RESUMEN
OBJECTIVES: To estimate, using probabilistic decision-analytic modelling techniques, the cost effectiveness of treating familial hypercholesterolaemia (FH) patients with high-intensity statins compared to treatment with low-intensity statins. For the purpose of this economic analysis, and based on their known differences, statins were categorised as high intensity if they produce greater LDL-cholesterol reductions than simvastatin 40 mg (e.g., simvastatin 80 mg and appropriate doses of atorvastatin and rosuvastatin or combination of statins + ezetimibe). METHODS: A lifetime Markov model was developed to estimate the incremental cost per quality adjusted life year (QALY) of treating a hypothetical cohort of 1000 FH patients aged between 20 and 70 years. Baseline coronary heart disease risks reported in the NICE TA 94 on statins, and age-adjusted risk of cardiovascular disease reported in the FH population, were used to populate the model. A meta-analysis estimate of the reduction in cardiovascular events from using high-intensity compared with low-intensity statins was obtained from published trials. Results were interpreted using a cost-effectiveness threshold of pound20 000/QALY. RESULTS: Fewer cardiovascular events and deaths were predicted to occur in the group treated with higher-intensity statins, and the incremental cost-effectiveness ratio (ICER) was estimated at pound11 103/QALY. The ICER remained below the pound20 000 threshold for 20-39-year-olds and 40-59-year-olds, but rose above this threshold in individuals aged over 60 years. One-way sensitivity analysis showed that results were most sensitive to variation in treatment effect on mortality and the cost of high-intensity statins. CONCLUSIONS: Modelling demonstrates that high-intensity statins are cost-effective for the treatment of younger FH patients. If, as is likely, the relative price of high-intensity statins fall in the future as they come off patent, then their cost effectiveness will improve further.
Asunto(s)
Anticolesterolemiantes/economía , Azetidinas/economía , Inhibidores de Hidroximetilglutaril-CoA Reductasas/economía , Hiperlipoproteinemia Tipo II/economía , Modelos Teóricos , Adulto , Factores de Edad , Anciano , Anticolesterolemiantes/administración & dosificación , Azetidinas/administración & dosificación , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Costos y Análisis de Costo , Quimioterapia Combinada/economía , Ezetimiba , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hiperlipoproteinemia Tipo II/complicaciones , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hiperlipoproteinemia Tipo II/mortalidad , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
This article presents the multifaceted efforts of Syracuse Healthy Start, a federally funded initiative of the Onondaga County Health Department and over 20 partnering agencies to reduce racial and ethnic disparities in infant mortality. The analyses presented in this article demonstrate that many women--Caucasian, African American, and Hispanic--have serious risks for low birth weight and infant death. In many cases, multiple, simultaneous risks complicate a pregnant woman's situation and in other cases the longitudinal cumulative risks impact health across generations. Infant mortality decreased overall, and for both Caucasian and African American infants during the first 3 years of the project.
Asunto(s)
Etnicidad/estadística & datos numéricos , Mortalidad Infantil , Servicios de Salud Materna , Administración en Salud Pública , Negro o Afroamericano/estadística & datos numéricos , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , New York/epidemiología , Embarazo , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Población Blanca/estadística & datos numéricosAsunto(s)
Atlas como Asunto , Atención a la Salud/tendencias , Pautas de la Práctica en Medicina , Federación para Atención de Salud , Encuestas de Atención de la Salud , Humanos , New Hampshire , Innovación Organizacional , Objetivos Organizacionales , Participación del Paciente , Programas Informáticos , Estados UnidosRESUMEN
With ORYX, healthcare organizations will have to report two measures of the quality of care provided 20% of its population. Can we interpret this as evidence of JCAHO's commitment to change? Critics say not yet.
Asunto(s)
Acreditación , Evaluación de Resultado en la Atención de Salud/clasificación , Eficiencia Organizacional , Hospitales/normas , Joint Commission on Accreditation of Healthcare Organizations , Programas Informáticos , Estados UnidosRESUMEN
Healthcare practices in neighboring towns vary as much as 33-fold, according to the Dartmouth Atlas of Health Care analysis of claims and census data. Still unknown is the effect that this variation has on outcomes. The new regional version of the atlas makes it possible to compare care at the local community level and decide what to do about it.
Asunto(s)
Atlas como Asunto , Encuestas de Atención de la Salud , Pautas de la Práctica en Medicina/tendencias , Dorso/cirugía , Puente de Arteria Coronaria/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Indiana , Programas Controlados de Atención en Salud/tendencias , Educación del Paciente como Asunto , Estados UnidosAsunto(s)
Prótesis Articulares/rehabilitación , Tiempo de Internación , Cuidados Posoperatorios/normas , Vías Clínicas , Ejercicio Físico , Humanos , Prótesis Articulares/psicología , Prótesis Articulares/normas , Evaluación de Resultado en la Atención de Salud , Educación del Paciente como Asunto , Pennsylvania , Apoyo SocialAsunto(s)
Planes de Asistencia Médica para Empleados/organización & administración , Costos de Hospital/normas , Organizaciones del Seguro de Salud/organización & administración , Análisis Costo-Beneficio , Servicios de Información , Pennsylvania , Organizaciones del Seguro de Salud/economía , Calidad de la Atención de Salud , Estados UnidosRESUMEN
By visual examination of calli derived from germinating seeds of wheat, oats, rice, proso millet, and pearl millet it has been possible to visually select embryogenic (E) callus which, on transfer to a regeneration medium, forms plants an average of 33 times more frequently than non-embryogenic (NE) callus of equal mass. Embryogenic callus consists of small isodiametric cells averaging 31 µm in diameter; NE callus consists of long tubular cells averaging 52 µm in width and 355 µm in length. Production of E callus is in many cases promoted by media containing 2,4-di- or 2,4,5-trichlorophenoxyacetic acid (2,4-D or 2,4,5-T) plus indole-3-acetic acid or tryptophan+kinetin. Production on NE callus is promoted by media containing 2,4-D or 2,4,5-T alone. As a result of initial experiments to optimize both media for E callus production and media for plant regeneration, callus derived in six passages from an average of 26 seeds could produce about 1,000 regenerated plants.