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Fulltext The Typical Damage Form and Mechanism of a Railway Prestressed Concrete Sleeper

You R, Wang J, Ning N, Wang M, Zhang J

Materials (Basel), 2022 Nov 15;15(22).
PMID: 36431559 DOI: 10.3390/ma15228074

Prestressed concrete sleepers are an important track component that is widely used in railway ballast track. Prestressed concrete sleepers have high strength, strong stability, and good durability; thus, their operation and use in railways are beneficial. However, in different countries and regions, certain damage to sleepers typically appears. Existing research on concrete sleepers focuses primarily on the structural design method, the application of new materials, theoretical analysis, and bearing strength test research, while ignoring sleeper damage. There are a few sleeper damage studies, but they look at only one type of damage; thus, there is no comprehensive study of prestressed concrete sleeper damage. The damage forms of prestressed concrete sleeper damage are thus summarized in this study, and the theory of the causes of prestressed concrete sleepers is analyzed based on the limit state method for the first time. The findings indicate that sleeper structure design is the primary cause of its operation and use status, and that special measures should be considered based on sleeper use conditions. In addition to meeting design requirements, materials, curing systems, product inspection, and other factors must be considered during manufacturing to improve the sleepers' long-term performance. Keeping the track in good condition, including but not limited to the state of fasteners, ballast bed, and track geometry is also an important aspect of preventing sleeper damage. The outcomes of this study provide better insights into the influences of damage to railway prestressed concrete sleepers and can be used to improve track maintenance and inspection criteria.
Fulltext Cost-Effectiveness Analysis Of EGFR Mutation Testing And Afatinib Versus Gemcitabine-Cisplatin As First-Line Therapy For Advanced Non-Small-Cell Lung Cancer In China

You R, Liu J, Wu DB, Qian X, Lyu B, Zhang Y, et al.

Cancer Manag Res, 2019;11:10239-10248.
PMID: 31824194 DOI: 10.2147/CMAR.S219722

Objective: The purpose of this study was to evaluate the cost-effectiveness of the combined use of afatinib and epidermal growth factor receptor (EGFR) testing versus gemcitabine-cisplatin as the first-line treatment for patients with non-small cell lung cancer (NSCLC) in China.
Methods: A decision-analytic model, based on clinical phase III trials, was developed to simulate patient transitions. Direct costs were estimated from the perspective of the Chinese healthcare system. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were calculated over a 5-year lifetime horizon. Model robustness was conducted in sensitivity analyses.
Results: For the base case, EGFR mutation testing followed by afatinib treatment for advanced NSCLC increased 0.15 QALYs compared with standard chemotherapy at an additional cost of $5069.12. The ICER for afatinib maintenance was $33,416.39 per QALY gained. The utility of PFS and the cost of afatinib had the most important impact on the ICER. Scenario analyses suggested that when a patient assistance program (PAP) was available, ICER decreased to $22,972.52/QALY lower than the willingness-to-pay (WTP) threshold of China ($26,508/QALY).
Conclusion: Our results suggest that gene-guided maintenance therapy with afatinib with the PAP might be a cost-effective treatment option compared with gemcitabine - cisplatin in China.
Fulltext Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China

You R, Zhang Y, Wu DB, Liu J, Qian X, Luo N, et al.

Front Pharmacol, 2020;11:456.
PMID: 32425768 DOI: 10.3389/fphar.2020.00456

Objective: This study aims to estimate the cost-effectiveness of yearly intravenous zoledronic acid treatment versus weekly oral alendronate for postmenopausal osteoporotic women in China.
Methods: We used a Markov microsimulation model to compare the cost-effectiveness of zoledronic acid with alendronate in Chinese postmenopausal osteoporotic women with no fracture history at various ages of therapy initiation from health care payer perspective.
Results: The incremental cost-effectiveness ratios (ICERs) for the zoledronic acid versus alendronate were $23,581/QALY at age 65 years, $17,367/QALY at age 70 years, $14,714/QALY at age 75 years, and $12,169/QALY at age 80 years, respectively. In deterministic sensitivity analyses, the study demonstrated that the two most impactful parameters were the annual cost of zoledronic acid and the relative risk of hip fracture with zoledronic acid. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective compared with alendronate were 70-100% at a willingness-to-pay of $29,340 per QALY.
Conclusions: Among postmenopausal osteoporotic women in China, zoledronic acid therapy is cost-effective at all ages examined from health care payer perspective, compared with weekly oral alendronate. In addition, alendronate treatment is shown to be dominant for patients at ages 65 and 70 with full persistence. This study will help clinicians and policymakers make better decisions about the relative economic value of osteoporosis treatments in China.
Fulltext Cost-Effectiveness of Testing for NS5A Resistance to Optimize Treatment of Elbasvir/Grazoprevir for Chronic Hepatitis C in China

Liu J, Zhang Y, Wu B, Wang S, Bin-Chia Wu D, You R

Front Pharmacol, 2021;12:717504.
PMID: 34721016 DOI: 10.3389/fphar.2021.717504

Objectives: Baseline presence of nonstructural protein 5A (NS5A) resistance-associated variants can attenuate the efficacy of new direct-acting antivirals. A potential method to attain the higher efficacy would be to screen for NS5A polymorphisms prior to the initiation of therapy and to adjust the treatment length based on the test results. However, baseline testing adds additional costs and it is unclear whether this would represent a high value strategy for chronic hepatitis C in China. Methods: A hybrid model compared 1) standard 12-weeks treatment (no testing), 2) shortened 8-weeks treatment (no testing), and 3) baseline testing with 12-/8-weeks treatment for those with/without NS5A polymorphisms from a lifetime Chinese health care payer perspective. All model inputs were retrieved from clinical trials and publically available literature. And sensitivity analyses were also conducted to assess the impact of uncertainty. Results: Baseline testing was associated with overall increase in total health care cost of USD 13.50 and in QALYs of 0.002 compared with standard 12-weeks treatment (no testing), yielded in an ICER of USD 6750/QALY gained. Scenario analyses suggested that shortened 8-weeks treatment (no testing) was found to be lower costs and great QALYs compared with other two strategies when the sustained virologic response (SVR) rate increased to 95%. Sensitivity analyses indicated that the results were robust. Conclusions: Our results suggest prior assessment of NS5A sensitivity followed by optimizing treatment duration was an economic strategy. In addition, shortened 8-weeks treatment (no testing) was shown to be dominant with the SVR rate increased to 95%.