ABSTRACT
This study aimed to estimate the cost-effectiveness of pregabalin treatment for neuropathic pain.<br>Design:Long-term simulations based on state transition models.<br>Methods:We examined the cost-effectiveness of pregabalin for treatment of three common peripheral neuropathic pains, postherpetic neuralgia(PHN), painful diabetic peripheral neuropathy(DPN), and radiculopathy, using the incremental cost-effectiveness ratio(ICER). We used quality-adjusted life years(QALYs)as an index of effectiveness, and also estimated medical costs. For PHN and DPN, we constructed state transition models comprising two states, with and without pregabalin treatment, and performed 52-week simulations. The pain scores reported in Japanese phaseIII studies were used to set patients' weekly pain scores. The results of utility surveys conducted overseas were used as utility scores, while values randomly sampled from probability distributions were used to set weekly pain scores and drop-out rates. In base-case analyses, we performed 1000 1st-order Monte Carlo simulations using 1000 values randomly sampled from probability distributions, and calculated QALYs and medical costs for 52 weeks for each group. For radiculopathy, the ICER was calculated from changes in QALYs for 12 weeks reported overseas and medical costs estimated separately for the identical period.<br>Results:The ICERs for PHN, DPN, and radiculopathy were 1,116,886 Yen/QALY, 1,100,420 Yen/QALY, and 1,095,943 Yen/QALY, respectively, which were well below the upper limits of ICER ranges for treatments considered cost-effective. There were no cases in which ICERs obtained from scenario and sensitivity analyses differed significantly.<br>Conclusion:Pregabalin was shown to be cost-effective treatment for neuropathic pain.
ABSTRACT
PURPOSE: Fatty acid synthase (FAS) is a key enzyme in the de novo biosynthesis of fatty acids. Carcinoma cells are dependent on endogenous fatty acid synthesis for growth in vitro. In a subset of human cancers, elevated FAS is associated with poor prognosis; however, the expression of FAS and the relationship between FAS and prognosis in soft tissue sarcomas (STSs) have not been studied. The objective of this study is to examine the expression of FAS in STSs and determine its relationship to clinicopathological features and prognosis. EXPERIMENTAL DESIGN: Sixty-four cases of STS were examined. The clinicopathological features and immunohistochemical expression of FAS and Ki-67 antigen were studied. Survival analysis was performed using the log-rank test and the Cox multivariate regression model. RESULTS: FAS expression was observed in 20 of 64 cases (31.3%) of STS. FAS-positive sarcomas were found in 13 of 23 malignant fibrous histiocytomas, 3 of 17 liposarcomas, 3 of 7 malignant peripheral nerve sheath tumors, and 1 extraskeletal mesenchymal chondrosarcoma. No expression of FAS was seen in the synovial sarcomas, leiomyosarcomas, or rhabdomyosarcomas that were examined. Clinicopathologically, FAS-positive tumors were significantly deep-seated (P = 0.02) and large in size (P = 0.03). FAS expression correlated with decreased disease-free survival (P = 0.006) and decreased overall survival (P = 0.003). In a multivariate analysis, expression of FAS was able to predict decreased disease-free survival but did not reach the level of significance for overall survival. CONCLUSIONS: FAS expression is one of the predictive indicators for disease prognosis in STS.
