7%). Most patients (80.3%) received second-line treatment. Single-agent fluoropyrimidine was reported for 22.0% of patients, while 19.5% were treated with irinotecan and a fluoropyrimidine or platinum agent. The most common physician-reported symptoms during second-line treatment were nausea/vomiting (44.7%) and pain (11.3%), with antiemetics (44.7%), analgesics (36.5%), and nutritional support (11.3%) most often used as supportive care. Two-thirds of inpatient hospitalizations were for chemotherapy infusion. Outpatient hospitalization (31.6%) and visits to the oncologist (58.8%) were common among second-line patients. CONCLUSION: Most patients received second-line treatment, although regimens varied. Understanding MGC patient characteristics and treatment patterns in South Korea will help address unmet needs.

Custos e padrões de tratamento de pacientes com câncer de pulmão nãopequenas células (CPNPC) avançado no sistema suplementar de saúde / Costs and treatment patterns in patients with advanced non-small cell lung cancer in the private health system

Introdução: No Brasil, o câncer representa a segunda maior causa de morte, estando apenas atrás das doenças cardiovasculares e representando um grande impacto econômico observado pelo aumento no número de quimioterapias realizadas no país. Entre as neoplasias, o câncer de pulmão é o mais comum em todo o mundo e, de acordo com dados do INCA, em 2013 foi o câncer com o maior número de mortes. Objetivo: Estimar os custos médicos diretos do tratamento dos pacientes diagnosticados com câncer de pulmão não-pequenas células (CPNPC) no sistema de saúde suplementar. Método: Foi realizada uma análise retrospectiva em uma base de dados do sistema de saúde privado brasileiro entre o período de 2012 a 2015. Para o custeio de cada esquema terapêutico analisado foi utilizado o método de microcusteio em que os custos foram obtidos a partir da Classificação Brasileira Hierarquizada de Procedimentos Médicos, revista SIMPRO e lista CMED. Resultados: Foi demonstrado que 88% dos pacientes com câncer de pulmão são diagnosticados tardiamente (IIIB/IV) e possuem idade média de 65 anos, e apenas 10,15% dos pacientes apresentaram resultados positivos para os testes genéticos de EGFR e ALK. Não foram observadas alterações na escolha terapêutica no período analisado e o custo de tratamento pode atingir R$ 410.848,34 no tratamento do paciente com CPNPC avançado. Conclusão: A análise demonstrou a necessidade crescente por terapias que promovam o aumento de sobrevida nos pacientes de CPNPC e que possam contribuir para otimizar os recursos utilizados.

Introduction: In Brazil, the cancer represents the second cause of death, being only behind of cardiovascular diseases and representing a great economic impact, which is observed by the raise of chemotherapies performed in the country. Among neoplasm, lung cancer is the most common cancer around the world and in accordance with INCA data, in 2013, it was the cancer with the largest number of deaths. Objective: Estimate the direct medical costs of patients diagnosed with non-small cell lung cancer (NSCLC) in the private healthcare system. Methods: It was performed a retrospective analysis of diagnosed patients' data who were treated for advanced NSCLC during the period of 2012 to 2015 in the Brazilian private healthcare system. For the cost of each treatment regimen, it was used the micro-costing method in which the costs were obtained from Hierarchical Brazilian Classification of Medical Procedures, SIMPRO magazine, and CMED list. Results: The analysis demonstrated that 88% of patients with lung cancer are diagnosed late (IIIB/ IV) with the median age of 65 years and only 10,15% of patients had positive results for EGFR and ALK genetic tests. There were no observed changes in the therapeutic choice during the period analyzed and the cost of treatment can achieve R$ 410.848,34 for the treatment of advanced NSCLC. Conclusion: The analysis demonstrated the increasing need of therapies that promote increasing survival in NSCLC patients and can contribute to optimize the resource use.

Treatment Patterns, Costs, and Survival among Medicare-Enrolled Elderly Patients Diagnosed with Advanced Stage Gastric Cancer: Analysis of a Linked Population-Based Cancer Registry and Administrative Claims Database

PURPOSE: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. MATERIALS AND METHODS: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) > or =65 years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemo-therapy agent. RESULTS: In total, 2,583 patients met the inclusion criteria. The mean age at index was 74.8+/-6.0 years. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) 70,808+/-56,620. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). CONCLUSIONS: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

Estudio MULATA: muestra latinoamericana de pacientes con tensión arterial elevada / MULATA study: Latin American sample of high blood pressure patients

Introducción: Por prevalencia y trascendencia como factor de riesgo para enfermedad cardiovascular, la hipertensión arterial es una de las enfermedades de mayor importancia en la práctica médica. Este trabajo describe las características clínicas y sociodemográficas de una muestra de pacientes hipertensos con al menos un factor de riesgo cardiovascular adicional, en Argentina, Colombia y Venezuela. Metodología: Es un estudio de corte transversal, con recolección prospectiva de la información en una muestra por conveniencia de pacientes con hipertensión arterial que consultaron a los médicos participantes en cada uno de los tres países. Resultados: Se detectaron diferencias estadísticamente significativas en la distribución de los factores de riesgo cardiovascular (obesidad central, hipertensión arterial no controlada, tabaquismo y dislipidemia) entre las poblaciones de Colombia, Venezuela y Argentina. La población participante estuvo compuesta en su mayoría por mujeres (53,7%), la edad promedio fue de 59,3 +/- DE 13,6 años; 29% de los participantes en el estudio tenían cifras tensionales controladas en el momento de la evaluación. El manejo con dos medicamentos fue el más frecuente en la población total (40,6%) así como en los subgrupos, argentino (47,1%) y colombiano (46,4%), mientras que en la población venezolana el manejo más común fue monoterapia (45%). Los bloqueadores del sistema renina angiotensina II fueron los más utilizados en los tres países. Discusión: Los factores de riesgo cardiovascular susceptibles de ser modificados tienen diferencias geográficas que justifican cambios en su manejo. La hipertensión requiere no solamente manejo farmacológico, sino la intervención sobre estos factores.

Introduction: Due to its high prevalence and its importance as a risk factor for stroke, heart disease, and renal failure, hypertension is one of the most important diseases in common medical practice. The aim of this study was to describe the clinical and demographic characteristics of a sample of hypertensive patients, with at least one additional cardiovascular risk factor, in Argentina, Colombia and Venezuela. Methods: We performed a cross sectional study, with prospective data collection from a convenience sample of patients. Results: we found statistically significant differences in the distribution of cardiovascular risk factors (obesity, non-controlled hypertension, smoking and dyslipidemia) in the population of the different countries. There were slightly more women in our sample (53.7%), the average age was 59.3 (SD 13.6) years. In 29% of the patients hypertension was controlled. The most common practice in the whole sample was the use of two different drugs (40.6%). This was true both in Colombia (46.4%) and in Argentina (47.1%), while in Venezuela the use of monotherapy was more common (45%). Angiotensin II receptor antagonists are the most commonly used drug family in the three countries, either alone or in combination with other therapies. Discussion: Our population shows a poor control of blood pressure. Our patients need a more strict pharmacological therapy together with a strategy to identify and reduce all modifiable cardiovascular risk factors.