Our latest research, all in one place. Browse our collection of journal articles, reports and conference proceedings to see how we’re contributing to HEOR research. Remember to:
Interventions for drug-using offenders are employed internationally to reduce subsequent drug use and criminal behavior. This paper provides information from a systematic review of 24 randomized controlled trials (RCTs) conducted between 1980 and 2004. Thirteen of the 24 trials were included in a series of meta-analyses, and tentative conclusions are drawn on the basis of the evidence. Pretrial release with drugs testing and intensive supervision were shown to have limited success when compared to routine parole and probation, with effect sizes favoring routine parole and probation. Therapeutic community interventions showed promising results when compared to dispensation of treatment to individuals as usual, reducing risk of future offending behavior. A few studies evaluated the effectiveness of assertive case management and other community-based programs, but due to the paucity of information few inferences could be drawn from these studies. Little is known about the cost and cost effectiveness of such interventions, and the development of established protocols is required.
We estimated the incidence and cost of accidental falls for the population with visual impairment, and the incidence and cost of falls directly attributable to visual impairment for the UK in 1999. Methods: A prevalence-based cost model of medical care was developed using national data for Accident and Emergency (A&E) attendances and hospital inpatient admissions. The population with visual impairment was based on the age-specific prevalence rates of visual impairment. The number of falls directly attributable to visual impairment was estimated from the relative risk of falls for visual impairment reported in the literature. The number of health service resource events in each age group (0-14, 15-64, 65-74, and 75+ years) was multiplied by the respective cost of each event. Results: There were over 2.35 million accidental falls in the UK that required hospital treatment in 1999. Of these falls, 189,000 occurred in individuals with visual impairment, of which 89,500 can be attributed to the visual impairment itself. The estimated medical costs of these falls were £269 m (range: £193 m - £360 m) and £128 m (range: £32 m - £240 m), respectively. Eighty-nine percent of these falls and the majority of costs occurred in those aged 75 years and over. Results were most sensitive to the relative risks of falls and the proportion of long-term care costs attributed to the fall. Conclusions: Of the total cost of treating all accidental falls in the UK, 21% was spent on the population with visual impairment and 10% was directly attributable to visual impairment.
OBJECTIVES: The overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.
METHODS: A Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.
RESULTS: Over a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was 2680 pound per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was 5338 pound. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was 4672 pound.
CONCLUSIONS: For patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI.
Identifying information to inform patient care decisions can be straightforward if you know the important key resources. In recent years the NHS has invested in services that collate evidence and identify the messages from research. You can use these to help make patient care more evidence-based and to reduce health inequalities. This article describes some of the key resources you can use to inform life-long learning and to answer day-to-day clinical queries.
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Treatment with imatinib has demonstrated high response rates and improved prognosis in chronic myelogenous leukemia. However, while the short-term response to imatinib is high, there are some concerns that the long-term response is substantially lower. Durable response with imatinib is difficult to achieve in patients with resistant disease. The use of higher doses has also been associated with increased toxicity and intolerance. Dasatinib is a new SRC–ABL-kinase inhibitor that has been developed for treating chronic myelogenous leukemia patients, across all phases of disease, who are resistant or intolerant to imatinib. This article details the existing evidence on the clinical efficacy, safety and value for money of dasatinib in the treatment of imatinib-resistant and -intolerant patients with chronic myelogenous leukemia. Dasatinib is associated with higher levels of response compared with high-dose imatinib. In addition, higher levels of response are associated with improved health outcomes in terms of both quality- and quantity-of-life years.
