• Asian Pacific Journal of Cancer Prevention
• /
• 제15권20호
• /
• pp.8993-9004
• /
• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• 한국정보과학회논문지:데이타베이스
• /
• 제37권4호
• /
• pp.177-184
• /
• 2010

센서 정보, 물류/유통정보, 신용 정보, 주식 정보 등이 과거보다 다양하면서 대용량의 연속 발생 형태 데이터가 발생하고 있다. 이러한 데이터는 대용량의 특의 변화가 빠른 특징들을 가지고 있기 때문에 학습이 어렵다. 이러한 문제점을 해결하기 위해 일정 윈도우 크기의 최근 데이터를 연속적으로 학습시킴으로써 전체 모형을 새롭게 만들거나 모형의 일부분을 대체 하는 방법을 사용하여 왔다. 그러나 이러한 방법은 계속해서 새로운 학습모형을 만들어야 하므로 대용량의 연속 데이터를 학습시키는데 많은 시간과 비용이 든다. 따라서, 이러한 특성에 대비하기 위하여 추가적인 학습 데이터가 발생할 때 마다, 점진적이며 지속적으로 학습을 할 수 있는 학습 기법이 필요하다. 보다 빠른 속도로 학습 모형의 변화 없이 분류를 하기 위하여 대표적인 점진적 학습 방법으로 베이지안 분류기를 사용할 수 있지만, 사전확률을 알고 있다는 가정으로부터 시작을 하게 되어 일정량 이상의 학습데이터가 필요하다. 따라서 본 연구에서는 베이지안 분류기와 같이 점진적으로 학습을 할 수 있지만, 사전 확률을 알지 못하더라고 학습을 할 수 있는 새로운 점진적 학습 알고리즘을 제안하고자 한다. 본 연구에서 제안하는 알고리즘의 기본 개념은 여러 전문가의 의견을 종합하는 방식이다. 여기서는 속성값(attribute value)을 한명의 전문가로 보고 전문가 집단의 의사 결정이 맞을 경우에는 가점을 주고 틀릴 경우에는 감점을 하는 방식으로 학습을 하게 된다. 실험결과 이 방법은 의사결정나무나 베이지언 분류기와 비교해 비슷한 성능을 나타내었으며, 향후에 스트림 데이터 분석에 사용할 가능성을 보였다.

• 병원약사회지
• /
• 제35권4호
• /
• pp.409-417
• /
• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.