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Justine Alderfer,1 Jyoti Aggarwal,2 Kim Gilchrist,1 Jose Maria Jimenez Alvir,3 Joseph Cook,4 Sang Hee Park,5 Jennifer M Stephens5 1Medical Affairs, Pfizer Inc., Collegeville, PA, USA; 2Evidence &; Access, OPEN Health, Newton, MA, USA; 3Global Product Development, Pfizer Inc., New York, NY, USA; 4Clinical Development and Medical Affairs, Viatris, Canonsburg, PA, USA; 5Evidence & Access, OPEN Health, Bethesda, MD, USACorrespondence: Justine Alderfer, US Medical Affairs, Pfizer, 500 Arcola Rd., Collegeville, PA, 19426, USA, Tel +1 484-865-3105, Email Justine.Alderfer@pfizer.comBackground: Despite demonstration of bioequivalence of generics to brands and the potential for reduced costs, some patients switch back from a generic to the brand. A prior retrospective analysis suggested that this switchback rate may be lower among patients that had initially switched to authorized generics (AG), often both produced and marketed by the brand company, compared to those initially switched to another generic.Objective: Explore switching patterns of brands, AGs, and generics, switchback rates, and the potential impact of switchbacks on healthcare costs.Methods: An analysis of the Pharmetrics Plus™ database (2007– 2019), a United States (US) payer administrative database, was conducted to examine the use of Upjohn medications available as AGs across multiple therapeutic areas. Patients initiating treatment with brand medication in the 6 months prior to generic market entry were identified and switch rates to generics and AGs, as well as switchback rates, were evaluated. Costs were descriptively compared between patients who switched back to brand and those who remained on any generic.Results: Across 14 brand medications, more than half of the patients initiating treatment with the brand medication were switched to a generic. Generally, switching to AG, which ranged from 0.5 to 39.6%, was lower than switching to non-AG generics (16.7– 79.9%). The comparison of switchback rates from AGs to brand and non-AGs to brand showed similar results (AG:1.3– 7.5%; non-AG:1.4– 12.9%); however, the most substantial differences were observed where non-AG switchbacks were higher. Patients that switched back to brand remained on AG or generic for an average of 1– 3 months (32– 88 days). The analysis showed a tendency towards increased medical costs in the period immediately preceding switchback for all medications except sildenafil in both indications (erectile dysfunction and pulmonary arterial hypertension). For the remaining medications, medical costs ranged from $63 to $1544 higher for the switchback population. Pharmacy costs similarly tended to be higher for patients who had a switchback, with the exception of sildenafil for pulmonary arterial hypertension and sirolimus.Conclusion: Patients receiving a brand medication are likely to be switched to a generic upon market availability. Some patients switch back to the brand medication, usually within 1– 3 months; this may be associated with increased medical costs. Additional research is needed to understand switching, its potential disruption to patients, and the role of brands, generics, and AGs.Keywords: authorized generic, Generic, medication switching, costs more...

Walter Danker III,1 Jyoti Aggarwal,2 Sneha S Kelkar,2 Xiaocong L Marston,2 Xin Gao,2 Stephen S Johnston3 1Ethicon Inc., Somerville, NJ, USA; 2OPEN Health, Bethesda, MD, USA; 3Johnson & Johnson Co., New Brunswick, NJ, USACorrespondence: Jyoti Aggarwal, OPEN Health, 4350 East West Hwy #1100, Bethesda, MD, 20814, USA, Tel +1-240-821-1265, Email jyotiaggarwal@OpenHealthgroup.comBackground: Topical hemostatic agents are an option for controlling bleeding during cardiovascular surgery. Previous studies comparing topical hemostatic agents in cardiovascular surgery predate the 2012 reformulation of Surgiflo®, which had been re-engineered to increase paste viscosity and thus be more adherent to the bleeding surface.Objective: To compare clinical and economic outcomes in patients receiving the current formulation of Surgiflo vs Floseal during cardiovascular surgeries.Methodology: A retrospective analysis was conducted using the Premier Healthcare Database. Eligible patients had an inpatient cardiovascular surgery between 1/1/2013 and 6/1/2018, were ≥ 18 years old and received the current formulation of Surgiflo or Floseal during surgery. Propensity score matching was performed, with exact matching on the surgery year and surgery type (aortic, coronary artery bypass grafting, valve, or other). Descriptive analysis and generalized estimating equations models compared outcomes between the Surgiflo and Floseal groups.Results: The matched sample included 5768 patients in each group (mean age: 66.5 years; 66.3% male). In the matched sample, rates of any documented bleeding event were similar in Surgiflo and Floseal groups (6.9% vs 7.2%; P = 0.576). Differences in transfusion rates between patients receiving Surgiflo vs Floseal varied by operational definition and timing of measurement but did not differ by > 2 percentage points. Compared to Floseal, patients who received Surgiflo experienced longer surgery duration (306.0 vs 299.4 minutes), lower hospitalization cost ($44,146 vs $46,812), and lower odds of readmission at 30, 60, and 90 days post-discharge (all P < 0.05). Inpatient mortality and LOS were comparable between Surgiflo and Floseal (all P > 0.05).Conclusion: In this large study of real-world clinical and economic outcomes after cardiovascular surgery involving the current formulation of Surgiflo vs Floseal, Surgiflo was associated with mostly similar clinical outcomes as compared with Floseal. Differences in selected economic/resource use outcomes were also observed, for which root-cause analysis in future research would be informative.Keywords: Surgiflo®, Floseal, cardiovascular surgery, economic outcomes, bleeding, transfusion more...

Aggarwal J, Lustrino J, Stephens J, Morgenstern D, Tang WY. Clinicoecon Outcomes Res. 2020;12:389–397. Tables 1– 4 on pages 391-394, the reference citations listed in the Data Source columns are incorrect. The correct Tables 1– 4 are shown below. Page 397, references 41 and 42 are missing from the reference list. These references are shown below. 41. Jelacic S, Craddick K, Nair BG, et al. Relative Costs of Anesthesiologist Prepared, Hospital Pharmacy Prepared and Outsourced Anesthesia Drugs. Journal of Clinical Anesthesia. 2017;36:178-183. 42. van der Linden P, Douchamps J, Schmitt C, Forget D. Ready-to-Use Injection Preparations versus Conventional Reconstituted Admixtures: Economic Evaluation in a Real- Life Setting. PharmacoEconomics. 2002;20(8):529-536. Read the original article more...

Primary sinonasal tumors with neuroendocrine differentiation (SCND) are uncommon tumors with considerable overlap of histological features. Based on their neuroendocrine differentiation they can be sub categorized into sinonasal undifferentiated carcinoma (SNUC), sinonasal neuroendocrine carcinoma (SNEC), esthesioneuroblastoma (ENB) and small cell carcinoma (SmCC). The natural history and biological behavior varies in this group of tumors. Hence the histo-morphological diagnosis coupled with grading/staging is important for the prognostication of these tumors. Aim : To study the clinicopathological characteristics of sinonasal neuroendocrine malignancies at our institute. Material and Methods : We searched our institute′s pathology database for the period from 2002 to 2007, for the four subcategories of sinonasal tumors with neuroendocrine differentiation. Morphological and immunohistochemical features were studied and, grading, staging was done in accordance with standard criteria. The clinical treatment and follow- up data were retrieved from the case files in available cases. Results : A total of 37 cases were retrieved from our database which include 14 cases of SNUC, 14 cases of ENB and nine cases of SNEC. The cases of SNUC were immunopositive for cytokeratin, epithelial membrane antigen and weakly for neuron-specific enolase. SNEC showed strong reactivity with epithelial and neuroendocrine markers whereas ENB demonstrated immunoreactivity to synaptophysisn and chromogranin strongly, with weak to negative expression of epithelial markers. All cases of SNUC and SNEC were of high grade and stage whereas 50% of ENB cases were of grade II but high stage tumors. Most of the SNUC and SNEC patients had been treated with multimodality treatment regimens including upfront chemotherapy followed by surgery and loco- regional radiation. In contrast, ENB patients had undergone surgical extirpation followed by radiation therapy in majority of cases. With limited follow-up data, it was observed that four out of five SNUC patients and three out of four SNEC patients developed either loco-regional (three of SNUC and two of SNEC) or distant metastasis (one patient each of SNUC and SNEC). ENB patients also had loco-regional recurrences (five out of seven patients) with a more protracted course but no distant metastases were observed during the follow up in available cases. Conclusion : Sino nasal tumors with neuroendocrine differentiation are a heterogenous group of tumors with overlapping histo-morphological features. They can be distinguished based on immunohistochemical characteristics. Pathological sub categorization is imperative for management and prognostication of these aggressive tumors. more...

This document is a guest editorial from the International Journal of Uncertainty, Fuzziness & Knowledge-Based Systems. It discusses the potential of fuzzy-based systems in statistical learning theory and their ability to handle uncertainty and ambiguity in real-time data. The editorial highlights recent advancements in integrating fuzzy systems with deep learning architectures and other machine learning techniques. The special issue aims to explore the intersection of fuzzy logic and statistical learning theory and includes twelve accepted papers that investigate the capabilities of fuzzy-based systems. The document provides a brief summary of each paper, covering topics such as pop-up text recognition, alignment of laser images, knowledge graph reasoning, land use changes, 3D printing in vehicle design, defect detection in electronic components, digital management process improvement, spectrum sharing in IoV, deep clustering for time series data, anti-collision algorithms, missing data filling, and video action recognition. The guest editor expresses gratitude to the authors and reviewers for their contributions and to the Editor-in-Chief for the opportunity to curate the special issue. [Extracted from the article] more...

Mammary-derived growth inhibitor (MDGI), a member of the lipophilic family of fatty acid-binding proteins, plays an important role in the development, regulation, and differentiation of the mammary gland. The aim of the study was to identify polymorphism in the MDGI gene and its expression analysis in the mammary gland at various stages of lactation, in Indian buffalo. Nucleotide sequence analysis of MDGI gene in different breeds of riverine and swamp buffaloes revealed a total of 16 polymorphic sites and one Indel. Different transcription factor binding sites were predicted for buffalo MDGI gene promoter sequence, using online tools and in-silico analysis indicating that the SNPs in this region can impact the gene expression regulation. Phylogenetic analysis exhibited the MDGI of buffalo being closer to other ruminants like cattle, yak, sheep, and goats. Further, the expression analysis revealed that buffalo MDGI being highly expressed in well-developed mammary glands of lactating buffalo as compared to involution/non-lactating and before functional development to start the milk production stage in heifers. Stage-specific variation in expression levels signifies the important functional role of the MDGI gene in mammary gland development and milk production in buffalo, an important dairy species in Southeast Asia. [ABSTRACT FROM AUTHOR] more...