Friday, May 3, 2019

Sew Chaotically and Melanoma Awareness! ~ #MeMadeRobes - Part 2

Robe #2 feels very decadent.  And BRIGHT!  And BEAUTIFUL!!!  I love it!

It is made up in an African wax print by way of London's Walthamstow Market!  The pattern is an extended version of Lisette's B6464 easy Kimono-esq jacket that I treated with Sashiko embroidery and even stitched up in fleece in prior makes.   With that combo, I could be accused of cultural appropriation on TWO fronts!!!  And maybe I should be.  However, I think the life I have lived, the things I read, the lives I celebrate, and the rights I fight for have been made clear in my almost 55 years on this planet.  And with approval from gals like Oonaballoona, aka Marcy Harriell - who certainly has a horse in this 'race' and rocks such prints like no other - in her post Wax on, Wax off (whom I actually contacted for advice on the care and sewing of wax prints generally as well as their use on the body of a POW - person of whiteness - in particular) I feel my use of these fabrics and shapes is a way of honoring the beauty and history of those who developed and produced them.  Culture, language, art, racial division, appropriation and injustice are incredibly important human issues.  As such, I am pleased with my special robe and feel great appreciation for those who walked this earth before me, as well as those who stand beside me, in order to make so many delicious foods, beautiful art, incredible fabric, amazing literature and great FRIENDS - part of my life today.

In keeping with what is my multifaceted life and May ~ Melanoma Awareness continues!!

I have serious concerns in all sorts of ways when the issue of cost as it pertains to needed medical care comes up.  It is SOOOOOOOOOOO nutters in every regard!  The incredible price attached to drugs and medical care generally.  The ludicrous deals all parties cut with insurance companies in the United States.  The audacity of some to decide that certain folks are just not worth the 'price'.  Now...there's this:

Cost-effectiveness of pembrolizumab for the adjuvant treatment of resected high-risk stage III melanoma in the United States.  Bensiomon, Zhou, Jenkins, et al.  J Med Econ. 2019 Apr 23. 
To evaluate the cost-effectiveness of adjuvant pembrolizumab relative to observation alone following complete resection of high-risk stage III melanoma with lymph node involvement, from a US health system perspective.

A Markov cohort model with four health states (recurrence-free, locoregional recurrence, distant metastases, and death) was developed to estimate costs, life-years, and quality-adjusted life-years associated with pembrolizumab versus observation over a lifetime (46-year) horizon. Using a parametric multi-state modeling approach, transition probabilities starting from recurrence-free were estimated based on patient-level data from KEYNOTE-054, a direct head-to-head phase 3 trial. Post-recurrence transition probabilities were informed by real-world retrospective data and clinical trials in advanced melanoma. Health state utilities and adverse event-related disutility were derived from KEYNOTE-054 trial data and published literature. Costs of drug acquisition and administration, adverse events, disease management, and terminal care were estimated in 2018 US dollars. Deterministic and probabilistic sensitivity analyses were conducted to assess robustness.

Over a lifetime horizon, adjuvant pembrolizumab and observation were associated with total QALYs of 9.24 and 5.95, total life-years of 10.54 and 7.15, and total costs of $489,820 and $440,431, respectively. The resulting incremental cost-effectiveness ratios (ICERs) for pembrolizumab versus observation were $15,009/QALY and $14,550/life-year. Across the range of input values and assumptions tested in deterministic sensitivity analyses, pembrolizumab ranged from being a dominant strategy to having an ICER of $57,449/QALY versus observation. The ICER was below a willingness-to-pay threshold of $100,000/QALY in 90.2% of probabilistic simulations.

Long-term extrapolation of outcomes was based on interim results from KEYNOTE-054 with a median follow-up of 15 months.  Based on common willingness-to-pay benchmarks, pembrolizumab is highly cost-effective compared with observation alone for the adjuvant treatment of completely resected stage III melanoma in the US.

Well!  I'm glad they concluded "pembrolizumab is highly cost-effective compared with observation alone for the adjuvant treatment of completely resected stage III melanoma in the US" else-wise I may have had to hurt somebody!!  But really, what IS one life worth?  I defer to dear Pati.  Her videoed response is MORE than worth - your time:  Melanoma Treatment Options: What is it Worth to Extend ONE Life?

Live (and sew) chaotically!  For yourself.  For Pati and every other cancer patient who no longer can. - les

Oh.... PS - This pattern creates a much more comfy robe than the Purl Soho pattern does.  Still love my other one.  Just keep'n it 100!  ~ c

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