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Cost of treatment support for multidrug-resistant tuberculosis using patient-centred approaches in Ethiopia: a model-based method

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Infectious Diseases of Poverty 2023年第4期12卷 54-62页

作者： Laura Rosu lucy morgan Ewan M.Tomeny Claire Worthington Mengdi Jin Jasper Nidoi David Worthington Liverpool School of Tropical Medicine Pembroke PlaceLiverpoolL35QAUK Management Science Lancaster UniversityLancasterUK Makerere University Lung Institute KampalaUganda

Background Patient and health system costs for treating multidrug-resistant tuberculosis (MDR-TB) remain high even after treatment duration was shortened. Many patients do not finish treatment, contributing to increased transmission and antimicrobial resistance. A restructure of health services, that is more patient-centred has the potential to reduce costs and increase trust and patient satisfaction. The aim of the study is to investigate how costs would change in the delivery of MDR-TB care in Ethiopia under patient-centred and hybrid approaches compared to the current *** We used published data, collected from 2017 to 2020 as part of the Standard Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM) trial, to populate a discrete event simulation (DES) model. The model was developed to represent the key characteristics of patients’ clinical pathways following each of the three treatment delivery strategies. To the pathways of 1000 patients generated by the DES model we applied relevant patient cost data derived from the STREAM trial. Costs are calculated for treating patients using a 9-month MDR-TB treatment and are presented in 2021 United States dollars (USD).Results The patient-centred and hybrid strategies are less costly than the standard-of-care, from both a health system (by USD 219 for patient-centred and USD 276 for the hybrid strategy) and patient perspective when patients do not have a guardian (by USD 389 for patient-centred and USD 152 for the hybrid strategy). Changes in indirect costs, staff costs, transport costs, inpatient stay costs or changes in directly-observed-treatment frequency or hospitalisation duration for standard-of-care did not change our *** Our findings show that patient-centred and hybrid strategies for delivering MDR-TB treatment cost less than standard-of-care and provide critical evidence that there is scope for such strategies to be implemented in routine care. These

关键词： Affordability Multidrug-resistant tuberculosis Directly-observed treatment Patient-centred approach Tuberculosis treatment delivery

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Increased ARF6 activation correlates with HGF stimulation in non-invasive prostate cancer cells

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Journal of Cancer Metastasis and Treatment 2018年第1期4卷 535-547页

作者： Claire morgan lucy J.Swithenbank Helen Whiteland Shareen H.Doak Swansea University Medical School Institute of Life ScienceSwansea UniversitySwansea SA28PPUK

Aim:The effects of hepatocyte growth factor(HGF)on a non-invasive prostate cancer cell line(CAHPV-10),expressing cMET were studied,to mimic the possible effects neo-adjuvant androgen deprivation therapy may have in promoting tumour ***:Prostate epithelial cells and prostate cancer cells derived from cancer metastatic sites were analysed using cell culture assays,immunofluorescence,quantitative real-time polymerase chain reaction and western blotting,with or without HGF ***:HGF significantly enhanced cell proliferation and induced cell scattering and invasion in CAHPV-10 cells compared to untreated *** adenosine diphosphate-ribosylation factor 6(ARF6)was found to be present in all metastatic prostate cancer cells,with levels highest in the most aggressive cell line,*** stimulation with HGF,active ARF6 expression was substantially elevated in CAHPV-10 ***:These findings provide further molecular insight into the progression of prostate cancer and highlights potential issues for early prostate cancer therapeutic strategies.

关键词： Prostate cancer adenosine diphosphate-ribosylation factor 6 hepatocyte growth factor stimulation androgen

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