@article{LewkowiczBoettingerSiegel2023, author = {Lewkowicz, Daniel and B{\"o}ttinger, Erwin and Siegel, Martin}, title = {Economic evaluation of digital therapeutic care apps for unsupervised treatment of low back pain}, series = {JMIR mhealth and uhealth}, volume = {11}, journal = {JMIR mhealth and uhealth}, publisher = {JMIR Publications}, address = {Toronto}, issn = {2291-5222}, doi = {10.2196/44585}, pages = {14}, year = {2023}, abstract = {Background: Digital therapeutic care (DTC) programs are unsupervised app-based treatments that provide video exercises and educational material to patients with nonspecific low back pain during episodes of pain and functional disability. German statutory health insurance can reimburse DTC programs since 2019, but evidence on efficacy and reasonable pricing remains scarce. This paper presents a probabilistic sensitivity analysis (PSA) to evaluate the efficacy and cost-utility of a DTC app against treatment as usual (TAU) in Germany. Objective: The aim of this study was to perform a PSA in the form of a Monte Carlo simulation based on the deterministic base case analysis to account for model assumptions and parameter uncertainty. We also intend to explore to what extent the results in this probabilistic analysis differ from the results in the base case analysis and to what extent a shortage of outcome data concerning quality-of-life (QoL) metrics impacts the overall results. Methods: The PSA builds upon a state-transition Markov chain with a 4-week cycle length over a model time horizon of 3 years from a recently published deterministic cost-utility analysis. A Monte Carlo simulation with 10,000 iterations and a cohort size of 10,000 was employed to evaluate the cost-utility from a societal perspective. Quality-adjusted life years (QALYs) were derived from Veterans RAND 6-Dimension (VR-6D) and Short-Form 6-Dimension (SF-6D) single utility scores. Finally, we also simulated reducing the price for a 3-month app prescription to analyze at which price threshold DTC would result in being the dominant strategy over TAU in Germany. Results: The Monte Carlo simulation yielded on average a euro135.97 (a currency exchange rate of EUR euro1=US \$1.069 is applicable) incremental cost and 0.004 incremental QALYs per person and year for the unsupervised DTC app strategy compared to in-person physiotherapy in Germany. The corresponding incremental cost-utility ratio (ICUR) amounts to an additional euro34,315.19 per additional QALY. DTC yielded more QALYs in 54.96\% of the iterations. DTC dominates TAU in 24.04\% of the iterations for QALYs. Reducing the app price in the simulation from currently euro239.96 to euro164.61 for a 3-month prescription could yield a negative ICUR and thus make DTC the dominant strategy, even though the estimated probability of DTC being more effective than TAU is only 54.96\%. Conclusions: Decision-makers should be cautious when considering the reimbursement of DTC apps since no significant treatment effect was found, and the probability of cost-effectiveness remains below 60\% even for an infinite willingness-to-pay threshold. More app-based studies involving the utilization of QoL outcome parameters are urgently needed to account for the low and limited precision of the available QoL input parameters, which are crucial to making profound recommendations concerning the cost-utility of novel apps.}, language = {en} } @article{BogenBenderLoeweetal.2015, author = {Bogen, Oliver and Bender, Olaf and Loewe, Jana and Blenau, Wolfgang and Thevis, Beatrice and Schroeder, Wolfgang and Margolis, Richard U. and Levine, Jon D. and Hucho, Ferdinand}, title = {Neuronally produced versican V2 renders C-fiber nociceptors IB4-positive}, series = {Journal of neurochemistry}, volume = {134}, journal = {Journal of neurochemistry}, number = {1}, publisher = {Wiley-Blackwell}, address = {Hoboken}, issn = {0022-3042}, doi = {10.1111/jnc.13113}, pages = {147 -- 155}, year = {2015}, abstract = {A subpopulation of nociceptors, the glial cell line-derived neurotrophic factor (GDNF)-dependent, non-peptidergic C-fibers, expresses a cell-surface glycoconjugate that can be selectively labeled with isolectin B4 (IB4), a homotetrameric plant lectin from Griffonia simplicifolia. We show that versican is an IB4-binding molecule in rat dorsal root ganglion neurons. Using reverse transcriptase polymerase chain reaction (RT-PCR), insitu hybridization and immunofluorescence experiments on rat lumbar dorsal root ganglion, we provide the first demonstration that versican is produced by neurons. In addition, by probing Western blots with splice variant-specific antibodies we show that the IB4-binding versican contains only the glycosaminoglycan alpha domain. Our data support V2 as the versican isoform that renders this subpopulation of nociceptors IB4-positive (+). A subset of nociceptors, the GDNF-dependent non-peptidergic C-fibers can be characterized by its reactivity for isolectin B4 (IB4), a plant lectin from Griffonia simplicifolia. We have previously demonstrated that versican V2 binds IB4 in a Ca2+-dependent manner. However, given that versican is thought to be the product of glial cells, it was questionable whether versican V2 can be accountable for the IB4-reactivity of this subset of nociceptors. The results presented here prove - for the first time - a neuronal origin of versican and suggest that versican V2 is the molecule that renders GDNF-dependent non-peptidergic C-fibers IB4-positive.}, language = {en} } @article{Dornhof2011, author = {Dornhof, Sarah}, title = {Regimes of visibility representing violence against women in the French banlieue}, series = {Feminist review}, journal = {Feminist review}, number = {98}, publisher = {Palgrave Macmillan}, address = {Basingstoke}, issn = {0141-7789}, doi = {10.1057/fr.2011.2}, pages = {110 -- 127}, year = {2011}, abstract = {Recent discussions about violence against women have shifted their attention to specific forms of violence in relation to migration and Islam. In this article, I consider different modes of representing women's experiences in French immigrant communities. These representations relate to the French feminist movement Ni Putes Ni Soumises (neither whore nor submissive), a movement that in the early 2000s deplored both the sustained degradation of certain banlieue neighborhoods and also the charges and restrictions that this entails, particularly for young women. Drawing on different narratives and images of women's painful experience, I consider, in a first step, how the question of representing violence against (post) migrant women is framed in terms of the tension between universality and particularity within French republicanism. In the next part of my argument, I bring into focus the question of how to access women's suffering. For a perspective on pain not as an interiorized, private experience but as an accessible complex of practices, articulations, memories, visions and social reconfigurations, I consider Smain Laacher's sociological study (2008) about written testimonies of violent experience that had been addressed by (post) migrant women to French women organizations such as Ni Putes Ni Soumises. I finally suggest reading women's accounts on violence not in relation to a universal discourse of rights, but as a political contestation of the naturalized order of representing violence, suffering and agency inside French banlieue communities. Drawing on Jacques Ranciere's notion of dissensus, such a contestation can be staged through words by those who have no visibility in the representational order, words not to criticize the unaccomplished ideals of universal equality, but to create a universal community and a common language of experience in the mode of 'as-if'.}, language = {en} } @article{WallnyBrackmannGuniaetal.2006, author = {Wallny, Thomas A. and Brackmann, H. H. and Gunia, G{\"u}nter and Wilbertz, P. and Oldenburg, J. and Kraft, Clayton. N.}, title = {Successful pain treatment in arthropathic lower extremities by acupuncture in haemophilia patients}, series = {Haemophilia : the official journal of the World Federation of Haemophilia}, volume = {12}, journal = {Haemophilia : the official journal of the World Federation of Haemophilia}, number = {5}, publisher = {Wiley-Blackwell}, address = {Oxford}, issn = {1351-8216}, doi = {10.1111/j.1365-2516.2006.01308.x}, pages = {500 -- 502}, year = {2006}, abstract = {Acupuncture is successfully used in the treatment of degenerative osteoarthritis. The treatment of haemophilic arthropathies can require strong painkillers with severe side-effects. Therefore, a special yet simple acupuncture technique was evaluated in the treatment of these joint problems. Twelve patients with a factor VIII activity < 1\% and at least one painful arthropathy in both lower extremities were included in this single-blinded study. The non-treated side served as a control. Treatment was assessed by a visual analogue scale (VAS) and an orthopaedic clinical examination. Only one needle was inserted at the rear fontanelle once per week and in 15 cycles. Ten of 12 patients showed an improvement of their pain perception. The average VAS could be reduced from 6.8 to 5.0. The side not receiving treatment showed a reduction from 4.1 to 4.0. No side-effects were observed. Even though interpretation of our data are limited due to the small patient numbers, significant improvement of the VAS after treatment suggests that acupuncture has a measurable positive effect in pain management for haemophilic arthropathy of the lower extremities.}, language = {en} }