Background: Malignant pleural mesothelioma (MPM) is a rare tumor. The approved systemic treatment of MPM is limited to chemotherapy. The purpose of this study was to evaluate the economic efficacy of an NIV plus IPI regimen for the treatment of MPM in China. Methods: The data estimated were from a multicenter randomized phase III trial that showed an improved survival benefit in patients with MPM treated with a NIV+IPI combination regimen. A partitioned survival model was constructed to estimate the incremental cost–benefit ratio (ICER) from the perspective of Chinese society. The uncertainty in the model is solved by one-way certainty and probabilistic sensitivity analysis. Results: Our base case analysis showed that the total costs of treatment increased from $28,833.84 to $236,590.48 with the NIV+IPI combination regimen versus platinum plus pemetrexed chemotherapy. Treatment with NIV+IPI combination therapy was associated with an increase in effectiveness of 0.08 QALYs from 1.08 QALYs to 1.16 QALYs. The incremental cost-effectiveness ratio was $2,596,958.00/QALY, with a 0% probability of being cost-effective at a WTP threshold of $36,203.87/QALY. Cost changes associated with grade 3-4 AE management, tests used, or hospitalization costs had little effect on the ICER values predicted by sensitivity analysis. Conclusions: Taken together, the results of this study suggest that the combination of NIV plus IPI is not a cost-effective option from the perspective of Chinese payers as a first-line treatment option for MPM patients in China. Appropriate drug donation programs and social assistance are necessary.

AIM: Proton pump inhibitors (PPIs) were widely used around the world. Studies suggested conflicting results between PPIs treatment and the risk of dementia. This study examined the association between PPIs and dementia risk by mining the US FDA Adverse Event Reporting System (FAERS) database. METHODS: We identified six PPI agents and adverse reports of dementia based on FAERS database from 2004 to 2019. We employed reporting odds ratio (ROR) and proportional reporting ratio (PRR) to detect the signals of dementia relevant to PPIs. We also analyzed characteristics of PPI reports, compared dementia events between short- and long- duration PPIs treatment. RESULTS: We identified 2104 dementia cases with PPIs treatment. We did not detect significant signals between PPIs and dementia, ROR = 0.99, 95%CI 0.94 - 1.03, PRR = 0.99, 95%CI 0.95 - 1.03, even in gastroesophageal reflux disease cases ROR = 0.65, 95%CI 0.58 - 0.73, PRR = 0.67, 95%CI 0.60 - 0.74. No significant differences of dementia events were detected between short- and long- duration groups, the OR (95%CI) of the 6 months, 1 year, 3 years and 5 years comparison were 0.85 (0.68 - 1.06), 0.92 (0.71 - 1.18), 0.81 (0.57 - 1.15) and 0.79 (0.52 - 1.22), respectively. CONCLUSIONS: Based on the current FAERS data mining, we discovered no association between PPIs use and the risk of dementia.

Objectives: Multimorbidity and polypharmacy in older adults always increase the prevalence of potentially inappropriate medications (PIMs) and affect the quality of life of the older adults. The purposes of this study were aimed to investigate the prevalence of PIMs prescription and the most frequent PIMs among outpatients according to Beers criteria and to explore related risk factors for PIMs prescription. Methods: The cross-sectional retrospective study was conducted among elderly outpatients in Chengdu (a city in China) from January 2018 to December 2018. The 2015 Beers criteria was used to assess PIMs in elderly outpatients. Univariate analysis and multivariate logistic regression analysis were adopted to determine the factors that may affect the prevalence of PIMs in elderly outpatients. Results: A total of 15523 patient prescriptions were enrolled, of which 4654 (29.98%) were identified with at least one PIM based on Beers criteria, and 6460 PIMs were detected. Of these PIM prescriptions, 76.32% were detected to receive 1 PIM, 16.54% were detected to receive 2 PIMs, and only 7.13% were found to have at least 3 PIMs. Benzodiazepines (2371, 50.95%), diuretics (1197, 25.72%), and selective serotonin reuptake inhibitors (439, 9.43%) were three common types of drugs that were the most frequent PIMs used. Sex, age, number of diseases, number of medications, and diseases or disease states were risk factors for PIMs in outpatients. Conclusion: The results of the study showed that the phenomenon of PIM was common among elderly outpatients in Chengdu. Risk factors for PIM in elderly outpatients include gender, age, number of diseases, number of medications, and sleep disorder.