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BACKGROUND AND AIMS: Current guidelines in Germany recommend use of Rosiglitazone (RSG) in combination with Metformin for treatment of obese patients with Type 2 diabetes when Metformin monotherapy is no longer effective in maintaining glycaemic control. We assess the cost-effectiveness
of this strategy compared to combination therapy with Glibenclamide.
MATERIALS AND METHODS: DiDACT, an established long-term economic model of Type 2 diabetes, was adapted for clinical practice and health care financing rules in Germany. The model was calibrated using CODE-2® study data and national statistics. The perspective is that of the sickness
funds, and includes all hospital care, physician consultations, medications (incl. test strips), rehabilitation, physiotherapy, foot care and sick leave. The model was used to simulate treatment histories for a mixed incident cohort of 1000 obese patients (BMI=30). Following failure of glycaemic control
with Metformin alone, combination therapy adding RSG was compared to adding Glibenclamide. The threshold for switching therapies was 7% HbA1c. In line with national guidelines, costs were discounted at 5% pa.
RESULTS: The model predicts that adding RSG (4mg titrated to 8mg daily) to Metformin produces better glycaemic control in most patients, and extends viability of combination therapy by at least 7 years before requiring insulin. The extra life-years estimated in a mixed cohort of newly diagnosed patients are conservative as some progress too rapidly to insulin to be eligible for combination therapy. Additional gains in QALYs arise from fewer or delayed complications, and improved quality of life while insulin treatment is avoided. Net cost increases are modest since additional costs of RSG are partly offset by savings from delaying insulin therapy.
CONCLUSIONS: Use of RSG in combination with Metformin to improve glycaemic control and delay use of insulin is highly cost-effective in Germany when compared to Metformin + Glibenclamide.
INTRODUCTION: Influenza is associated with illnesses such as pneumonia and other respiratory conditions and in severe cases leads to death. The prevalence of these illnesses and deaths fluctuates with the seasons during the year, even in the absence of influenza. Although many studies have focussed on mortality associated with influenza epidemics, and some have examined hospitalizations in elderly patients, there are very few studies that have examined the effect of influenza epidemics on adults or children. This study seeks to determine the association between general practitioner (GP) consultations for influenza-like illnesses and hospital admissions of adults and children associated with influenza epidemics.
METHODS: Structural Time Series Models with stochastic trend and seasonal components were developed for two age groups (children aged 0-15 years, and adults aged 16-50 years). Data from the Swiss Sentinel Surveillance Network on GP consultation rates for influenza-like illnesses, and data from Swiss hospital admissions, were obtained for the period 1987-1996. The explanatory variables (i.e., the percentage of GP consultations for influenza-like illnesses and a 1-week lag of this variable) were modeled against hospital admission rates for pneumonia and influenza and other respiratory conditions. Excess hospitalizations were calculated as the difference between predicted hospital admissions during influenza epidemics and expected hospital admissions in the absence of influenza epidemics.
RESULTS: In these two age groups, there was an annual average of 1452 (range: 1000-1700) hospital admissions directly associated with influenza epidemics. Excess admission rates were substantially higher in children (pneumonia and influenza: 4.77 per 10 000 children per year, and other respiratory conditions: 2.29 per 10 000 children per year) compared with adults (pneumonia and influenza: 0.86 per 10 000 adults per year and other respiratory conditions: 0.68 per 10 000 adults per year). The models explained 56-84% of the variation in hospital admissions. The seasonal patterns were stable over the 10 years modeled and the variances of the trends were small.
CONCLUSION: The structural time series models is an ideal approach to model influenza-related hospitalizations as the models capture trends, seasonal variation, and the association with exogenous factors.
No abstract available
OBJECTIVES: This paper examines the cost effectiveness of the compulsory bicycle helmet wearing law (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries.
METHODS: Three age groups were examined: cyclists aged 5-12 years, 13-18 years, and >/=19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness-to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated.
RESULTS: The net benefit (benefit:cost ratios) of the HWL for the 5-12, 13-18, and >/=19 year age groups was $0.3m (2.6), -$0.2m (0.8), and -$1.5m (0.7) (in NZ $, 2000 prices; NZ $1.00 = US $0.47 = UK pound 0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries.
CONCLUSIONS: The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (>/=19 years) cyclists.
BSCKGROUND: Young people with physical disabilities often have difficulty attaining independence in adult life and consequently need lifelong support from parents and from health-care and social-care services. There are concerns about the organisation and cost-effectiveness of such services and their ability to meet the independence training and serious health needs of these young people. Our aim was to compare a young adult team (YAT) approach with the ad hoc service approach in four locations in England, in terms of their ability to enhance the participation in society of these young people and their cost.
METHODS: We did a retrospective cohort study, in which we interviewed 254 physically disabled young people. 124 healthy controls were given a questionnaire. We interviewed with standardised measures and used logistic regression analysis to test for effects of ad hoc and YAT services. The Mantel-Haenszel χ2 statistic was used to test for differences in resource use between areas in which the YAT and ad hoc services were available.
FINDINGS: The absence of pain, fatigue, and stress increased the odds of participation two-fold to four-fold. After adjustment for these factors, young people cared for by multidisciplinary YAT teams were 2·54 times (95% Cl 1·30-4·98) more likely than those who used ad hoc services to participate in society. Resource use did not differ between the two service types.
INTERPRETATION: A YAT approach costs no more to implement than an ad hoc approach, and is more likely to enhance participation in society of young people with physical disabilities.
BACKGROUND: In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).
AIMS: To perform a systematic review of all such studies.
METHOD: We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.
RESULTS: A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was -0.14, 95% Cl -0.07 to -0.22). A similar significant advantage was found against SSRIs (20 studies) but not tricyclic antidepressants (7 studies).
CONCLUSIONS: Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.
OBJECTIVES:The impact of economic evaluation studies on health-care decision makers has been shown to be rather limited. However, there is an increasing requirement for the cost-effectiveness of health-care interventions to be considered in formulating and implementing guidelines for clinical practice. This paper reports the findings of recent focus group research among UK health authorities, which examined the usefulness of published economic evaluations within the decision-making processes. The findings are presented and discussed in light of other studies that have addressed this issue.
METHODS: Focus group research was conducted with decision makers from a sample of two UK health authorities using the National Health Service Economic Evaluation Database (NHS EED) as a research vehicle to locate and report the findings of relevant economic studies. The study sample was initially invited to respond to questionnaires exploring the usefulness of published economic evaluations in the decision-making process and to outline particular topics that it felt would benefit from similar economic evidence. Following this, a detailed search was undertaken to retrieve structured NHS EED abstracts on these topics such that the usefulness and limitations of economic evaluations to decision making could be determined.
RESULTS: Decision makers generally recognized the usefulness and necessity of published economic evaluations in informing their decision-making processes. However, the value of studies was often limited because of the poor generalizability of results, the narrowness of research questions, and the lack of methodological rigor common to many published studies. A total of 237 NHS EED full abstracts were retrieved in the specified areas of interest, which, within specified caveats, were generally found to be useful as decision-making tools. There was a general consensus among decision makers in favor of developing a quality-scoring system for studies, thereby going beyond the critical summaries given in NHS EED.
CONCLUSIONS: Decision makers value information on cost-effectiveness as well as effectiveness alone, but methodological improvements are necessary to increase the reliability of economic studies. A quality-scoring system for published studies would be a useful development as a filtering mechanism for decision makers but would raise a number of challenges for health economists.
