Henry W.C. Leung

Multivitamin Supplement Use and Risk of Breast Cancer: A Meta-Analysis

Background The association between consumption of multivitamins and breast cancer is inconsistent in epidemiologic studies. Objective: To perform a meta-analysis of cohort and case-control studies to evaluate multivitamin intake and its relationship with breast cancer risk. Methods: The published literature was systematically searched and reviewed using MEDLINE (1950 through July 2010), EMBASE (1980 through July 2010). and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010 issue 1). Studies that included specific risk estimates were pooled using a random-effects model. The bias and quality of these studies were assessed with REVMAN statistical software (version 5.0) and the GRADE method of the Cochrane Collaboration. Results: Eight of 27 studies that included 355,080 subjects were available for analysis. The total duration of multivitamin use in these trials ranged from 3 to 10 years. The frequency of current use in these studies ranged from 2 to 6 times/week. In analyses by duration of use 10 years or longer or 3 years or longer and by frequency 7 or more times/week that were reported in these studies, multivitamin use was not significantly associated with the risk of breast cancer. Only 1 recent Swedish cohort study concluded that multivitamin use is associated with an increased risk of breast cancer. The results of a meta-analysis that pooled data from 5 cohort studies and 3 case-control studies indicated that the overall multivariable relative risk and odds ratio were 0.10 (95% CI 0.60 to 1.63; p = 0.98) and 1.00 (95% CI 0.51 to 1.00; p = 1.00), respectively. The association was not statistically significant. Conclusions: Multivitamin use is likely not associated with a significant increased or decreased risk of breast cancer, but these results highlight the need for more case-control studies or randomized controlled clinical trials to further examine this relationship.

Risk of Hemorrhage Associated with Co-Prescriptions for Ginkgo biloba and Antiplatelet or Anticoagulant Drugs

OBJECTIVES The aim of this study was to explore the risk of hemorrhage associated with co-prescriptions for Ginkgo biloba extract (GBE) and antiplatelet or anticoagulant agents, and evaluate the trends of co-prescriptions. METHODS A retrospective population based study was performed by using claim data of the Taiwan National Health Insurance Research Database from 2000 to 2008. Prescriptions for GBE alone and in combination with antiplatelet/anticoagulant drugs were retrieved and the odds ratio for co-prescriptions after the first prescription of GBE was explored. RESULTS The total number of prescriptions for GBE alone or in combination with antiplatelet or anticoagulant agents increased gradually from 1547 (0.08%) and 3575 (0.19%) in 2000 to 4676 (0.23%) and 15,297 (0.79%) in 2008, respectively. GBE was mostly prescribed to patients aged 60 years or older. The adjusted odds ratio for co-prescriptions associated with the risk of hemorrhage is 1.5 (95% confidence interval, 0.5-5.0). The risk of hemorrhage was associated with patients aged ≥65 and male patients, who were prescribed GBE alone (adjusted odds ratio: 3.8 and 1.4; 95% confidence interval, 2.8-5.2 and 1.1-1.9). CONCLUSIONS Although the combination of G. biloba extract with antiplatelet or anticoagulants showed insignificant correlation to the risk of hemorrhage, patients using ginkgo, particularly those with known bleeding risks and elderly, should take a particular attention to the possibility of increasing risk of bleeding.

Cost of Depression of Adults in Taiwan

Objective: To estimate the direct cost of depression in Taiwanese adults for the years 2000–2002. Methods: The medical claims database of the National Health Bureau was analyzed and the cost of treating adults (>15 years of age) with the diagnosis of depression was calculated. Results: The total direct medical costs of adult depression in the three years 2000, 2001, and 2002 were approximately US

Multikinase Inhibitors in Metastatic Renal Cell Carcinoma: Indirect Comparison Meta-Analysis

93 million, US

Reliability of 95% confidence interval revealed by expected quality-of-life scores: an example of nasopharyngeal carcinoma patients after radiotherapy using EORTC QLQ-C 30

117 million, and US

Cost effectiveness of cetuximab concurrent with radiotherapy for patients with locally advanced head and neck cancer in Taiwan: a decision-tree analysis.

140million, respectively. Conclusion: The cost of depression increased continuously over the period from 2000–2002. However, the percentage of patients receiving treatment did not increase steadily over the same time period with treatment rates of 1.5% in 2000, 2.3% in 2001, and 2.0% in 2002. The recent annual prevalence of depression in Taiwan has been estimated at 4–5%. Thus, the Taiwanese health authority spends an annual average of US

Cost-utility of stereotactic radiation therapy versus proton beam therapy for inoperable advanced hepatocellular carcinoma

116.6 million to treat depression (1.2% of total national expenses). In sum, the treatment of depression, while costly, deserves greater attention by public health officials in order to avoid the already significant burden of this disease on both patients and society. Future research will therefore require more accurate statistical data in order to assess the effects of depression-related burdens on individuals and society, especially with respect to the capacity to work.

Using statistical process control chart techniques to ensure quality of care in pharmacy department of a hospital

BACKGROUND Randomized controlled trials (RCTs) of multikinase inhibitors sunitinib, sorafenib, and pazopanib have reported efficacy compared with results from placebo and interferon-α (INF-α). To date, these drugs have not been compared in head-to-head trials. OBJECTIVE To review systematically the evidence of clinical effectiveness of multikinase inhibitors in the treatment of metastatic renal cell carcinoma (mRCC) and, via an indirect meta-analysis, to determine an optimal treatment among these agents. METHODS A systematic literature search of MEDLINE, EMBASE, CANCERLIT, and Cochrane controlled trials register databases was performed. All RCTs of multikinase inhibitors (sorafenib, sunitinib, and pazopanib) used to treat mRCC were included. The study selection, data extraction, and quality assessment were performed independently by 2 reviewers, with all disagreements being resolved by consensus. The effects of multikinase inhibitors on progression-free survival (PFS) were compared using an indirect treatment comparison method with INF-α or placebo as a comparator. RESULTS Four studies were included. Two studies examined sunitinib or sorafenib versus IFN-α, and the other 2 studies investigated sorafenib or pazopanib versus placebo. Compared with placebo, 2 interventions reported improvement for PFS (sorafenib: hazard ratio [HR] = 0.44, P = 0.01; pazopanib: HR = 0.46, P = 0.0001), whereas only sunitinib improved PFS over IFN-α (HR = 0.539, P = 0.001). An indirect comparison suggests that sunitinib is likely to demonstrate greater clinical benefit than sorafenib in terms of PFS (HR = 0.47; 95% CI, 0.316-0.713; P < 0.001), using IFN-α as the comparator. Sorafenib was not statistically different from pazopanib using placebo as the comparator in the indirect comparison (HR = 0.957; 95% CI, 0.657-1.39; P = 0.24). CONCLUSION Some multikinase inhibitors have a favorably reported PFS for patients with mRCC compared with results using IFN-α or placebo. Our findings suggest that sunitinib might offer some clinical benefit over sorafenib in terms of PFS. No statistical difference was found between sorafenib and pazopanib treatments. However, these conclusions are based on 2 indirect comparisons of single RCTs. More RCTs are required to confirm these findings and investigate the clinical effectiveness of multikinase inhibitors in the treatment of mRCC.

Incorporation of a gentamicin dosage calculator into a computerized prescriber-order-entry system.

BackgroundMany researchers use observed questionnaire scores to evaluate score reliability and to make conclusions and inferences regarding quality-of-life outcomes. The amount of false alarms from medical diagnoses that would be avoided if observed scores were substituted with expected scores is interesting, and understanding these differences is important for the care of cancer patients. Using expected scores to estimate the reliability of 95% confidence intervals (CIs) is rarely reported in published papers. We investigated the reliability of patient responses to a quality-of-life questionnaire and made recommendations for future studies of the quality of life of patients.MethodsA total of 115 patients completed the EORTC core questionnaire QLQ-C30 (version 3) after radiotherapy. The observed response scores, assumed to be one-dimensional, were summed and transformed into expected scores using the Rasch rating scale model with WINSTEPS software. A series of simulations was performed using a unified bootstrap procedure after manipulating scenarios with different questionnaire lengths and patient numbers to estimate the reliability at 95% confidence intervals. Skewness analyses of the 95% CIs were compared to detect different effects between groups according to the two data sets of observed and expected response scores.ResultsWe found that (1) it is necessary to report CIs for reliability and skewness coefficients in papers; (2) data derived from expected response scores are preferable to making inferences; and (3) visual representations displaying the 95% CIs of skewness values applied to item-by-item analyses can provide a useful interpretation of quality-of-life outcomes.ConclusionReliability coefficients can be reported with 95% CIs by statistical software to evaluate the internal consistency of respondent scores on questionnaire items. The SPSS syntax procedures for estimating the reliability of the 95% CI, expected score generation and visual skewness analyses are demonstrated in this study. We recommend that effect sizes such as a 95% CI be reported along with p values reporting significant differences in quality-of-life studies.

Direct medical cost of radiation therapy for cancer patients in Taiwan

AbstractBackground: Concomitant chemotherapy with radiotherapy is considered to be the standard of care for patients with head and neck cancer and good performance status. However, published reports on the cost effectiveness of this therapeutic approach are extremely rare. Objective: The aim of this study was to estimate the cost effectiveness of cetuximab combined with radiotherapy compared with radiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck. Methods: A decision-tree analysis was used to compare cetuximab combined with radiotherapy and radiotherapy alone in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck from the perspective of the national health payer (the Bureau of National Health Insurance [BNHI]) in Taiwan. The model was based on individual patient data extracted from an international phase III trial. The direct medical costs of care were estimated by clinical expert panels based on the reimbursement price of the BNHI (2007 values). One-way sensitivity analyses were performed while varying the costs and clinical parameters. Results: The incremental cost per quality-adjusted life-year (QALY) for patients receiving radiotherapy in combination with cetuximab compared with radiotherapy alone was