Oncologic patient with COVID-19 discovered incidentally by PET/CT examination: (A COVID­19-pandémia orvosszakmai kérdései) / Onkológiai beteg tervezett PET/CT vizsgálata során véletlenszeruen felfedezett COVID-19-betegség

The scientific literature of coronavirus-disease 2019 (COVID-19) is rapidly expanding. There is a growing evidence on the discrepancy between clinical symptoms and radiologic findings in many patients. This case report gives details about a patient with only mild symptoms but relatively severe radiological findings. The 75-year-old patient suffering from oncologic disease had a planned a F18-fluoro-deoxy-glucose positron-emission tomography/computer tomography scan with a routine oncological indication where incidental radiomorphologic findings of pneumonia suspect for COVID-19 were detected. After immediate isolation, the patient was transferred to the corresponding medical department, where further investigations verified the diagnosis of COVID-19. With this case, our aim is to raise the awareness for the importance of the instant evaluation of chest computer tomography series when performing planned imaging examination, especially in frail patients. With this practice, potential radiomorphologic findings of pneumonia suspect for COVID-19 could be identified in time, which fundamentally determines further patient management steps. Orv Hetil. 2020; 161(23): 971-976.

The economic burden of metastatic breast cancer in Spain.

Objectives: The study aimed to estimate the burden of metastatic breast cancer (mBC) in Spain over 5 years. Methods: An incidence-based cost-of-illness model was developed in which a cohort of patients with mBC was followed from the diagnosis of metastatic disease over 5 years or death. Resource use data were collected through a physician survey conducted with 10 clinical experts in Spain. The model distinguished patients according to HER2 and hormonal receptor (HR) status, and followed the patient cohort in monthly cycles. Results: The incident cohort was estimated to be 2,923 patients with mBC, consisting of 1,575 HER2-/HR+, 520 HER2+/HR+, 324 HER2+/HR-, and 503 triple negative patients. The estimated mean survival over the 5-year time period was 2.51 years, on average, with longer survival of 3.36 years for HER2+/HR+, 2.41 years for HER2-/HR+, 2.82 years for HER2+/HR- and shortest mean survival of 1.74 years for triple negative patients. The total costs were €469,92,731 for the overall population, €190,079,787 for the HER2-/HR+, €151,045,260 for the HER2+/HR+, €80,827,171 for the HER2+/HR- and €47,540,512 for the triple negative subgroups over 5 years. Per patient total costs were €160,642 on average, €120,664 for HER2-/HR+, €290,346 for HER2+/HR+, €249,152 for HER2+/HR-and €94,572 for triple negative patients over 5 years. Conclusions: The economic burden of mBC in Spain is significant, but differs by HER2 and HR status. HER2-/HR +patients account for the highest burden due to the prevalence of this category, but HER2+/HR +patients have the highest per patient costs.

A cost-consequence analysis of parecoxib and opioids vs opioids alone for postoperative pain: Chinese perspective.

PURPOSE: The use of parecoxib plus opioids for postoperative analgesia in noncardiac surgical patients seems to be cost-saving in Europe due to a reduction in opioid use and opioid-related adverse events. Given the lack of information on postoperative analgesic use in Asia, this study assessed the economic consequences of the addition of parecoxib to opioids vs opioids alone to treat postsurgical pain in China. METHODS: A cost-consequence economic evaluation assessed direct medical costs related to opioid-related clinically meaningful events (CMEs) utilizing dosing information and reported frequency of events from a Phase III, randomized, double-blind, global clinical trial (PARA-0505-069) of parecoxib plus opioids vs opioids alone for 3 days following major orthopedic, abdominal, gynecologic, or noncardiac thoracic surgery requiring general or regional anesthesia. The cost of CMEs was calculated using information on resource utilization and unit costs provided by a panel of clinical experts in China. Sensitivity analyses were performed to test the robustness of the results. RESULTS: Patients treated with parecoxib plus opioids reported fewer CMEs (mean 0.62 vs 1.04 events per patient [P<0.0001]) compared with opioids alone for the 3-day postoperative period. This suggested a potential savings of 356 Chinese yuan (¥) per patient over the 3 days (total cost of ¥1,418 for parecoxib plus opioids vs ¥1,774 with opioid use alone). CONCLUSION: Fewer CMEs with parecoxib plus opioids suggest a reduction in medical resource utilization and reduced costs compared to opioids alone when modeling analgesic use in non-cardiac surgery patients in China.

[Model concept of the health economic evaluation of low-dose CT lung cancer screening in Hungary]. / Az alacsony dózisú CT-vel végzett tüdorákszurés magyarországi egészség-gazdaságtani elemzésének koncepcionális terve.

INTRODUCTION: Lung cancer is a rapidly progressing, often life-threatening disease that constitutes a huge societal burden. Because of the scarce resources of the Hungarian health care system, the cost-effectiveness of introducing low-dose computed tomography screening is a relevant health policy matter. AIM: The aim of this study is to design a model concept for assessing the cost-effectiveness of low-dose computed tomography lung cancer screening in Hungary, and to define the required steps for performing the analysis. METHOD: A targeted literature review was conducted to identify and synthesize the evidence on efficacy and effectiveness of screening, and results were evaluated based on adaptability to Hungarian settings. We also summarized the available Hungarian scientific evidence and reconstructed the potential patient pathways. RESULTS: In accordance with these findings, we recommend to perform the full health-economic evaluation of low-dose computed tomography lung cancer screening using a complex model structure that consists of several sub-models and is capable to follow the population at risk on life-time horizon. CONCLUSIONS: The proposed cost-effectiveness model will be suitable to provide data for further analyses that support decision-making on introducing low-dose computed tomography lung cancer screening as public health program. Orv Hetil. 2017; 158(25): 963-975.