Huiying Sun - Academia.edu (original) (raw)

Papers by Huiying Sun

BMJ Open

ObjectivesTo analyse the effects of health status on work exit and absenteeism among the older wo... more ObjectivesTo analyse the effects of health status on work exit and absenteeism among the older working population in China.DesignSecondary analysis of a cohort sample.Setting and participantsCommunity samples who engaged in either agricultural or non-agriculture work or both in the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) and whose age was 45–55 years for women or 45–60 years for men in the 2013 wave.Outcome measuresWork exit and number of absent workdays due to health problems in 2013. To address the problems of measurement error of self-rated health status, we used disability condition, number of chronic diseases and functional limitation to construct an index of health. We divided the sample into four groups according to gender and work types (farmers who conducted any agricultural work in 2011 vs non-farmers who conducted non-agricultural work only) and conducted analyses separately.ResultsFarmers (11.0% for women and 4.9% for men) were less likel...

Vaccine, Jun 27, 2018

People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbid... more People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbidity and mortality. In order to assess comparative efficacy of influenza vaccine strategies among HIV-positive people, we performed a systematic review and Bayesian network meta-analysis (NMA). In this systematic review, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL between 1946 and July 2015 for randomized controlled trials (RCTs) on influenza vaccines for HIV-positive adults reporting seroconversion or seroprotection outcomes. The NMAs were conducted within a Bayesian framework and logistic models were used for comparing the effect of the vaccine strategies on the two outcomes. A total of 1957 publications were identified, 143 were selected for full review, and 13 RCTs were included in our final analysis. Fourteen separate NMAs were conducted by outcomes, vaccine strain, and different outcome measurement ...

Annals of Internal Medicine

The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be ... more The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be noninferior to etanercept-methotrexate in patients with active rheumatoid arthritis (RA). To determine the cost-effectiveness of etanercept-methotrexate versus triple therapy as a first-line strategy. A within-trial analysis based on the 353 participants in the RACAT trial and a lifetime analysis that extrapolated costs and outcomes by using a decision analytic cohort model. The RACAT trial and sources from the literature. Patients with active RA despite at least 12 weeks of methotrexate therapy. 24 weeks and lifetime. Societal and Medicare. Etanercept-methotrexate first versus triple therapy first. Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The within-trial analysis found that etanercept-methotrexate as first-line therapy provided marginally more QALYs but accumulated substantially higher drug costs. Differences in other costs between strategies were negligible. The ICERs for first-line etanercept-methotrexate and triple therapy were 2.7millionperQALYand2.7 million per QALY and 2.7millionperQALYand0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime analysis suggested that first-line etanercept-methotrexate would result in 0.15 additional lifetime QALY, but this gain would cost an incremental 77290,leadingtoanICERof77 290, leading to an ICER of 77290,leadingtoanICERof521 520 per QALY per patient. Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions. Data on the long-term benefit of triple therapy are uncertain. Initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit. The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

Current rheumatology reports, 2017

One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that... more One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that it can reduce future healthcare utilization such as joint surgeries and physician visits. However, the evidence to support this assertion is unclear. We conducted a review of the literature for studies which have analyzed the trends in resource use of RA patients, and then undertook a retrospective observational analysis of a Canadian administrative database using instrumental variable methods. Our review found a trend in reduced resource utilization prior to the introduction of biologics and no evidence that biologic therapies have specifically contributed to this reduction. Our observational analysis, which overcame some of the epidemiological challenges with determining the influence of biologics on resource utilization, found a possible reduction in other medications but possible increases rather than decreases in physician visits and hospitalizations. However, our sample was not su...

Health economics review, 2017

In health economic evaluation studies, to value productivity loss due to absenteeism, existing me... more In health economic evaluation studies, to value productivity loss due to absenteeism, existing methods use wages as a proxy value for marginal productivity. This study is the first to test the equality between wage and marginal productivity losses due to absenteeism separately for team workers and non-team workers. Our estimates are based on linked employer-employee data from Canada. Results indicate that team workers are more productive and earn higher wages than non-team workers. However, the productivity gap between these two groups is considerably larger than the wage gap. In small firms, employee absenteeism results in lower productivity and wages, and the marginal productivity loss due to team worker absenteeism is significantly higher than the wage loss. No similar wage-productivity gap exists for large firms. Our findings suggest that productivity loss or gain is most likely to be underestimated when valued according to wages for team workers. The findings help to value the ...

Expert review of pharmacoeconomics & outcomes research, Jan 27, 2016

In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the f... more In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics' price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of the first or subsequent generic entrants. This study assessed the impact of such price-cap regulations on market entry by generic firms using the formulary database from 9 provinces (January 2004-March 2013). A logistic regression was estimated to compare the probability of entry during the three policy periods in Ontario ('70/90', '25', versus '50'). Since different price-caps were subsequently introduced in other provinces, Alberta, British Columbia, New Brunswick and Saskatchewan, difference-in-differences was used to compare market entry. In Ontario, compared with the period '50', generic firms were 76% ...

RMD open, 2016

To assess changes in work productivity in patients who have achieved response using etanercept (E... more To assess changes in work productivity in patients who have achieved response using etanercept (ETN) 50 mg+methotrexate (MTX) (phase I) are randomised to ETN 25 mg+MTX versus MTX versus placebo (phase II) and then withdrawn from treatment (phase III). Patients included in the analysis were in employment entering phase II of the PRIZE trial and had one or more follow-ups. Phase II was a 39-week, randomised and double-blind comparison of the 3 dose-reduction treatments. Phase III was a 26-week observational study where treatment was withdrawn. The Valuation of Lost Productivity was completed approximately every 13 weeks to estimate productivity impacts from a societal perspective. A total of 120 participants were included in our analyses. During phase II, ETN25+MTX or MTX improved paid work productivity by over 100 hours compared with placebo, amounting to a gain of €1752 or €1503, respectively. ETN25+MTX compared with placebo gains €1862 in total paid/unpaid productivity. At week 52,...

Social Science & Medicine, 2015

One source of productivity loss due to illness is the reduced &am... more One source of productivity loss due to illness is the reduced "quantity" or…

Collectanea Mathematica

This paper presents some properties of singular functionals on Orlicz spaces, from which, criteri... more This paper presents some properties of singular functionals on Orlicz spaces, from which, criteria for weak convergence and weak compactness in such spaces are obtained. In [1], T. Ando shows that every linear bounded functional can be decomposed into a function part and a singular part, and the last part is represented by some class of finite additive set functions. Since very few properties of such set functions are known, most problems concerning weak topology in Orlicz spaces are left open; for instance, even T. Ando himself in [2], leaving the singular functionals aside, discusses only the L N-weak convergence and L N-weak compactness. In this paper, we first give criteria for a singular functional on an Orlicz space to be norm attainable and to be an extreme point of the unit ball of the dual space, then, applying Rainwater's Theorem, we obtain criteria for weak convergence and weak compactness in the space. Throughout this paper, we denote by M : R → R + an Orlicz function, i.e., it is even, continuous, convex and satisfies M (u) = 0 iff u = 0, and M (u) u → 0 as u → 0, M (u) u → ∞ as u → ∞. If M is an Orlicz function, then its complemented * To the memory of Professor W. Orlicz.

The Journal of Rheumatology

Purpose: A new, efficient method is proposed which calculates single-parameter Expected Value of ... more Purpose: A new, efficient method is proposed which calculates single-parameter Expected Value of Partial Perfect Information (EVPPI) using just one level of Monte-Carlo simulation (MCS). Methods: We propose that the maximization step in the EVPPI calculation can be transformed into a root-finding problem. The domain of the parameter of interest (θi) is divided into discrete intervals defined by the roots of the incremental net benefit (INB) functions on θi. Since the strategy with the highest expected Net Benefit (NB) remains the same within each interval there is no need to perform the maximization step at each value of θi. Root finding is performed by maximizing a ‘score’ function for a solution for the number and location of roots and using model comparison techniques to find the optimal solution. The algorithm requires N random draws and corresponding NB estimates from the whole set of parameters (including θi) from a one-level MCS. Results: We compared the performance of our al...

RMD Open, 2015

To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on wo... more To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on work productivity in patients with early rheumatoid arthritis (RA) over 52 weeks. Methods: MTX-and biological-naïve patients with RA (symptom onset ≤12 months; Disease Activity Score based on a 28-joint count (DAS28) >3.2) received open-label ETN50/MTX for 52 weeks. The Valuation of Lost Productivity (VOLP) questionnaire, measuring paid and unpaid work productivity impacts, was completed approximately every 13 weeks. Bootstrapping methods were used to test changes in VOLP outcomes over time. One-year productivity impacts were compared between responders (DAS28 ≤3.2) at week 13 and non-responders using zeroinflated models for time loss and two-part models for total costs of lost productivity. Results: 196 patients were employed at baseline and had ≥1 follow-up with VOLP. Compared with baseline, at week 52, patients gained 33.4 h per 3 months in paid work and 4.2 h per week in unpaid work. Total monetary productivity gains were €1322 per 3 months. Over the 1-year period, responders gained paid (231 h) and unpaid work loss (122 h) compared with non-responders, which amounted to a gain of €3670 for responders. Conclusions: This is the first clinical trial to measure and value the impact of biological treatment on all the labour input components that affect overall productivity. Combination therapy with ETN50/MTX was associated with a significant productivity gain for patients with early RA who were still observed at week 52. Over the 1-year treatment period, responders at week 13 suffered significantly less productivity loss than non-responders suggesting this gain was related to treatment response.

Rheumatology, 2009

Objectives. To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone o... more Objectives. To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone on work productivity among MTX-naïve patients with active early RA over a 12-month period. Methods. The COMET (COmbination of Methotrexate and ETanercept) trial was a 2-year double-blind randomized clinical trial. Absenteeism during the first year was measured and it included: (i) number of missed workdays; (ii) reduced working time; and (iii) number of stopped workdays. Each absenteeism measure was estimated using a mixed model, and their variations were estimated by bootstrapping. As a sensitivity analysis, the lost workdays due to presenteeism (reduced performance at work) was also estimated. Results. Two hundred and five patients [MTX (n ¼ 100) vs ETN þ MTX (n ¼ 105)], who were working full time or part time at baseline and had at least one follow-up observation, were included in the analysis. Compared with the MTX group, the ETN þ MTX group had a maximum of 37 fewer missed workdays or at minimum 22 fewer missed workdays. The associated productivity gain equalled £2586 and £1555, respectively. When additionally accounting for presenteeism, the total improvement could be as high as 42 (95% CI 16, 69) fewer lost workdays representing a productivity gain of £2968. Conclusions. Our results demonstrated that early treatment with ETN þ MTX led to a significant attenuation of absenteeism among patients with early active RA. These productivity gains represent benefit beyond the traditional measures of clinical and radiographic improvements. Further research to simultaneously measure both absenteeism and presenteeism is warranted.

Rheumatology, 2012

Objectives. To evaluate the impact of clinical response on work stoppage or work absence among em... more Objectives. To evaluate the impact of clinical response on work stoppage or work absence among employed people with early RA. Methods. First-year data from the combination of MTX and etanercept trial was used. The analyses were restricted to the 205 patients working full or part time at baseline who answered questions on whether they stopped working or missed days from work in one or more of the four follow-up visits. Work stoppage referred to the first occurrence of subjects reporting stopping work. Work absence was defined as whether patients reported missed days from work. Clinical response and activity state considered included the ACR and European League against Rheumatism response criteria, 28-joint DAS (DAS-28) remission and the minimum clinically important difference of the HAQ score. Results. After adjustment for baseline characteristics, ACR70 responders were 72% less likely to stop working and 55% less likely to miss work than ACR20 non-responders (P < 0.05). Patients achieving DAS-28 remission were 54% less likely to stop work than those with DAS-28 > 3.2 (P < 0.05). Moderate improvements did not appear to effect work stoppage or missed days after adjustments. Conclusions. Results suggest that achieving clinical remission or major improvement might be necessary to significantly impact work outcomes.

Proceedings of the American Mathematical Society, 1995

This paper presents some properties of bounded linear functionals on a complete abstract M spaces... more This paper presents some properties of bounded linear functionals on a complete abstract M spaces, from which some criteria for weak convergence and weak compactness in such spaces are obtained.

Medical Decision Making, 2012

The effect of antiretroviral therapy (ART) interruption or intensification on health-related qual... more The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL. A 2 x 2 factorial open label randomized controlled trial. Hospitals in the United States, Canada, and the United Kingdom. Multidrug resistant (MDR) HIV patients. Patients were randomized to receive a 12-wk interruption or not, and ART intensification or standard ART. The Health Utilities Index (HUI3), EQ-5D, standard gamble (SG), time tradeoff (TTO), visual analog scale (VAS), and the Medical Outcomes Study HIV Health Survey (MOS-HIV). There were no significant differences in HRQoL among the four groups during follow-up; however, there was a temporary significant decline in HRQoL on some measures within the interruption group during interruption (HUI3 -0.05, P = 0.03; VAS -5.9, P = 0.002; physical health summary -2.9, P = 0.001; mental health summary -1.9, P = 0.02). Scores declined slightly overall during follow-up. Multivariate analysis showed significantly lower HRQoL associated with some clinical events. Limitations. The results may not apply to HIV patients who have not experienced multiple treatment failures or who have not developed MDR HIV. Temporary ART interruption and ART intensification provided neither superior nor inferior HRQoL compared with no interruption and standard ART. Among surviving patients, HRQoL scores declined only slightly over years of follow-up in this advanced HIV cohort; however, approximately one-third of patients died during the trial follow up. Lower HRQoL was associated with adverse clinical events.

BMJ Open

ObjectivesTo analyse the effects of health status on work exit and absenteeism among the older wo... more ObjectivesTo analyse the effects of health status on work exit and absenteeism among the older working population in China.DesignSecondary analysis of a cohort sample.Setting and participantsCommunity samples who engaged in either agricultural or non-agriculture work or both in the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) and whose age was 45–55 years for women or 45–60 years for men in the 2013 wave.Outcome measuresWork exit and number of absent workdays due to health problems in 2013. To address the problems of measurement error of self-rated health status, we used disability condition, number of chronic diseases and functional limitation to construct an index of health. We divided the sample into four groups according to gender and work types (farmers who conducted any agricultural work in 2011 vs non-farmers who conducted non-agricultural work only) and conducted analyses separately.ResultsFarmers (11.0% for women and 4.9% for men) were less likel...

Vaccine, Jun 27, 2018

People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbid... more People with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbidity and mortality. In order to assess comparative efficacy of influenza vaccine strategies among HIV-positive people, we performed a systematic review and Bayesian network meta-analysis (NMA). In this systematic review, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL between 1946 and July 2015 for randomized controlled trials (RCTs) on influenza vaccines for HIV-positive adults reporting seroconversion or seroprotection outcomes. The NMAs were conducted within a Bayesian framework and logistic models were used for comparing the effect of the vaccine strategies on the two outcomes. A total of 1957 publications were identified, 143 were selected for full review, and 13 RCTs were included in our final analysis. Fourteen separate NMAs were conducted by outcomes, vaccine strain, and different outcome measurement ...

Annals of Internal Medicine

The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be ... more The RACAT (Rheumatoid Arthritis Comparison of Active Therapies) trial found triple therapy to be noninferior to etanercept-methotrexate in patients with active rheumatoid arthritis (RA). To determine the cost-effectiveness of etanercept-methotrexate versus triple therapy as a first-line strategy. A within-trial analysis based on the 353 participants in the RACAT trial and a lifetime analysis that extrapolated costs and outcomes by using a decision analytic cohort model. The RACAT trial and sources from the literature. Patients with active RA despite at least 12 weeks of methotrexate therapy. 24 weeks and lifetime. Societal and Medicare. Etanercept-methotrexate first versus triple therapy first. Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The within-trial analysis found that etanercept-methotrexate as first-line therapy provided marginally more QALYs but accumulated substantially higher drug costs. Differences in other costs between strategies were negligible. The ICERs for first-line etanercept-methotrexate and triple therapy were 2.7millionperQALYand2.7 million per QALY and 2.7millionperQALYand0.98 million per QALY over 24 and 48 weeks, respectively. The lifetime analysis suggested that first-line etanercept-methotrexate would result in 0.15 additional lifetime QALY, but this gain would cost an incremental 77290,leadingtoanICERof77 290, leading to an ICER of 77290,leadingtoanICERof521 520 per QALY per patient. Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions. Data on the long-term benefit of triple therapy are uncertain. Initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit. The Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research, and an interagency agreement with the National Institutes of Health-American Recovery and Reinvestment Act.

Current rheumatology reports, 2017

One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that... more One justification for using expensive biologic therapy in rheumatoid arthritis (RA) has been that it can reduce future healthcare utilization such as joint surgeries and physician visits. However, the evidence to support this assertion is unclear. We conducted a review of the literature for studies which have analyzed the trends in resource use of RA patients, and then undertook a retrospective observational analysis of a Canadian administrative database using instrumental variable methods. Our review found a trend in reduced resource utilization prior to the introduction of biologics and no evidence that biologic therapies have specifically contributed to this reduction. Our observational analysis, which overcame some of the epidemiological challenges with determining the influence of biologics on resource utilization, found a possible reduction in other medications but possible increases rather than decreases in physician visits and hospitalizations. However, our sample was not su...

Health economics review, 2017

In health economic evaluation studies, to value productivity loss due to absenteeism, existing me... more In health economic evaluation studies, to value productivity loss due to absenteeism, existing methods use wages as a proxy value for marginal productivity. This study is the first to test the equality between wage and marginal productivity losses due to absenteeism separately for team workers and non-team workers. Our estimates are based on linked employer-employee data from Canada. Results indicate that team workers are more productive and earn higher wages than non-team workers. However, the productivity gap between these two groups is considerably larger than the wage gap. In small firms, employee absenteeism results in lower productivity and wages, and the marginal productivity loss due to team worker absenteeism is significantly higher than the wage loss. No similar wage-productivity gap exists for large firms. Our findings suggest that productivity loss or gain is most likely to be underestimated when valued according to wages for team workers. The findings help to value the ...

Expert review of pharmacoeconomics & outcomes research, Jan 27, 2016

In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the f... more In 1998, the province of Ontario, Canada implemented price-cap '70/90' regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics' price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of the first or subsequent generic entrants. This study assessed the impact of such price-cap regulations on market entry by generic firms using the formulary database from 9 provinces (January 2004-March 2013). A logistic regression was estimated to compare the probability of entry during the three policy periods in Ontario ('70/90', '25', versus '50'). Since different price-caps were subsequently introduced in other provinces, Alberta, British Columbia, New Brunswick and Saskatchewan, difference-in-differences was used to compare market entry. In Ontario, compared with the period '50', generic firms were 76% ...

RMD open, 2016

To assess changes in work productivity in patients who have achieved response using etanercept (E... more To assess changes in work productivity in patients who have achieved response using etanercept (ETN) 50 mg+methotrexate (MTX) (phase I) are randomised to ETN 25 mg+MTX versus MTX versus placebo (phase II) and then withdrawn from treatment (phase III). Patients included in the analysis were in employment entering phase II of the PRIZE trial and had one or more follow-ups. Phase II was a 39-week, randomised and double-blind comparison of the 3 dose-reduction treatments. Phase III was a 26-week observational study where treatment was withdrawn. The Valuation of Lost Productivity was completed approximately every 13 weeks to estimate productivity impacts from a societal perspective. A total of 120 participants were included in our analyses. During phase II, ETN25+MTX or MTX improved paid work productivity by over 100 hours compared with placebo, amounting to a gain of €1752 or €1503, respectively. ETN25+MTX compared with placebo gains €1862 in total paid/unpaid productivity. At week 52,...

Social Science & Medicine, 2015

One source of productivity loss due to illness is the reduced &amp;amp;amp;amp;amp;amp;amp;am... more One source of productivity loss due to illness is the reduced &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;quantity&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or…

Collectanea Mathematica

This paper presents some properties of singular functionals on Orlicz spaces, from which, criteri... more This paper presents some properties of singular functionals on Orlicz spaces, from which, criteria for weak convergence and weak compactness in such spaces are obtained. In [1], T. Ando shows that every linear bounded functional can be decomposed into a function part and a singular part, and the last part is represented by some class of finite additive set functions. Since very few properties of such set functions are known, most problems concerning weak topology in Orlicz spaces are left open; for instance, even T. Ando himself in [2], leaving the singular functionals aside, discusses only the L N-weak convergence and L N-weak compactness. In this paper, we first give criteria for a singular functional on an Orlicz space to be norm attainable and to be an extreme point of the unit ball of the dual space, then, applying Rainwater's Theorem, we obtain criteria for weak convergence and weak compactness in the space. Throughout this paper, we denote by M : R → R + an Orlicz function, i.e., it is even, continuous, convex and satisfies M (u) = 0 iff u = 0, and M (u) u → 0 as u → 0, M (u) u → ∞ as u → ∞. If M is an Orlicz function, then its complemented * To the memory of Professor W. Orlicz.

The Journal of Rheumatology

Purpose: A new, efficient method is proposed which calculates single-parameter Expected Value of ... more Purpose: A new, efficient method is proposed which calculates single-parameter Expected Value of Partial Perfect Information (EVPPI) using just one level of Monte-Carlo simulation (MCS). Methods: We propose that the maximization step in the EVPPI calculation can be transformed into a root-finding problem. The domain of the parameter of interest (θi) is divided into discrete intervals defined by the roots of the incremental net benefit (INB) functions on θi. Since the strategy with the highest expected Net Benefit (NB) remains the same within each interval there is no need to perform the maximization step at each value of θi. Root finding is performed by maximizing a ‘score’ function for a solution for the number and location of roots and using model comparison techniques to find the optimal solution. The algorithm requires N random draws and corresponding NB estimates from the whole set of parameters (including θi) from a one-level MCS. Results: We compared the performance of our al...

RMD Open, 2015

To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on wo... more To measure and value the impact of combined etanercept (ETN) and methotrexate (MTX) therapy on work productivity in patients with early rheumatoid arthritis (RA) over 52 weeks. Methods: MTX-and biological-naïve patients with RA (symptom onset ≤12 months; Disease Activity Score based on a 28-joint count (DAS28) >3.2) received open-label ETN50/MTX for 52 weeks. The Valuation of Lost Productivity (VOLP) questionnaire, measuring paid and unpaid work productivity impacts, was completed approximately every 13 weeks. Bootstrapping methods were used to test changes in VOLP outcomes over time. One-year productivity impacts were compared between responders (DAS28 ≤3.2) at week 13 and non-responders using zeroinflated models for time loss and two-part models for total costs of lost productivity. Results: 196 patients were employed at baseline and had ≥1 follow-up with VOLP. Compared with baseline, at week 52, patients gained 33.4 h per 3 months in paid work and 4.2 h per week in unpaid work. Total monetary productivity gains were €1322 per 3 months. Over the 1-year period, responders gained paid (231 h) and unpaid work loss (122 h) compared with non-responders, which amounted to a gain of €3670 for responders. Conclusions: This is the first clinical trial to measure and value the impact of biological treatment on all the labour input components that affect overall productivity. Combination therapy with ETN50/MTX was associated with a significant productivity gain for patients with early RA who were still observed at week 52. Over the 1-year treatment period, responders at week 13 suffered significantly less productivity loss than non-responders suggesting this gain was related to treatment response.

Rheumatology, 2009

Objectives. To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone o... more Objectives. To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone on work productivity among MTX-naïve patients with active early RA over a 12-month period. Methods. The COMET (COmbination of Methotrexate and ETanercept) trial was a 2-year double-blind randomized clinical trial. Absenteeism during the first year was measured and it included: (i) number of missed workdays; (ii) reduced working time; and (iii) number of stopped workdays. Each absenteeism measure was estimated using a mixed model, and their variations were estimated by bootstrapping. As a sensitivity analysis, the lost workdays due to presenteeism (reduced performance at work) was also estimated. Results. Two hundred and five patients [MTX (n ¼ 100) vs ETN þ MTX (n ¼ 105)], who were working full time or part time at baseline and had at least one follow-up observation, were included in the analysis. Compared with the MTX group, the ETN þ MTX group had a maximum of 37 fewer missed workdays or at minimum 22 fewer missed workdays. The associated productivity gain equalled £2586 and £1555, respectively. When additionally accounting for presenteeism, the total improvement could be as high as 42 (95% CI 16, 69) fewer lost workdays representing a productivity gain of £2968. Conclusions. Our results demonstrated that early treatment with ETN þ MTX led to a significant attenuation of absenteeism among patients with early active RA. These productivity gains represent benefit beyond the traditional measures of clinical and radiographic improvements. Further research to simultaneously measure both absenteeism and presenteeism is warranted.

Rheumatology, 2012

Objectives. To evaluate the impact of clinical response on work stoppage or work absence among em... more Objectives. To evaluate the impact of clinical response on work stoppage or work absence among employed people with early RA. Methods. First-year data from the combination of MTX and etanercept trial was used. The analyses were restricted to the 205 patients working full or part time at baseline who answered questions on whether they stopped working or missed days from work in one or more of the four follow-up visits. Work stoppage referred to the first occurrence of subjects reporting stopping work. Work absence was defined as whether patients reported missed days from work. Clinical response and activity state considered included the ACR and European League against Rheumatism response criteria, 28-joint DAS (DAS-28) remission and the minimum clinically important difference of the HAQ score. Results. After adjustment for baseline characteristics, ACR70 responders were 72% less likely to stop working and 55% less likely to miss work than ACR20 non-responders (P < 0.05). Patients achieving DAS-28 remission were 54% less likely to stop work than those with DAS-28 > 3.2 (P < 0.05). Moderate improvements did not appear to effect work stoppage or missed days after adjustments. Conclusions. Results suggest that achieving clinical remission or major improvement might be necessary to significantly impact work outcomes.

Proceedings of the American Mathematical Society, 1995

This paper presents some properties of bounded linear functionals on a complete abstract M spaces... more This paper presents some properties of bounded linear functionals on a complete abstract M spaces, from which some criteria for weak convergence and weak compactness in such spaces are obtained.

Medical Decision Making, 2012

The effect of antiretroviral therapy (ART) interruption or intensification on health-related qual... more The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL. A 2 x 2 factorial open label randomized controlled trial. Hospitals in the United States, Canada, and the United Kingdom. Multidrug resistant (MDR) HIV patients. Patients were randomized to receive a 12-wk interruption or not, and ART intensification or standard ART. The Health Utilities Index (HUI3), EQ-5D, standard gamble (SG), time tradeoff (TTO), visual analog scale (VAS), and the Medical Outcomes Study HIV Health Survey (MOS-HIV). There were no significant differences in HRQoL among the four groups during follow-up; however, there was a temporary significant decline in HRQoL on some measures within the interruption group during interruption (HUI3 -0.05, P = 0.03; VAS -5.9, P = 0.002; physical health summary -2.9, P = 0.001; mental health summary -1.9, P = 0.02). Scores declined slightly overall during follow-up. Multivariate analysis showed significantly lower HRQoL associated with some clinical events. Limitations. The results may not apply to HIV patients who have not experienced multiple treatment failures or who have not developed MDR HIV. Temporary ART interruption and ART intensification provided neither superior nor inferior HRQoL compared with no interruption and standard ART. Among surviving patients, HRQoL scores declined only slightly over years of follow-up in this advanced HIV cohort; however, approximately one-third of patients died during the trial follow up. Lower HRQoL was associated with adverse clinical events.