![]() ![]() All ICERs remained consistently within the willingness-to-pay (WTP) threshold of US$53,333.33 per QALY gained. As to treatment-experienced mMCC patients, avelumab was associated with ICERs of US$27243.06 (vs BSC)/US$26557.43 (vs chemotherapy) per QALY gained. For treatment-naïve patients, the incremental cost-effectiveness ratios (ICERs) for avelumab vs BSC and avelumab vs chemotherapy were US$44885.06 and US$42993.06 per QALY gained, respectively. Cost-utility analysis was performed, and results were presented as cost per quality-adjusted life year (QALY) gained. The data of clinical efficacy, safety, and patient utilities were obtained from the JAVELIN Merkel 200 trial, literature review, and Taiwanese clinical expert opinion. Incorporating trial results, this analysis aimed to evaluate the cost-utility of avelumab in Taiwan.Ī de novo partitioned-survival model with three key health states related to survival (progression-free disease, progressed disease, and death) was applied in this study. ![]() Avelumab, a novel anti-programmed death-ligand 1 (PD-L1) human monoclonal antibody for mMCC treatment, is being studied in the pivotal JAVELIN Merkel 200 trial. ![]() Conclusions EUS-FNB improves diagnostic sensitivity and confers additional information to cytological assessment of PanNETs.Metastatic Merkel cell carcinoma (mMCC) has traditionally been managed with palliative chemotherapy regimens or best supportive care (BSC). There was one reported complication, a post-FNA bleeding, treated conservatively. Diagnostic sensitivity among the adequate samples for EUS-FNA, EUS-FNB and for the combination of the two methods was 88.4 % (95 %CI: 80.9 - 96.0 %), 94.3 % (95 %CI: 86.6 - 100 %) and 100 % (95 %CI: 100 - 100 %). The combination of both sampling modalities established the diagnosis in 96.4 % of cases (27/28) (95 %CI: 89.6 - 100 %), significantly superior to EUS-FNA alone ( P = 0.023). Diagnostic yield of EUS-FNA and EUS-FNB alone, including the inadequate specimens, was 77.5 % (95 %CI: 68.9 - 86.2 %) and 85.4 % (95 %CI: 74.6 - 96.2 %), respectively. Both EUS-guided sampling modalities were used in 28 procedures, EUS-FNA alone was used in 61 cases, while EUS-FNB alone in 13 cases. Results A total of 91 patients (M/F: 42/49, median age: 57 years), who underwent 102 EUS procedures had a final diagnosis of PanNET. The accuracy and safety of different EUS-guided sampling methods for confirmed PanNETs were investigated. Lesions underwent EUS-FNA or FNB sampling, or a combination of the two. Patients and methods Over a 13-year period, all patients who underwent EUS-guided tissue sampling of suspicious pancreatic lesions with clinical, endoscopic and pathologic details were entered into an electronic database. However, the differences in efficacy between these sampling methods in the diagnosis of PanNETs still needs to be defined. Fine-needle biopsies (FNB) are increasingly employed to obtain core specimens during EUS. Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a method of obtaining preoperative diagnosis of pancreatic neuroendocrine tumors (PanNETs) has been reported in several series. ![]()
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