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No abstract available
OBJECTIVE: To assess the cost effectiveness of post-acute care for older people in a locality based community hospital compared with a department for care of elderly people in a district general hospital, which admits patients aged over 76 years with acute medical conditions.
DESIGN: Cost effectiveness analysis within a randomised controlled trial.
SETTING: Community hospital and district general hospital in Yorkshire, England.
PARTICIPANTS: 220 patients needing rehabilitation after an acute illness for which they required admission to hospital.
INTERVENTIONS: Multidisciplinary care in the district general hospital or prompt transfer to the community hospital.
MAIN OUTCOME MEASURES: EuroQol EQ-5D scores transformed into quality adjusted life years (QALYs), and health and social service costs over six months from randomisation.
RESULTS: The mean QALY score for the community hospital group was marginally non-significantly higher than that for the district general hospital group (0.38 v 0.35) at six months after recruitment. The mean (standard deviation) costs per patient of the health and social services resources used were similar for both groups: community hospital group 7233 pounds sterling (euros 10,567; 13,341 dollars) (5031 pounds sterling), district general hospital group 7351 pounds sterling(6229 pounds sterling), and these findings were robust to several sensitivity analyses. The incremental cost effectiveness ratio for community hospital care dominated. A cost effectiveness acceptability curve, based on bootstrapped simulations, suggests that at a willingness to pay threshold of 10,000 pounds sterling per QALY, 51% of community hospital cases will be cost effective, which rises to 53% of cases when the threshold is 30,000 pounds sterling per QALY.
CONCLUSION: Post-acute care for older people in a locality based community hospital is of similar cost effectiveness to that of an elderly care department in a district general hospital.
No abstract available
OBJECTIVE: The researchers sought to assess whether the widely used 1994 Cochrane Highly Sensitive Search Strategy (HSSS) for randomized controlled trials (RCTs) in MEDLINE could be improved in terms of sensitivity, precision, or parsimony.
METHODS: A gold standard of 1,347 RCT records and a comparison group of 2,400 non-trials were randomly selected from MEDLINE. Terms occurring in at least 1% of RCT records were identified. Fifty percent of the RCT and comparison group records were randomly selected, and the ability of the terms to discriminate RCTs from nontrial records was determined using logistic regression. The best performing combinations of terms were tested on the remaining records and in MEDLINE.
RESULTS: The best discriminating term was ''Clinical Trial'' (Publication Type). In years where the Cochrane assessment of MEDLINE records had taken place, the strategies identified few additional unindexed records of trials. In years where Cochrane assessment has yet to take place, ''Randomized Controlled Trial'' (Publication Type) proved highly sensitive and precise. Adding six more search terms identified further, unindexed trials at reasonable levels of precision and with sensitivity almost equal to the Cochrane HSSS.
CONCLUSIONS: Most reports of RCTs in MEDLINE can now be identified easily using ''Randomized Controlled Trial'' (Publication Type). More sensitive searches can be achieved by a brief strategy, the Centre for Reviews and Dissemination/Cochrane Highly Sensitive Search Strategy (2005 revision).
The effectiveness of rosuvastatin in improving lipid measurements and achieving guideline target levels in patients has been demonstrated in short-term randomised clinical trials. The Framingham Heart Study has provided some of the strongest evidence in establishing the relationship between risk factors such as smoking, hypertension and cholesterol and events from cardiovascular disease and subsequent mortality. Using Framingham risk equations for coronary heart disease, we used a Markov model to extrapolate beyond short-term trial evidence to calculate the cost-effectiveness of cholesterol-lowering therapy in 55-year-old men and women, with an initial total cholesterol: high-density lipoprotein cholesterol (TC:HDL) ratio of 5.5 and an untreated expected survival (under adjusted Framingham risk equations) of 17 years (men) and 19 years (women). After titration, cholesterol-lowering therapy reduced the weighted average TC:HDL ratio to 3.4 (rosuvastatin), 3.7 (atorvastatin), 3.9 (simvastatin), 4.1 (fluvastatin) and 4.2 (pravastatin). In comparison with no treatment, rosuvastatin produced the greatest health gain (0.71 quality-adjusted life-years [QALYS]) and pravastatin the smallest (0.42). In the base case analysis, rosuvastatin dominated atorvastatin and delivered additional benefits at the cost of £9,735 per QALY for men in comparison with generic simvastatin. Sensitivity analysis showed a high probability of rosuvastatin being cost-effective under conditions of uncertainty.
OBJECTIVE: This study aimed to assess the performance, in terms of sensitivity and precision, of different approaches to searching MEDLINE and EMBASE to identify studies of adverse effects.
METHODS: Five approaches to searching for adverse effects evidence were identified: approach 1, using specified adverse effects; approach 2, using subheadings/qualifiers; approach 3, using text words; approach 4, using indexing terms; approach 5, searching for specific study designs. The sensitivity and precision of these five approaches, and combinations of these approaches, were compared in a case study using a systematic review of the adverse effects of seven anti-epileptic drugs.
RESULTS: The most sensitive search strategy in MEDLINE (97.0%) required a combination of terms for specified adverse effects, floating subheadings, and text words for 'adverse effects'. In EMBASE, a combination of terms for specified adverse effects and text words for 'adverse effects' provided the most sensitive search strategy (98.6%). Both these search strategies yielded low precision (2.8%).
CONCLUSIONS: A highly sensitive search in either database requires a combination of approaches, and has low precision. This suggests that better reporting and indexing of adverse effects is required and that an effective generic search filter may not yet be feasible.
BACKGROUND: Drug strategies internationally recognize link between drug use and crime. This review consider interventions for drug-using offenders
under the care of the criminal justice system.
OBJECTIVES: To assess the effectiveness of interventions for drug-using offenders in reducing criminal activity and drug use in the courts, secure
establishments and community-based settings.
SEARCH METHODS: Twenty two electronic databases were searched (1980 to 2004). Internet sites and experts in the field were contacted for further
information.
SELECTION CRITERIA: Randomised Controlled Trials designed to reduce, eliminate or prevent relapse in drug using offenders
DATA COLLECTION AND ANALYSIS: Two authors independently assessed trials for inclusion. Data were extracted by one author and double checked.
MAIN RESULTS: Twenty four studies, 8936 participants, met the inclusion criteria. Results show that comparing a court-based community pre-trial
release with drugs testing and sanctions versus routine pre-trial, for arrest at 90 days results favoured the comparison group OR 1.33
(95% CI 1.04 to 1.70). Comparing therapeutic community with aftercare with a mental health programme with a waiting list control,
considering incarceration at 12 months OR 0.37 (95% CI 0.16 to 0.87), results in favour of the treatment Comparing intensive
supervision with routine parole/probation, for recidivism OR 1.98 (95% CI 1.01 to 3.87) results in favour of comparison group, no
