Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model.

BACKGROUND: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients. METHODS: This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed. RESULTS: A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis). CONCLUSION: This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen.

Pancreatic neuroendocrine tumor detected by technetium-99m methoxy-2-isobutylisonitrile single photon emission computed tomography/computed tomography: A case report.

BACKGROUND: Pancreatic neuroendocrine tumors (NETs) account for about 1%-2% of pancreatic tumors and about 8% of all NETs. Computed tomography (CT), magnetic resonance imaging, and endoscopic ultrasound are common imaging modalities for the diagnosis of pancreatic NETs. Furthermore, somatostatin receptor imaging is of great value for diagnosing pancreatic NETs. Herein, we report the efficacy of technetium-99m methoxy-2-isobutylisonitrile (99mTc-MIBI) single photon emission CT (SPECT)/CT for detecting pancreatic NETs. CASE SUMMARY: A 57-year-old woman presented to our hospital with a 1-d history of persistent upper abdominal distending pain. The distending pain in the upper abdomen was aggravated after eating, with nausea and retching. Routine blood test results showed a high neutrophil percentage, low leukomonocyte and monocyte percentages, and low leukomonocyte and eosinophil counts. Amylase, liver and kidney function, and tumor markers alpha-fetoprotein, carcinoembryonic antigen, and cancer antigen (CA) 125, CA72-4, CA19-9, and CA153 were normal. Abdominal CT showed a mass, with multiple calcifications between the pancreas and the spleen. The boundary between the mass and the pancreas and spleen was poorly defined. Contrast-enhanced CT revealed that the upper abdominal mass was unevenly and gradually enhanced. 99mTc-MIBI SPECT/CT revealed that a focal radioactive concentration, with mild radioactive concentration extending into the upper abdominal mass, was present at the pancreatic body and tail. The 99mTc-MIBI SPECT/CT manifestations were consistent with the final pathological diagnosis of pancreatic NET. CONCLUSION: 99mTc-MIBI SPECT/CT appears to be a valuable tool for detecting pancreatic NETs.

[Acupoint catgut embedding improves gastric mucosal injury by down-regulating expression of HIF-1α and VEGF in chronic atrophic gastritis rats].

OBJECTIVE: To observe the effect of acupoint catgut embedding on histopathological changes of gastric mucosa and expression of mucosal hypoxia inducible factor (HIF)-1α and vascular endothelial growth factor (VEGF) proteins in chronic atrophic gastritis (CAG) rats, so as to explore its mechanisms underlying improvement of CAG. METHODS: Male SD rats were divided into blank group (n=10) and model group (n=9) and catgut embedment group (n=10). The CAG model was established by free drinking of N-methyl-N'-nitro-N-nitroso-guanidine solution (100 µg/mL) and irregular diet. Catgut embedment was applied to "Zhongwan" (CV12) and bilateral "Zusanli" (ST36) and "Pishu" (BL20), once every 10 days, 6 times in total. Histopathological changes of gastric mucosal tissue were observed under microscope after H.E. staining. The expression of HIF-1α and VEGF proteins in the antrum of stomach was detected by Western blot. RESULTS: H.E. staining showed that compared with the blank group, the number of rats with glandular necrosis, atrophy and mucosal stasis in the model group were increased significantly (P<0.001, P<0.05).Compared with the model group, the number of rats with gland necrosis, atrophy and mucosal stasis in the catgut embedment group were significantly reduced (P<0.01, P<0.05). Western blot displayed that the expression levels of HIF-1α and VEGF proteins were significantly higher in rats with blood stasis and model group than in those without blood stasis and the blank group (P<0.01), and were considerably down-regulated in the catgut embedment group than in the model group (P<0.05, P<0.01). CONCLUSION: Acupoint catgut embedment can improve the injury of gastric mucosa in CAG rats, which may be associated with its function in down-regulating the expression of HIF-1α and VEGF proteins in the gastric mucosa.

[Impact of Catgut Embedding Intervention on JAK 2-STAT 3 Signaling in Gastric Mucosa of Chronic Atrophic Gastritis Rats].

OBJECTIVE: To observe the impact of catgut embedding on histopathological changes and expression of phosphorylated-Janus kinase-2 (p-JAK 2), phosphorylated-signal transducer and activator of transcription 3 (p-STAT 3), Cyclin D 1, Bcl-2, and suppressor of cytokine signaling (SOCS) of the gastric mucosa in chronic atrophic gastritis (CAG) rats, so as to explore its mechanisms underlying improving CAG. METHODS: Forty-one SD rats were randomly divided into normal (n＝12), model (n＝9), natural recovery (n＝10) and catgut embedding (n＝10) groups. The CAG model was established by free drinking of N-methyl-N'-nitro-N-nitroso-guanidine (MNNG) solution (100µg/mL) and irregular diet for 24 weeks. Catgut embedding was applied at bilateral "Zusanli" (ST 36), "Pishu" (BL 20) and "Zhongwan" (CV 12), once every 10 days, 6 times altogether. The histopathological changes of the gastric mucosa were observed by naked eye and light microscope after H．E. staining. Wes-tern blot was used to detect the expression of p-JAK 2, p-STAT 3, CyclinD 1, Bcl-2 and SOCS 3 proteins in the gastric antrum tissue. RESULTS: After modeling, the regional gastric tissue showed pale thinner gastric wall, and poorer elasticity with fewer plica, congestion of blood vessels, reduction of regional glands with necrosis and disordered arrangement as well as evident hyperplasia of the connective tissue, which was evidently milder in the catgut embedding group. Compared with the normal group, the expression levels of p-JAK 2, p-STAT 3, CyclinD 1, Bcl-2, SOCS 3 proteins were significantly up-regulated in both model group and natural recovery group (P<0.01), without significant differences between the latter two groups (P>0.05). After catgut embedding intervention, the expression levels of p-JAK 2, p-STAT 3, Cyclin D 1, Bcl-2 proteins were considerably down-regulated (P<0.01), and that of SOCS 3 protein was notably further increased relevant to the natural recovery group (P<0.01)．. CONCLUSION: Catgut embedding may improve pathological changes of gastric mucosa in CAG rats, which possibly associated with its effects in up-regulating gastric SOCS 3 protein expression and in inhibiting the activation of JAK 2-STAT 3 signaling pathway to reduce the expression of CyclinD 1 and Bcl-2 proteins.