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Cost-effective
Terms modified by Cost-effective Selected AbstractsAre Aggressive Treatment Strategies Less Cost-Effective for Older Patients?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2001Aggressive Care for Patients with Acute Respiratory Failure, The Case of Ventilator Support OBJECTIVES: A common assumption is that life-sustaining treatments are much less cost-effective for older patients than for younger patients. We estimated the incremental cost-effectiveness of providing mechanical ventilation and intensive care for patients of various ages who had acute respiratory failure. DESIGN: Retrospective analysis of data on acute respiratory failure from Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). SETTING: Acute hospital. PARTICIPANTS: 1,005 with acute respiratory failure; 963 received ventilator support and 42 had ventilator support withheld. MEASUREMENTS: We studied 1,005 patients enrolled in a five-center study of seriously ill patients (SUPPORT) with acute respiratory failure (pneumonia or acute respiratory distress syndrome and an Acute Physiology Score ,10) requiring ventilator support. For cost-effectiveness analyses, we estimated life expectancy based on long-term follow-up of SUPPORT patients and estimated utilities (quality-of-life weights) using time-tradeoff questions. We used hospital fiscal data and Medicare data to estimate healthcare costs. We divided patients into three age groups (<65, 65,74, and ,75 years); for each age group, we performed separate analyses for patients with a ,50% probability of surviving at least 2 months (high-risk group) and those with a> 50% probability of surviving at least 2 months (low-risk group). RESULTS: Of the 963 patients who received ventilator support, 44% were female; 48% survived 6 months; and the median (25th, 75th percentile) age was 63 (46, 75) years. For the 42 patients for whom ventilator support was withheld, the median survival was 3 days. For low-risk patients (>50% estimated 2-month survival), the incremental cost (1998 dollars) per quality-adjusted life-year (QALY) saved by providing ventilator support and aggressive care increased across the three age groups ($32,000 for patients age <65, $44,000 for those age 65,74, and $46,000 for those age ,75). For high-risk patients, the incremental cost-effectiveness was much less favorable and was least favorable for younger patients ($130,000 for patients age <65, $100,000 for those age 65,74, and $96,000 for those age ,75). When we varied our assumptions from 50% to 200% of our baseline estimates in sensitivity analyses, results were most sensitive to the costs of the index hospitalization. CONCLUSIONS: For patients with relatively good short-term prognoses, we found that ventilator support and aggressive care were economically worthwhile, even for patients 75 years and older. For patients with poor short-term prognoses, ventilator support and aggressive care were much less cost-effective for adults of all ages. [source] ChemInform Abstract: Sulfamic Acid: An Efficient, Cost-Effective, and Reusable Solid Acid Catalyst for the Synthesis of 1,8-Naphthyridines under Solvent-Free Heating and Microwave Irradiation.CHEMINFORM, Issue 6 2009Y. Thirupathi Reddy Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 200 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a "Full Text" option. The original article is trackable via the "References" option. [source] Sulfamic Acid as a Cost-Effective and Recyclable Catalyst for Protection of Carbonyls to Acetals and Ketals under Mild Conditions.CHEMINFORM, Issue 18 2005Weizhong Gong No abstract is available for this article. [source] A data integration framework to support Triad projectsREMEDIATION, Issue 1 2004Jim Mack Cost-effective and efficient site remediation and scientifically defensible decisions require site characterizations that are representative of site conditions. The Triad conceptual site model (CSM) is at the center of a continually improving site characterization process that begins during systematic planning and ends after the last data are developed. To gain the full benefit and greatest cost-effectiveness, the process of CSM refinement should be performed in real time. Thus, the use of collaborative data is critical for evolving and maturing the CSM. In the field, through the use of all available data that are of known quality, a skilled and experienced field team can collect sufficient site information to mature the CSM in a timely manner. To facilitate the planning and execution of such a process, an easily understandable framework is needed to structure data quality that supports scientifically defensible decisions and efficient projects. This article explores such a framework. © 2004 Wiley Periodicals, Inc. [source] A moving planar mirror based approach for cultural reconstructionCOMPUTER ANIMATION AND VIRTUAL WORLDS (PREV: JNL OF VISUALISATION & COMPUTER ANIMATION), Issue 3-4 2004Kyung Ho Jang Abstract Modelling from images is a cost-effective means of obtaining virtual cultural heritage models. These models can be effectively constructed from classical Structure from Motion algorithm. However, it's too difficult to reconstruct whole scenes using SFM method since general oriental historic sites contain a very complex shapes and brilliant colours. To overcome this difficulty, the current paper proposes a new reconstruction method based on a moving planar mirror. We devise the mirror posture instead of scene itself as a cue for reconstructing the geometry. That implies that the geometric cues are inserted into the scene by compulsion. With this method, we can obtain the geometrical details regardless of the scene complexity. For this purpose, we first capture image sequences through the moving mirror containing the interested scene, and then calibrate the camera through the mirror's posture. Since the calibration results are still inaccurate due to the detection error, the camera pose is revised using frame-correspondence of the corner points that are easily obtained using the initial camera posture. Finally, 3D information is computed from a set of calibrated image sequences. We validate our approach with a set of experiments on some cultural heritage objects. Copyright © 2004 John Wiley & Sons, Ltd. [source] Significance of Specimen Databases from Taxonomic Revisions for Estimating and Mapping the Global Species Diversity of Invertebrates and Repatriating Reliable Specimen DataCONSERVATION BIOLOGY, Issue 2 2004RUDOLF MEIER More specifically, we demonstrate for a specimen database assembled during a revision of the robber-fly genus Euscelidia (Asilidae, Diptera) how nonparametric species richness estimators (Chao1, incidence-based coverage estimator, second-order jackknife) can be used to (1) estimate global species diversity, (2) direct future collecting to areas that are undersampled and/or likely to be rich in new species, and (3) assess whether the plant-based global biodiversity hotspots of Myers et al. (2000) contain a significant proportion of invertebrates. During the revision of Euscelidia, the number of known species more than doubled, but estimation of species richness revealed that the true diversity of the genus was likely twice as high. The same techniques applied to subsamples of the data indicated that much of the unknown diversity will be found in the Oriental region. Assessing the validity of biodiversity hotspots for invertebrates is a formidable challenge because it is difficult to decide whether species are hotspot endemics, and lists of observed species dramatically underestimate true diversity. Lastly, conservation biologists need a specimen database analogous to GenBank for collecting specimen records. Such a database has a three-fold advantage over information obtained from digitized museum collections: (1) it is shown for Euscelidia that a large proportion of unrevised museum specimens are misidentified; (2) only the specimen lists in revisionary studies cover a wide variety of private and public collections; and (3) obtaining specimen records from revisions is cost-effective. Resumen:,Sostuvimos que los millones de registros de especimenes publicados en miles de revisiones taxonómicas en décadas anteriores son una fuente de información costo-efectiva de importancia crítica para la incorporación de invertebrados en decisiones de investigación y conservación. Más específicamente, para una base de datos de especimenes de moscas del género Euscelidia (Asilidae, Diptera) demostramos como se pueden utilizar estimadores no paramétricos de riqueza de especies (Chao 1, estimador de cobertura basado en incidencia, navaja de segundo orden) para (1) estimar la diversidad global de especies, (2) dirigir colecciones futuras a áreas que están sub-muestreadas y/o probablemente tengan especies nuevas y (3) evaluar si los sitios globales de importancia para la biodiversidad basados en plantas de Myers et al. (2000) contienen una proporción significativa de invertebrados. Durante la revisión de Euscelidia el número de especies conocidas fue más del doble, pero la estimación de riqueza de especies reveló que la diversidad real del género probablemente también era el doble. Las mismas técnicas aplicadas a las sub-muestras de datos indicaron que gran parte de la diversidad no conocida se encontrará en la Región Oriental. La evaluación de la validez de sitios de importancia para la biodiversidad de invertebrados es un reto formidable porque es difícil decidir si las especies son endémicas de esos sitios y si las listas de especies observadas subestiman dramáticamente la diversidad real. Finalmente, los biólogos de la conservación requieren de una base de datos de especimenes análoga a GenBank, para obtener registros de especimenes. Dicha base de datos tiene una triple ventaja sobre la información obtenida de colecciones de museos digitalizadas. (1) Se muestra para Euscelidia que una gran proporción de especimenes de museo no revisados están mal identificados. (2) Sólo las listas de especimenes en estudios de revisión cubren una amplia variedad de colecciones privadas y públicas. (3) La obtención de registros en revisiones es costo-efectiva. [source] The World Has Changed,Have Analytical Procedure Practices?CONTEMPORARY ACCOUNTING RESEARCH, Issue 2 2010GREG TROMPETER M1; M42 Analytical Procedures (APs) provide a means for auditors to evaluate the "reasonableness" of financial disclosures by comparing a client's reported performance to expectations gained through knowledge of the client based on past experience and developments within the company and its industry. Thus, APs are fundamentally different than other audit tests in taking a broader perspective of an entity's performance vis-à-vis its environment. As such, APs have been found to be a cost-effective means to detect misstatements, and many have argued that a number of prior financial frauds would have been detected had auditors employed effective APs. With several dramatic and far-reaching developments over the past decade, the current study examines whether and how APs have changed during this period. In particular, we focus on the impact of significant "enablers" and "drivers" of change such as technological advancements and the enactment of the Sarbanes-Oxley Act. We also compare our findings to an influential study of the practices of APs by Hirst and Koonce (1996) that was conducted over 10 years ago. We interview 36 auditors (11 seniors, 13 managers, and 12 partners) from all of the Big 4 firms using a structured questionnaire. The data reveal some similarities in findings when compared to prior research (e.g., auditors continue to use fairly simple analytical procedures). However, there are a number of significant differences reflecting changes in AP practices. For instance, as a result of technology auditors now rely more extensively on industry and analyst data than previously. Further, auditors report that they develop more precise quantitative expectations and use more non-financial information. They also appear to rely more on lower level audit staff to perform APs, conduct greater inquiry of non-accounting personnel, and are willing to reduce substantive testing to a greater extent as a result of APs conducted in the planning phase. Finally, the Sarbanes-Oxley Act has had an impact in greater consideration and knowledge of internal controls, which is seen as the most important factor driving the use and reliance on APs. [source] Towards a New Logic for Front End Management: From Drug Discovery to Drug Design in Pharmaceutical R&DCREATIVITY AND INNOVATION MANAGEMENT, Issue 2 2007Maria Elmquist Under pressure to innovate and be cost-effective at the same time, R&D departments are being challenged to develop new organizations and processes for Front End activities. This is especially true in the pharmaceutical industry. As drug development becomes more risky and costly, the discovery departments of pharmaceutical companies are increasingly being compelled to provide strong drug candidates for efficient development processes and quick market launches. It is argued that the Fuzzy Front End consists less of the discovery or recognition of opportunities than of the building of expanded concepts: the notion of concept generation is revisited, suggesting the need for a new logic for organizing Front End activities in order to support sustainable innovative product development. Based on an in-depth empirical study at a European pharmaceutical company, this paper contributes to improved understanding of the actual management practices used in the Front End. Using a design reasoning model (the C-K model), it also adds to the growing body of literature on the management of Front End activities in new product development processes. [source] Diagnostic accuracy of cytology and immunocytology in carcinomatous effusionsCYTOPATHOLOGY, Issue 4 2008G. Metzgeroth Background:, Immunocytology substantially improves the diagnostic accuracy of conventional cytology in the diagnosis of carcinomatous effusions. Due to the unequivocal characterization of the various cell populations, a sensitivity of 92% and specificity of 100% was achieved by immunocytology, examining samples of 1234 serous effusions. Objective:, Cytology plays a central role in the aetiological clarification of serous effusions. The sensitivity of this method for the diagnosis of carcinomatous effusions varies between 40% and 80%. The aim of the present study was to investigate whether immunocytology substantially improves the diagnostic quality of the cytological examination in the diagnosis of carcinomatous effusions. Method:, Consecutive serous effusions were examined by conventional cytology and by immunocytology. The immunocytological examination was performed on smears, using a standard panel of three antibodies against pancytokeratin, human epithelial antigen 125 and calretinin. Results:, Altogether, 1234 effusion samples were examined. A total of 603 effusions were caused by carcinomas, five by malignant mesotheliomas, 11 by malignant lymphomas and 615 by non-malignant disorders. In conventional cytology, carcinomatous effusions were correctly diagnosed in 314 samples, corresponding to a sensitivity of 52%. In 31 specimens (5%) tumour cells without further specification were described and in 161 samples (27%) the presence of tumour cells was suspected (84% overall sensitivity). A total of 97 carcinomatous effusions (16%) were diagnosed false-negatively and 50 (8%) of the 615 non-malignant effusions false-positively (92% specificity). In immunocytology, 561 carcinomatous samples were correctly diagnosed, representing a sensitivity of 93%. In six cases (1%) the presence of tumour cells was suspected. A total of 36 carcinomatous effusions (6%) were diagnosed false-negatively (94% over-all sensitivity). Out of the 615 non-malignant specimens, there were no false-positive diagnoses (100% specificity). Conclusion:, Immunocytology is a simple, cost-effective, routinely practicable method which substantially improves the diagnostic accuracy of conventional cytology in the diagnosis of carcinomatous effusions. Therefore, we recommend the use of immunocytology in all those cases where cytology on its own is not completely unequivocal. [source] Health Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally,DECISION SCIENCES, Issue 2 2009Kingshuk K. Sinha ABSTRACT This article is motivated by the gap between the growing demand and available supply of high-quality, cost-effective, and timely health care, a problem faced not only by developing and underdeveloped countries but also by developed countries. The significance of this problem is heightened when the economy is in recession. In an attempt to address the problem, in this article, first, we conceptualize care as a bundle of goods, services, and experiences,including diet and exercise, drugs, devices, invasive procedures, new biologics, travel and lodging, and payment and reimbursement. We then adopt a macro, end-to-end, supply chain,centric view of the health care sector to link the development of care with the delivery of care. This macro, supply chain,centric view sheds light on the interdependencies between key industries from the upstream to the downstream of the health care supply chain. We propose a framework, the 3A-framework, that is founded on three constructs,affordability, access, and awareness,to inform the design of supply chain for the health care sector. We present an illustrative example of the framework toward designing the supply chain for implantable device,based care for cardiovascular diseases in developing countries. Specifically, the framework provides a lens for identifying an integrated system of continuous improvement and innovation initiatives relevant to bridging the gap between the demand and supply for high-quality, cost-effective, and timely care. Finally, we delineate directions of future research that are anchored in and follow from the developments documented in the article. [source] Hydrophilic Polymers with Potassium Salt and Microporous Polysaccharides for Use as Hemostatic AgentsDERMATOLOGIC SURGERY, Issue 12 2007JULIA HO MD BACKGROUND Postoperative bleeding can lead to complications such as hematoma, infection, dehiscence, and an unscheduled office visit. Topical hemostatic agents can be used to aid in hemostasis. OBJECTIVE The objective is to familiarize physicians with topical hemostatic agents,hydrophilic polymers with potassium salts (Urgent QR powder) and microporous polysaccharide hemispheres (Bleed-X). METHODS Two hemostatic agents, microporous polysaccharide hemospheres and hydrophilic polymers with potassium salt, are discussed. The literature is reviewed. RESULTS Numerous types of hemostatic agents exist. Topical hemostatic agents are safe, cost-effective, and efficient. CONCLUSION Microporous polysaccharide hemospheres and hydrophilic polymers with potassium salts can be an adjunct to hemostasis after cautery and ligation. Patients can apply hemostatic agents if they experience any bleeding leading to decreased office visits. Hemostatic agents used intraoperatively shorten bleeding time and enable the physician to use less cautery. Using hemostatic agents can lead to fewer hematomas, infections, and office visits. [source] Insulin therapy in type 2 diabetes patients failing oral agents: cost-effectiveness of biphasic insulin aspart 70/30 vs. insulin glargine in the US,DIABETES OBESITY & METABOLISM, Issue 1 2007J. A. Ray Objectives:, To project the long-term clinical and economic outcomes of treatment with biphasic insulin aspart 30 (BIAsp 70/30, 30% soluble and 70% protaminated insulin aspart) vs. insulin glargine in insulin-naïve type 2 diabetes patients failing to achieve glycemic control with oral antidiabetic agents alone (OADs). Methods:, Baseline patient characteristics and treatment effect data from the recent ,INITIATE' clinical trial served as input to a peer-reviewed, validated Markov/Monte-Carlo simulation model. INITIATE demonstrated improvements in HbA1c favouring BIAsp 70/30 vs. glargine (,0.43%; p < 0.005) and greater efficacy in reaching glycaemic targets among patients poorly controlled on OAD therapy. Effects on life expectancy (LE), quality-adjusted life expectancy (QALE), cumulative incidence of diabetes-related complications and direct medical costs (2004 USD) were projected over 35 years. Clinical outcomes and costs were discounted at a rate of 3.0% per annum. Sensitivity analyses were performed. Results:, Improvements in glycaemic control were projected to lead to gains in LE (0.19 ± 0.24 years) and QALE (0.19 ± 0.17 years) favouring BIAsp 70/30 vs. glargine. Treatment with BIAsp 70/30 was also associated with reductions in the cumulative incidences of diabetes-related complications, notably in renal and retinal conditions. The incremental cost-effectiveness ratio was $46 533 per quality-adjusted life year gained with BIAsp 70/30 vs. glargine (for patients with baseline HbA1c , 8.5%, it was $34 916). Total lifetime costs were compared to efficacy rates in both arms as a ratio, which revealed that the lifetime cost per patient treated successfully to target HbA1c levels of <7.0% and , 6.5% were $80 523 and $93 242 lower with BIAsp 70/30 than with glargine, respectively. Conclusions:, Long-term treatment with BIAsp 70/30 was projected to be cost-effective for patients with type 2 diabetes insufficiently controlled on OADs alone compared to glargine. Treatment with BIAsp 70/30 was estimated to represent an appropriate investment of healthcare dollars in the management of type 2 diabetes. [source] Continuous subcutaneous insulin infusion (CSII) 30 years later: still the best option for insulin therapyDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2009Daniela Bruttomesso Abstract Thirty years after its introduction, the use of continuous subcutaneous insulin infusion (CSII) keeps increasing, especially among children and adolescents. The technique, when used properly, is safe and effective. Compared with traditional NPH-based multiple daily injections (MDI), CSII provides a small but clinically important reduction of HbA1c levels, diminishes blood glucose variability, decreases severe hypoglycaemic episodes and offers a better way to cope with the dawn phenomenon. Insulin analogues have improved the treatment of diabetes, eroding part of the place previously occupied by CSII, but CSII still remains the first option for patients experiencing severe hypoglycaemic episodes, high HbA1c values or marked glucose variability while being treated with optimized MDI. Furthermore CSII is better than MDI considering the effects on quality of life and the possibility to adjust insulin administration according to physical activity or food intake. CSII may be limited by cost. Present estimates suggest that CSII may be cost-effective just for patients experiencing a marked improvement in HbA1c or a decrease in severe hypoglycaemic episodes, but the effects on quality of life are difficult to measure. CSII does not merely imply wearing an external device; it requires a multidisciplinary team, intensive patient education and continuous follow up. Copyright © 2009 John Wiley & Sons, Ltd. [source] Diabetic retinopathy screening: a systematic review of the economic evidenceDIABETIC MEDICINE, Issue 3 2010S. Jones Diabet. Med. 27, 249,256 (2010) Abstract This paper systematically reviews the published literature on the economic evidence of diabetic retinopathy screening. Twenty-nine electronic databases were searched for studies published between 1998 and 2008. Internet searches were carried out and reference lists of key studies were hand searched for relevant articles. The key search terms used were ,diabetic retinopathy', ,screening', ,economic' and ,cost'. The search identified 416 papers of which 21 fulfilled the inclusion criteria, comprising nine cost-effectiveness studies, one cost analysis, one cost-minimization analysis, four cost,utility analyses and six reviews. Eleven of the included studies used economic modelling techniques and/or computer simulation to assess screening strategies. To date, the economic evaluation literature on diabetic retinopathy screening has focused on four key questions: the overall cost-effectiveness of ophthalmic care; the cost-effectiveness of systematic vs. opportunistic screening; how screening should be organized and delivered; and how often people should be screened. Systematic screening for diabetic retinopathy is cost-effective in terms of sight years preserved compared with no screening. Digital photography with telemedicine links has the potential to deliver cost-effective, accessible screening to rural, remote and hard-to-reach populations. Variation in compliance rates, age of onset of diabetes, glycaemic control and screening sensitivities influence the cost-effectiveness of screening programmes and are important sources of uncertainty in relation to the issue of optimal screening intervals. There is controversy in relation to the economic evidence on optimal screening intervals. Further research is needed to address the issue of optimal screening interval, the opportunities for targeted screening to reflect relative risk and the effect of different screening intervals on attendance or compliance by patients. [source] Hub-and-spoke model for a 5-day structured patient education programme for people with Type 1 diabetesDIABETIC MEDICINE, Issue 9 2009H. Rogers Abstract Aims, Structured education programmes for people with Type 1 diabetes can deliver improved diabetes control (including reduced severe hypoglycaemia) and quality of life. They can be cost-effective but are resource intensive. We tested the ability to deliver an evidence-based 5-day programme in diabetes centres too small to deliver the courses. Methods, Specialist medical and nursing staff from three district general hospital diabetes services (the ,spokes') were trained in all aspects of the education programme, except those directly related to course delivery, by a larger centre (the ,hub'). The hub staff delivered the 5-day patient education courses, but all other patient education and management was managed locally. Diabetes control and quality of life were assessed at 1 year post-course. Results, In 63 patients with follow-up data, glycated haemoglobin (HbA1c) fell by 0.42 ± 1.0% (P = 0.001), with a greater fall in those with high HbA1c at baseline, and no mean weight gain. Emergency call-out for severe hypoglycaemia fell from 10 episodes in seven patients the year before to one episode in one patient (P = 0.03). Quality-of-life measures improved, with reduced negative impact of diabetes on diabetes-related quality of life (P < 0.00004) and ,present quality of life' improving (P < 0.001). Conclusions, The benefits of a 5-day structured education programme can be provided to patients with Type 1 diabetes attending centres without the resources to provide the teaching course itself, by a ,hub-and-spoke' methodology. [source] Patient-centred and professional-directed implementation strategies for diabetes guidelines: a cluster-randomized trial-based cost-effectiveness analysisDIABETIC MEDICINE, Issue 2 2006R. F. Dijkstra Abstract Aims Economic evaluations of diabetes interventions do not usually include analyses on effects and cost of implementation strategies. This leads to optimistic cost-effectiveness estimates. This study reports empirical findings on the cost-effectiveness of two implementation strategies compared with usual hospital outpatient care. It includes both patient-related and intervention-related cost. Patients and methods In a clustered-randomized controlled trial design, 13 Dutch general hospitals were randomly assigned to a control group, a professional-directed or a patient-centred implementation programme. Professionals received feedback on baseline data, education and reminders. Patients in the patient-centred group received education and diabetes passports. A validated probabilistic Dutch diabetes model and the UKPDS risk engine are used to compute lifetime disease outcomes and cost in the three groups, including uncertainties. Results Glycated haemoglobin (HbA1c) at 1 year (the measure used to predict diabetes outcome changes over a lifetime) decreased by 0.2% in the professional-change group and by 0.3% in the patient-centred group, while it increased by 0.2% in the control group. Costs of primary implementation were < 5 Euro per head in both groups, but average lifetime costs of improved care and longer life expectancy rose by 9389 Euro and 9620 Euro, respectively. Life expectancy improved by 0.34 and 0.63 years, and quality-adjusted life years (QALY) by 0.29 and 0.59. Accordingly, the incremental cost per QALY was 32 218 Euro for professional-change care and 16 353 for patient-centred care compared with control, and 881 Euro for patient-centred vs. professional-change care. Uncertainties are presented in acceptability curves: above 65 Euro per annum the patient-directed strategy is most likely the optimum choice. Conclusion Both guideline implementation strategies in secondary care are cost-effective compared with current care, by Dutch standards, for these patients. Additional annual costs per patient using patient passports are low. This analysis supports patient involvement in diabetes in the Netherlands, and probably also in other Western European settings. [source] Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetesDIABETIC MEDICINE, Issue 2 2004A. Ben-Haroush Abstract Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors. Diabet. Med. 20, ***,*** (2003) [source] The cost-effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetesDIABETIC MEDICINE, Issue 7 2003P. Scuffham Abstract Aims To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. Methods We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. Key parameters were obtained from the published scientific literature. The primary outcome was quality-adjusted life years (QALYs). Monte Carlo simulations were undertaken for 10 000 hypothetical patients over 8 years of monthly cycles (the expected life of a pump). Results Over an 8-year period an average patient could expect to gain 0.48 [standard deviation (sd) 0.20] QALYs using CSII compared with MDI. The additional cost over 8 years for this gain was £5462 (sd£897). The incremental cost per QALY was £11 461 (sd£3656). CSII was most cost-effective in patients who had more than two severe hypoglycaemic events per year and who required admission to hospital at least once every year. Cases where CSII might be not economically viable are cases where diabetes is well controlled with few severe hypoglycaemic events. Results were most sensitive to the number of hypoglycaemic events per patient and the utility weights used to estimate QALYs. Conclusion CSII is a worthwhile investment when targeted to those who might benefit most. Diabet. Med. 20, 586,593 (2003) [source] Novel therapeutics with enhanced biological activity generated by the strategic introduction of silicon isosteres into known drug scaffoldsDRUG DEVELOPMENT RESEARCH, Issue 4 2007Stephen Gately Abstract The strategic replacement of carbon with silicon within biologically prevalidated drug scaffolds can generate focused libraries of pharmaceutically relevant agents with novel, durable and marketable intellectual property. This approach can be cost-effective and of lower developmental risk because known drugs have recognized pharmacology and toxicity profiles, proven safety in humans, and established manufacturing and formulation methods. The change in shape, charge, and lipophilicity that can result from the addition of silicon can favorably alter the biological activity and toxicology of the parent drug. Silicon-containing derivatives of indomethacin are COX-2 selective, suggesting they will not be associated with the classical toxicities associated with nonselective inhibition of the cyclooxygenases. The silicon-indomethacin derivatives also demonstrated superior anti-cancer activity at clinically achievable concentrations when tested in vitro against a human pancreatic cancer cell line, MiaPaCa-2, and a panel of 14 human multiple myeloma cell lines. Bioorganosilicon chemistry represents an attractive approach for emerging biopharmaceutical organizations seeking to rapidly develop a portfolio of novel pharmacological agents that have the potential for enhanced therapeutic and pharmacological benefit. Drug Dev Res 68:156,163, 2007. ©2007 Wiley-Liss, Inc. [source] Quantitation of valproic acid in pharmaceutical preparations using dispersive liquid-liquid microextraction followed by gas chromatography-flame ionization detection without prior derivatizationDRUG TESTING AND ANALYSIS, Issue 7 2010Hamid Reza Sobhi Abstract Dispersive liquid-liquid microextraction (DLLME), coupled with gas chromatography-flame ionization detection (GC-FID), has been successfully used for the extraction and determination of valproic acid (VPA) in pharmaceutical preparations. In the developed method, an appropriate mixture of extracting and disperser solvents was rapidly injected into an aqueous sample. Having formed a cloudy solution, the mixture was centrifuged and then the extracting solvent was sedimented at the bottom of a conical test tube. The extract was then injected into a GC system directly, without any further pretreatment. Initially, microextraction efficiency factors were optimized and the optimum experimental conditions found were as follows: tetrachloroethylene (9.0 µL) as extracting solvent; acetone (1.0 mL) as disperser solvent; 5 mL acidic aqueous sample (pH 1) without salt addition. Under the selected conditions, the calibration curve showed linearity in the range of 0.1,5.0 mg/L with regression coefficient corresponding to 0.9998. The limit of detection was found to be 0.05 mg/L. Finally, the method was applied for the determination of VPA in two different pharmaceutical preparations. A reasonable intra-assay (3.9,10.8%, n = 3) and inter-assay (5.6,11.4%, n = 3) precision illustrated the good performance of the analytical procedure. The protocol proved to be rapid and cost-effective for screening purposes. Copyright © 2010 John Wiley & Sons, Ltd. [source] Cost-effectiveness of extended buprenorphine,naloxone treatment for opioid-dependent youth: data from a randomized trialADDICTION, Issue 9 2010Daniel Polsky ABSTRACT Aims The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine,naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. Design Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. Participants 152 patients aged 15,21 years. Measurements Data were collected prospectively during the 12-week treatment and at follow-up interviews at months 6, 9 and 12. Findings The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25 049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100 000 per QALY. Conclusions Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth. [source] Computer-delivered interventions for alcohol and tobacco use: a meta-analysisADDICTION, Issue 8 2010Sally Rooke ABSTRACT Aims To quantify the overall effectiveness of computer-delivered interventions for alcohol and tobacco use. Methods Meta-analysis of 42 effect sizes from randomized controlled trials, based on the responses of 10 632 individuals. Results The weighted average effect size (d) was 0.20, P < 0.001. While lower effect sizes were associated with studies addressing tobacco use (d = 0.14) this may well reflect differences in the types of outcome measure used. Effect sizes did not vary significantly as a function of treatment location, inclusion of entertaining elements, provision of normative feedback, availability of a discussion feature, number of treatment sessions, emphasis on relapse prevention, level of therapist involvement or follow-up period. Conclusion Findings of the meta-analysis suggest that minimal contact computer-delivered treatments that can be accessed via the internet may represent a cost-effective means of treating uncomplicated substance use and related problems. [source] If you try to stop smoking, should we pay for it?ADDICTION, Issue 6 2010The cost, utility of reimbursing smoking cessation support in the Netherlands ABSTRACT Background Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost,utility is lacking. Objectives To evaluate long-term effects of reimbursement of SCS. Methods Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial's confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses. Results Intervention costs per QALY gained compared to the reference scenario were approximately ,1200 extrapolating the trial effects directly, and ,4200 when combining the trial's use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost,utility of ,4500 and ,7400, respectively. In both scenarios costs per QALY remained below ,16 000 in sensitivity analyses using a life-time horizon. Conclusions Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective. [source] Commentary on Vemer et al. (2010): When is smoking cessation really cost-effective?ADDICTION, Issue 6 2010HANS JOACHIM SALIZE No abstract is available for this article. [source] Penguins as oceanographers unravel hidden mechanisms of marine productivityECOLOGY LETTERS, Issue 3 2002Jean-Benoît Charrassin ABSTRACT A recent concept for investigating marine ecosystems is to employ diving predators as cost-effective, autonomous samplers of environmental parameters (such as sea-temperature). Using king penguins during their foraging trips at sea, we obtained an unprecedented high resolution temperature map at depth off the Kerguelen Islands, Southern Ocean, a poorly sampled but productive area. We found clear evidence of a previously unknown subsurface tongue of cold water, flowing along the eastern shelf break. These new results provide a better understanding of regional water circulation and help explain the high primary productivity above the Kerguelen Plateau. [source] Policy options for alcohol price regulation: the importance of modelling population heterogeneityADDICTION, Issue 3 2010Petra Sylvia Meier ABSTRACT Context and aims Internationally, the repertoire of alcohol pricing policies has expanded to include targeted taxation, inflation-linked taxation, taxation based on alcohol-by-volume (ABV), minimum pricing policies (general or targeted), bans of below-cost selling and restricting price-based promotions. Policy makers clearly need to consider how options compare in reducing harms at the population level, but are also required to demonstrate proportionality of their actions, which necessitates a detailed understanding of policy effects on different population subgroups. This paper presents selected findings from a policy appraisal for the UK government and discusses the importance of accounting for population heterogeneity in such analyses. Method We have built a causal, deterministic, epidemiological model which takes account of differential preferences by population subgroups defined by age, gender and level of drinking (moderate, hazardous, harmful). We consider purchasing preferences in terms of the types and volumes of alcoholic beverages, prices paid and the balance between bars, clubs and restaurants as opposed to supermarkets and off-licenses. Results Age, sex and level of drinking fundamentally affect beverage preferences, drinking location, prices paid, price sensitivity and tendency to substitute for other beverage types. Pricing policies vary in their impact on different product types, price points and venues, thus having distinctly different effects on subgroups. Because population subgroups also have substantially different risk profiles for harms, policies are differentially effective in reducing health, crime, work-place absence and unemployment harms. Conclusion Policy appraisals must account for population heterogeneity and complexity if resulting interventions are to be well considered, proportionate, effective and cost-effective. [source] The cost-effectiveness of consistent and early intervention of harm reduction for injecting drug users in BangladeshADDICTION, Issue 2 2010Lorna Guinness ABSTRACT Aims To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary with baseline human immunodeficiency virus (HIV) prevalence. Design Economic cost data were collected from the study site and combined with impact estimates derived from a dynamic mathematical model. Setting Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries. Findings The cost per HIV infection prevented over the first 3 years was US$110.4 (33.1,182.3). The incremental cost-effectiveness of continuing the intervention for a further year, relative to stopping at the end of year 3, is US$97 if behaviour returns to pre-intervention patterns. When baseline IDU HIV prevalence is increased to 40%, the number of HIV infections averted is halved for the 3-year period and the cost per HIV infection prevented doubles to US$228. Conclusions The analysis confirms that harm reduction activities are cost-effective. Early intervention is more cost-effective than delaying activities, although this should not preclude later intervention. Starting harm reduction activities when IDU HIV prevalence reaches as high as 40% is still cost-effective. Continuing harm reduction activities once a project has matured is vital to sustaining its impact and cost-effectiveness. [source] The cost-effectiveness of antidepressants for smoking cessation in chronic obstructive pulmonary disease (COPD) patientsADDICTION, Issue 12 2009Constant P. Van Schayck ABSTRACT Objectives In healthy smokers, antidepressants can double the odds of cessation. Because of its four times lower costs and comparable efficacy in healthy smokers, nortriptyline appears to be favourable compared to bupropion. We assessed which of both drugs was most effective and cost-effective in stopping smoking after 1 year compared with placebo among smokers at risk or with existing chronic obstructive pulmonary disease (COPD). Methods A total of 255 participants, aged 30,70 years, received smoking cessation counselling and were assigned bupropion, nortriptyline or placebo randomly for 12 weeks. Prolonged abstinence from smoking was defined as a participant's report of no cigarettes from week 4 to week 52, validated by urinary cotinine. Costs were calculated using a societal perspective and uncertainty was assessed using the bootstrap method. Results The prolonged abstinence rate was 20.9% with bupropion, 20.0% with nortriptyline and 13.5% with placebo. The differences between bupropion and placebo [relative risk (RR) = 1.6; 95% confidence interval (CI) 0.8,3.0] and between nortriptyline and placebo (RR = 1.5; 95% CI 0.8,2.9) were not significant. Severity of airway obstruction did not influence abstinence significantly. Societal costs were ,1368 (2.5th,97.5th percentile 193,5260) with bupropion, ,1906 (2.5th,97.5th 120,17 761) with nortriptyline and ,1212 (2.5th,97.5th 96,6602) with placebo. Were society willing to pay more than ,2000 for a quitter, bupropion was most likely to be cost-effective. Conclusions Bupropion and nortriptyline seem to be equally effective, but bupropion appears to be more cost-effective when compared to placebo and nortriptyline. This impression holds using only health care costs. As the cost-effectiveness analyses concern some uncertainties, the results should be interpreted with care and future studies are needed to replicate the findings. [source] A New Amperometric Hydrazine Sensor Based on Prussian Blue/Single-walled Carbon Nanotube NanocompositesELECTROANALYSIS, Issue 16 2010Cong Wang Abstract A slow reaction process has been successfully used to synthesize Prussian blue/single-walled carbon nanotubes (PB/SWNTs) nanocomposites. Electrochemical and surface characterization by cyclic voltammetry (CV), scanning electron microscopy (SEM), transmission electron microscopy (TEM), UV-vis absorption spectroscopy, Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD) confirmed the presence of PB nanocrystallites on SWNTs. PB/SWNTs modified glassy carbon electrode (GCE) exhibits efficient electron transfer ability and high electrochemical response towards hydrazine. The fabricated hydrazine sensor showed a wide linear range of 2.0×10,6,6.0×10,3,M with a response time less than 4,s and a detection limit of 0.5,,M. PB/SWNTs modified electrochemical sensors are promising candidates for cost-effective in the hydrazine assays. [source] Cost-effectiveness of interventions to prevent alcohol-related disease and injury in AustraliaADDICTION, Issue 10 2009Linda Cobiac ABSTRACT Aims To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Methods Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Measurements Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Findings Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Conclusions Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||