John C.

Background/Objectives: Respiratory syncytial virus (RSV) causes a significant hospitalization burden in infants. The objective of this study was to evaluate the cost-effectiveness of introducing clesrovimab, a recently approved long-acting monoclonal antibody, in all US infants born during or entering their first RSV season. Methods: A decision analytical model simulated the clinical and economic impact of clesrovimab in a yearly birth cohort, compared with three alternative interventions: nirsevimab, palivizumab, and the RSVpreF maternal vaccine. Model inputs were obtained from the published literature. Efficacy estimates for clesrovimab were derived from post hoc analyses of randomized control trial data, which were conducted to align endpoints from different studies (nirsevimab and RSVpreF). Medically attended lower respiratory infection (MALRI), quality-adjusted life years (QALYs, 3% discounting), and costs (in 2024 USD) were evaluated from a societal perspective. Both deterministic and probabilistic sensitivity analyses were performed. Results: Clesrovimab resulted in fewer (38,252) RSV-related MALRI outcomes and was cost-saving compared to nirsevimab, with significant reductions in total costs (USD 98 million saved). When compared with palivizumab, clesrovimab and nirsevimab were estimated to cost USD 38,655 and USD 79,912 per QALY, respectively. Results were sensitive to changes in intervention costs, efficacy, and QALY loss due to RSV infection. Conclusions: Clesrovimab may significantly reduce the burden of RSV among US infants in their first RSV season and may save costs compared to nirsevimab.

Integration of data representing 35,120 brain scans from diverse global studies enables construction of reference charts that define normative microstructural and macrostructural properties across the human lifespan for research and clinical diagnosis.

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This chapter traces the evolutionary development of financial systems from medieval Mediterranean trade networks to modern central banking institutions. Through analysis of historical trade patterns, monetary innovations, and institutional development, we document...

Publisher Correction: White matter micro- and macrostructure brain charts for the human lifespan

Purpose The Area Deprivation Index (ADI) ranks neighborhoods by adverse social exposome, considering factors related to income, education, employment, and housing quality. This study evaluates the association between socioeconomic status and outcomes following spine stereotactic body radiation therapy (SBRT). Methods A prospectively maintained database of consecutive patients treated with spine SBRT at a quaternary referral center from 2001 to 2024 was analyzed. Patient addresses were matched to the 2020 ADI to define most advantaged (ADI ≤ 50, 140 patients, 227 metastases) and least advantaged (ADI > 50, 357 patients, 553 metastases) cohorts. Results The distribution of race and ethnicity differed between cohorts, with a greater proportion of Black or African American patients in the least advantaged cohort (2% vs. 6%, P = 0.008). Public insurance coverage was more common in the least advantaged cohort (42% vs. 54%, P = 0.020). There were no differences with respect to age (P = 0.904), sex (P = 0.495), Karnofsky Performance Status (P = 0.930), radioresistant histologies (P = 0.626), systemic disease burden (P = 0.127), prior or adjuvant chemotherapy (P = 0.146) or immunotherapy (P = 0.537), prior open surgical resection (P = 0.196) or conventional external beam radiation therapy (P = 0.268), Bilsky grade (P = 0.191), Spinal Instability Neoplastic Score (P = 0.076), gross tumor volume (P = 0.731), fractionation regimen (P = 0.437), or biologically effective dose (P = 0.499). There was no difference in 6-month, 1-year, 2-year, and 3-year local control (96%, 88%, 85%, and 79% vs. 91%, 83%, 76%, and 73%; P = 0.062) or overall survival (72%, 56%, 37%, and 28% vs. 70%, 55%, 36%, and 28%; P = 0.890). There was no difference in complete or partial pain response (44% vs. 41%, P = 0.196), radiation toxicity (12% vs. 12%, P = 0.876), or vertebral compression fractures (11% vs. 10%, P = 0.637) following treatment. Multivariable Cox proportional hazards analyses did not identify race or ethnicity, insurance coverage, or the ADI as predictors of local control or overall survival. Conclusion Race or ethnicity, insurance coverage, and neighborhood deprivation were not associated with any measured outcomes following spine SBRT. These findings suggest equitable SBRT delivery once patients access care at an academic referral center and reinforce the need to improve referral pathways and insurance authorization for socioeconomically disadvantaged patients.