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Economic analysis of erythropoietin use in orthopaedic surgery.

https://arctichealth.org/en/permalink/ahliterature202337
Source
Transfus Med. 1999 Mar;9(1):21-30
Publication Type
Article
Date
Mar-1999
Author
D. Coyle
K M Lee
D A Fergusson
A. Laupacis
Author Affiliation
Clinical Epidemiology Unit, Loeb Research Institute, Ottawa Civic Hospital, Canada.
Source
Transfus Med. 1999 Mar;9(1):21-30
Date
Mar-1999
Language
English
Publication Type
Article
Keywords
Blood Transfusion
Canada
Cost-Benefit Analysis
Erythropoietin - economics - therapeutic use
Humans
Intraoperative Care - methods
Meta-Analysis as Topic
Orthopedics - economics
Randomized Controlled Trials as Topic
Risk factors
Sensitivity and specificity
Transplantation, Homologous
Abstract
The aim was to assess the cost-effectiveness of erythropoietin (EPO) to reduce patients' exposure to perioperative allogenic blood products in orthopaedic surgery. The use of EPO was assessed for EPO used alone and for EPO, to augment preoperative autologous donation (PAD). A decision analytical model was designed incorporating (i) the risk of receiving allogeneic blood, (ii) the costs of blood products, (iii) the likelihood of developing transfusion-related diseases, (iv) the costs of transfusion-related diseases, (v) the impact of transfusion-related diseases on patient morbidity and mortality and (vi) the effect of EPO upon the probability of transfusion. The efficacy of EPO was derived from data from a meta-analysis of published randomized trials. Estimates for the other parameters were obtained by a systematic review of the literature. EPO alone led to only modest incremental benefit compared to no intervention for orthopaedic surgery (0.000024 life-years gained per patient). As an augmentation to PAD, EPO also led to modest benefits (0.000006 life-years gained per patient). For EPO compared to no intervention, the incremental cost per life-year gained was $66 million (Canadian). For EPO to augment PAD, the incremental cost per life-year gained was $329 million (Canadian). Detailed sensitivity analysis did not reveal any circumstances in which the cost-effectiveness ratios reached a level generally considered attractive. On the basis of cost-effectiveness, the use of EPO to reduce perioperative allogeneic transfusions in orthopaedic surgery did not meet criteria conventionally considered acceptable.
PubMed ID
10216902 View in PubMed
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The impact of risk on preference values: implications for evaluations of postmenopausal osteoporosis therapy.

https://arctichealth.org/en/permalink/ahliterature192556
Source
Value Health. 2001 Sep-Oct;4(5):385-91
Publication Type
Article
Author
D. Coyle
G. Wells
I. Graham
K M Lee
J E Peterson
E. Papadimitropoulos
Author Affiliation
Departments of Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. dcoyle@lri.ca
Source
Value Health. 2001 Sep-Oct;4(5):385-91
Language
English
Publication Type
Article
Keywords
Aged
Attitude to Health
Breast Neoplasms - epidemiology - psychology
Consumer Satisfaction - statistics & numerical data
Coronary Disease - epidemiology - psychology
Decision Making
Estrogen Replacement Therapy - utilization
Female
Hip Fractures - epidemiology - psychology
Humans
Middle Aged
Ontario
Osteoporosis, Postmenopausal - prevention & control
Perception
Probability
Raloxifene - therapeutic use
Regression Analysis
Risk assessment
Selective Estrogen Receptor Modulators - therapeutic use
Value of Life - economics
Women's health
Abstract
The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values.
Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district.
Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT (p = .002) and no therapy (p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer (p
PubMed ID
11705129 View in PubMed
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More frequent extreme climate events stabilize reindeer population dynamics.

https://arctichealth.org/en/permalink/ahliterature299250
Source
Nat Commun. 2019 04 08; 10(1):1616
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-08-2019
Author
Brage B Hansen
Marlène Gamelon
Steve D Albon
Aline M Lee
Audun Stien
R Justin Irvine
Bernt-Erik Sæther
Leif E Loe
Erik Ropstad
Vebjørn Veiberg
Vidar Grøtan
Author Affiliation
Centre for Biodiversity Dynamics, Department of Biology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway. brage.b.hansen@ntnu.no.
Source
Nat Commun. 2019 04 08; 10(1):1616
Date
04-08-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Abstract
Extreme climate events often cause population crashes but are difficult to account for in population-dynamic studies. Especially in long-lived animals, density dependence and demography may induce lagged impacts of perturbations on population growth. In Arctic ungulates, extreme rain-on-snow and ice-locked pastures have led to severe population crashes, indicating that increasingly frequent rain-on-snow events could destabilize populations. Here, using empirically parameterized, stochastic population models for High-Arctic wild reindeer, we show that more frequent rain-on-snow events actually reduce extinction risk and stabilize population dynamics due to interactions with age structure and density dependence. Extreme rain-on-snow events mainly suppress vital rates of vulnerable ages at high population densities, resulting in a crash and a new population state with resilient ages and reduced population sensitivity to subsequent icy winters. Thus, observed responses to single extreme events are poor predictors of population dynamics and persistence because internal density-dependent feedbacks act as a buffer against more frequent events.
PubMed ID
30962419 View in PubMed
Less detail

More frequent extreme climate events stabilize reindeer population dynamics.

https://arctichealth.org/en/permalink/ahliterature300894
Source
Nat Commun. 2019 04 08; 10(1):1616
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-08-2019
Author
Brage B Hansen
Marlène Gamelon
Steve D Albon
Aline M Lee
Audun Stien
R Justin Irvine
Bernt-Erik Sæther
Leif E Loe
Erik Ropstad
Vebjørn Veiberg
Vidar Grøtan
Author Affiliation
Centre for Biodiversity Dynamics, Department of Biology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway. brage.b.hansen@ntnu.no.
Source
Nat Commun. 2019 04 08; 10(1):1616
Date
04-08-2019
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Animals
Arctic Regions
Cold Climate - adverse effects
Female
Models, Statistical
Population Dynamics - statistics & numerical data
Rain
Reindeer
Seasons
Snow
Stochastic Processes
Svalbard
Abstract
Extreme climate events often cause population crashes but are difficult to account for in population-dynamic studies. Especially in long-lived animals, density dependence and demography may induce lagged impacts of perturbations on population growth. In Arctic ungulates, extreme rain-on-snow and ice-locked pastures have led to severe population crashes, indicating that increasingly frequent rain-on-snow events could destabilize populations. Here, using empirically parameterized, stochastic population models for High-Arctic wild reindeer, we show that more frequent rain-on-snow events actually reduce extinction risk and stabilize population dynamics due to interactions with age structure and density dependence. Extreme rain-on-snow events mainly suppress vital rates of vulnerable ages at high population densities, resulting in a crash and a new population state with resilient ages and reduced population sensitivity to subsequent icy winters. Thus, observed responses to single extreme events are poor predictors of population dynamics and persistence because internal density-dependent feedbacks act as a buffer against more frequent events.
PubMed ID
30962419 View in PubMed
Less detail