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<p><b>INTRODUCTION</b>In light of the growing evidence base for better clinical results with the use of the dual bronchodilator indacaterol/glycopyrronium (IND/GLY) over inhaled corticosteroid-containing salmeterol/fluticasone combination (SFC), this study aimed to evaluate the cost-effectiveness of IND/GLY over SFC in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) who are at low risk of exacerbations, in the Singapore healthcare setting.</p><p><b>METHODS</b>A previously published patient-level simulation model was adapted for use in Singapore by applying local unit costs. The model was populated with clinical data from the LANTERN and ECLIPSE studies. Both costs and health outcomes were predicted for the lifetime horizon from a payer's perspective and were discounted at 3% per annum. Costs were expressed in 2015 USD exchange rates. Uncertainty was assessed through probabilistic sensitivity analysis.</p><p><b>RESULTS</b>Compared to SFC, use of IND/GLY increased mean life expectancy by 0.316 years and mean quality-adjusted life years (QALYs) by 0.246 years, and decreased mean total treatment costs (drug costs and management of associated events) by USD 1,474 over the entire lifetime horizon. IND/GLY was considered to be 100% cost-effective at a threshold of 1 × gross domestic product per capita. The cost-effectiveness acceptability curve showed that IND/GLY was 100% cost-effective at a willingness-to-pay threshold of USD 0 (additional cost) when compared to SFC.</p><p><b>CONCLUSION</b>IND/GLY was estimated to be highly cost-effective compared to SFC in patients with moderate-to-severe COPD who are not at high risk of exacerbations in the Singapore healthcare setting.</p>

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We evaluated a disease management and education programme delivered via telephone support (TS) to patients with poorly controlled diabetes (HbA1c >7%). All eligible patients were invited to participate in the programme, which involved education on lifestyle modification and disease management delivered via three scheduled monthly calls by trained nurses. Patients who declined or could not be contacted acted as the controls (usual care, UC). A per protocol analysis was conducted using a mixed effect model for two subgroups with different baseline HbA1c levels (i.e. baseline HbA1c <8.0% and HbA1c ≥8.0%). A total of 2646 patients with diabetes were eligible for enrolment. Of these, 1391 participants had HbA1c measurements available. The study comprised 633 patients (46%) who completed the programme (TS), 598 (43%) who were not contactable or refused to participate at the first telephone call (UC) and 160 patients who dropped out. In the patients with HbA1c ≥8%, TS reduced the adjusted mean HbA1c by 0.38% (P = 0.022) but the reduction in diabetes-related admissions (4.2% lower adjusted mean admission rate) was not significant. In patients with HbA1c <8%, TS had no additional effect on glycaemic control or diabetes-related admission. Telephone support appeared effective in improving glycaemic control in patients with poor diabetes control.

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<p><b>INTRODUCTION</b>Waiting times for kidney transplant are long in Singapore. Healthrelated quality of life (HRQoL) of patients might be affected as a result of the stress of the long wait and the uncertainty of being called to undergo a surgical operation. This study aimed to measure the HRQoL of patients on the kidney transplant waiting list and to identify factors which could impact on the HRQoL scores in this group of patients.</p><p><b>MATERIALS AND METHODS</b>This was a cross-sectional study of kidney transplant waiting list patients managed at a tertiary renal unit using the SF-36. A SF-36 normative calculator was used to generate HRQoL scores for the Singapore general population matched with the study cohort's age, gender and ethnicity.</p><p><b>RESULTS</b>There were 265 respondents with a response rate was 81%. Our study shows that HRQoL scores for the kidney transplant waiting list patients were lower than the population norms across all subscales and were clinically significant for General Health, Role Physical, Bodily Pain, Social Functioning and Mental Component Summary scores. Factors such as being Chinese, married, employed and undergoing haemodialysis predicted better HRQoL scores after adjusting for possible confounders. Age, gender, educational level, household income, history of kidney transplant, duration on the transplant waiting list and years on dialysis did not significantly influence SF-36 across all subscales scores.</p><p><b>CONCLUSION</b>Kidney transplant waiting list patients had worse HRQoL compared to the general population. Factors such as ethnicity, marital status, employment status, and type of dialysis treatment significantly influenced patients' perception of their HRQoL.</p>

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<p><b>INTRODUCTION</b>We compared the agreement of diabetic retinopathy (DR) assessment between trained non-physician graders (NPGs) and family physicians (FPs) in a primary healthcare setting.</p><p><b>METHODS</b>This was a cross-sectional study conducted retrospectively over a period of one month. The participants were diabetic patients from two primary healthcare clinics (polyclinics) in Singapore. Single-field digital retinal images were obtained using a non-mydriatic 45-degree fundus camera. Retinal images were graded for the presence or absence of DR by FPs at the polyclinics and by NPGs at a central ocular grading centre. The FPs' and NPGs' assessments of DR were compared with readings by a single retinal specialist (reference standard).</p><p><b>RESULTS</b>A total of 367 diabetic patients (706 eyes) were included in the study. The mean age of the patients was 63 years, and the majority were Chinese (83.8%). For DR assessment, the agreement between NPGs and the retinal specialist was substantial (ĸ = 0.66), while the agreement between FPs and the retinal specialist was only fair (ĸ = 0.40). NPGs' assessment showed higher sensitivity (70% vs. 45%) and comparable specificity (94% vs. 92%) as compared to FPs' assessment. The area under the receiver operating characteristic curve of NPGs' assessment of DR was greater than that of the FPs' (0.82 vs. 0.69, p < 0.001).</p><p><b>CONCLUSION</b>This study has demonstrated that trained NPGs are able to provide good detection of DR and maculopathy from fundus photographs. Our findings suggest that DR screening by trained NPGs may provide a costeffective alternative to FPs.</p>

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