METHODS: Retrospective cohort study. Medical claims data and long-term care claims data from Fukuoka Prefecture, Japan, were used. We identified 3,882 older adults (≥75 years) with advanced dementia who were hospitalized between April 2016 and March 2019 due to dysphagia, malnutrition, or aspiration pneumonia. Using propensity score matching, we matched 192 patients in the PEG group with 192 in the non-artificial nutrition group, and 490 patients in the NGT group with 490 in the non-artificial nutrition group. We examined the survival years and total costs of each patient from the date of admission to March 31, 2020, and thereby estimated the cost-effectiveness of PEG and NGT, respectively, versus non-artificial nutrition. The net benefit regression model was employed to estimate the incremental net benefits (INB) with varying values of willingness-to-pay (WTP) for PEG and NGT. Furthermore, cost-effectiveness acceptability curve was used to present the probability of the cost-effectiveness of each intervention.
RESULTS: As WTP increased from JPY 7,747,909 (equivalent to US$51,546) to JPY 28,163,651 (equivalent to US$187,371), the probability of PEG being cost-effective increased from 50 % to nearly100 %. The NGT group had negative INB estimates.
CONCLUSIONS: Both PEG and NGT are less likely to provide economic values for patients with advanced dementia. However, this conclusion should be further refined through detailed cost-effectiveness analysis from multiple perspectives.
METHOD: A comprehensive search was conducted for studies published up to December 2023, including English papers on HNC analyzing OPN expression. Data extraction, quality assessment, and quantitative analysis were performed using fixed and random effect models with 95% CI. Heterogeneity and publication bias were assessed with I2 and Egger's regression test.
RESULTS: Fifty-one studies were included. OPN expression was significantly elevated in tissue and plasma in HNC compared to control (SMD 0.98; 95% CI 0.47-1.49; I2 = 13%; p 0.05). Elevated plasma OPN correlated with smoking, poorly differentiated neoplasms, larger tumors, advanced stage, and lymph node metastasis. Positive tissue OPN was associated with nodal involvement, advanced stage, male gender, and smoking.
CONCLUSION: OPN is a robust prognostic biomarker in HNC, indicating tumor aggressiveness and poor prognostic outcomes. Standardized measurement protocols and further validation in prospective studies are necessary.