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Cost-effectiveness of positron emission tomography/computed tomography in the management of advanced head and neck cancer.

https://arctichealth.org/en/permalink/ahliterature126142
Source
J Otolaryngol Head Neck Surg. 2011 Dec;40(6):468-72
Publication Type
Article
Date
Dec-2011
Author
George Kurien
Jia Hu
Jeffrey Harris
Hadi Seikaly
Author Affiliation
Department of Surgery, University of Alberta, Edmonton, AB.
Source
J Otolaryngol Head Neck Surg. 2011 Dec;40(6):468-72
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Alberta
Carcinoma, Squamous Cell - diagnosis - economics - pathology - therapy
Cohort Studies
Contrast Media
Cost-Benefit Analysis
Disease Progression
Female
Fluorodeoxyglucose F18 - diagnostic use
Hospital Costs
Humans
Lung Neoplasms - diagnosis - economics - secondary - therapy
Male
Middle Aged
Multimodal Imaging - economics
Neoplasm Staging
Otorhinolaryngologic Neoplasms - diagnosis - economics - pathology - therapy
Palliative Care - economics
Positron-Emission Tomography
Retrospective Studies
Sensitivity and specificity
Tomography, X-Ray Computed
Whole Body Imaging - economics
Abstract
Positron emission tomography/computed tomography (PET/CT) is a newer imaging modality that combines whole-body PET using [(18)F]fluorodeoxyglucose (FDG) and contrasted high-resolution CT. This has the advantage of combining the functional imaging of FDG-PET with the anatomic detail afforded by CT.
To assess the cost-benefit of whole-body PET/CT as a diagnostic tool in head and neck cancer.
A retrospective cohort (American Joint Committee on Cancer III-IVB squamous cell carcinoma in 2003) was reviewed for costs of diagnostic tests, distant metastases, and treatment type. This was compared to a hypothetical cohort of patients using PET/CT as a sole diagnostic tool using the current literature on test characteristics in the detection of distant metastases. The main outcome measure was the cost of the diagnostic workup, and the secondary outcome measure was the cost of the treatment.
The cost of the traditional workup was $450 per patient, whereas the cost of PET/CT workup was $722 per patient. The sensitivity of the traditional workup for lung metastases at 12 months was 14.3%. The average cost of curative surgery was $81,290, radiotherapy was $8,224, and chemotherapy was $1,158. In the cohort of 76 patients reviewed, improved PET/CT sensitivity would theoretically detect three more cases of metastatic disease and reduce the total cohort cost of treatment by $198,526 by relegating these patients to palliation.
PET/CT is a more expensive test when used alone in the diagnostic workup of head and neck cancer but results in an overall cost savings by reducing the number of futile radical treatments. There is a cost benefit to the use of PET/CT as the diagnostic and staging test for head and neck cancer patients.
PubMed ID
22420434 View in PubMed
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The lifetime direct cost of periodontal treatment: a case study from a Norwegian specialist practice.

https://arctichealth.org/en/permalink/ahliterature126205
Source
J Periodontol. 2012 Dec;83(12):1455-62
Publication Type
Article
Date
Dec-2012
Author
Øystein Fardal
Ciaran O'Neill
Per Gjermo
Elizabeth Fardal
Leiv Sandvik
B Frode Hansen
Gerard J Linden
Author Affiliation
fardal@odont.uio.no
Source
J Periodontol. 2012 Dec;83(12):1455-62
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Chronic Periodontitis - economics - therapy
Cost-Benefit Analysis
Dental Implants - economics
Denture, Partial, Fixed - economics
Health Care Costs - statistics & numerical data
Humans
Norway
Organizational Case Studies
Periodontics - economics
Quality-Adjusted Life Years
Tooth Loss - economics
Abstract
Successful periodontal treatment requires a commitment to regular lifelong maintenance and may be perceived by patients to be costly. This study calculates the total lifetime cost of periodontal treatment in the setting of a specialist periodontal practice and investigates the cost implications of choosing not to proceed with such treatment.
Data from patients treated in a specialist practice in Norway were used to calculate the total lifetime cost of periodontal treatment that included baseline periodontal treatment, regular maintenance, retreatment, and replacing teeth lost during maintenance. Incremental costs for alternative strategies based on opting to forego periodontal treatment or maintenance and to replace any teeth lost with either bridgework or implants were calculated.
Patients who completed baseline periodontal treatment but did not have any additional maintenance or retreatment could replace only three teeth with bridgework or two teeth with implants before the cost of replacing additional teeth would exceed the cost of lifetime periodontal treatment. Patients who did not have any periodontal treatment could replace = 4 teeth with bridgework or implants before a replacement strategy became more expensive.
Within the limits of the assumptions made, periodontal treatment in a Norwegian specialist periodontal practice is cost-effective when compared to an approach that relies on opting to replace teeth lost as a result of progressive periodontitis with fixed restorations. In particular, patients who have initial comprehensive periodontal treatment but do not subsequently comply with maintenance could, on average, replace = 3 teeth with bridgework or two teeth with implants before this approach would exceed the direct cost of lifetime periodontal treatment in the setting of the specialist practice studied.
PubMed ID
22414260 View in PubMed
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Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment.

https://arctichealth.org/en/permalink/ahliterature126227
Source
CMAJ. 2012 Apr 3;184(6):E317-28
Publication Type
Article
Date
Apr-3-2012
Author
Bohdan Nosyk
Daphne P Guh
Nicholas J Bansback
Eugenia Oviedo-Joekes
Suzanne Brissette
David C Marsh
Evan Meikleham
Martin T Schechter
Aslam H Anis
Author Affiliation
Centre for Health Evaluation and Outcome Sciences, Vancouver, BC.
Source
CMAJ. 2012 Apr 3;184(6):E317-28
Date
Apr-3-2012
Language
English
Publication Type
Article
Keywords
Adult
Analgesics, Opioid - economics - therapeutic use
British Columbia
Chronic Disease
Cohort Studies
Cost-Benefit Analysis
Drug Costs
Female
Heroin - economics - therapeutic use
Humans
Male
Markov Chains
Methadone - economics - therapeutic use
Models, Statistical
Opiate Substitution Treatment - economics
Opioid-Related Disorders - drug therapy - economics
Quality-Adjusted Life Years
Abstract
Although diacetylmorphine has been proven to be more effective than methadone maintenance treatment for opioid dependence, its direct costs are higher. We compared the cost-effectiveness of diacetylmorphine and methadone maintenance treatment for chronic opioid dependence refractory to treatment.
We constructed a semi-Markov cohort model using data from the North American Opiate Medication Initiative trial, supplemented with administrative data for the province of British Columbia and other published data, to capture the chronic, recurrent nature of opioid dependence. We calculated incremental cost-effectiveness ratios to compare diacetylmorphine and methadone over 1-, 5-, 10-year and lifetime horizons.
Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each of the time horizons. Over a lifetime horizon, our model showed that people receiving methadone gained 7.46 discounted quality-adjusted life-years (QALYs) on average (95% credibility interval [CI] 6.91-8.01) and generated a societal cost of $1.14 million (95% CI $736,800-$1.78 million). Those who received diacetylmorphine gained 7.92 discounted QALYs on average (95% CI 7.32-8.53) and generated a societal cost of $1.10 million (95% CI $724,100-$1.71 million). Cost savings in the diacetylmorphine cohort were realized primarily because of reductions in the costs related to criminal activity. Probabilistic sensitivity analysis showed that the probability of diacetylmorphine being cost-effective at a willingness-to-pay threshold of $0 per QALY gained was 76%; the probability was 95% at a threshold of $100,000 per QALY gained. Results were confirmed over a range of sensitivity analyses.
Using mathematical modelling to extrapolate results from the North American Opiate Medication Initiative, we found that diacetylmorphine may be more effective and less costly than methadone among people with chronic opioid dependence refractory to treatment.
Notes
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Comment In: CMAJ. 2012 Sep 18;184(13):149922988293
PubMed ID
22410375 View in PubMed
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Reuse and refurbish: a cost savings delivery model for specialized seating.

https://arctichealth.org/en/permalink/ahliterature126230
Source
Arch Phys Med Rehabil. 2012 Jul;93(7):1286-8
Publication Type
Article
Date
Jul-2012
Author
Rodney S Li Pi Shan
Wendy M Chrusch
Angelo G Linassi
Rajini Sankaran
Jeanine Munchinsky
Author Affiliation
Division of Physical Medicine and Rehabilitation, University of Calgary, Alberta, Canada. Rodney.lipishan@albertahealthservices.ca
Source
Arch Phys Med Rehabil. 2012 Jul;93(7):1286-8
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Alberta
Child
Child, Preschool
Cost Savings
Cost-Benefit Analysis
Disability Evaluation
Disabled Children
Equipment Reuse - economics
Female
Humans
Infant
Longitudinal Studies
Male
Models, Economic
Retrospective Studies
Self-Help Devices - economics
Wheelchairs - economics
Abstract
To describe a unique specialized seating delivery model for children with disabilities that focuses on cost containment and environmental preservation. To determine whether this delivery model achieves cost containment.
A retrospective cost analysis using data from billing records and annual statistical reports of the specialized seating program, for the 2004 to 2009 billing period.
The specialized seating program is a service provided on a referral basis by the Saskatchewan Abilities Council, which is under contract to Saskatchewan Health.
Pediatric patients (N=40) with physical disabilities (cerebral palsy, developmental delay, acquired brain injury, spinal cord injury, Down syndrome, other) who were referred, assessed, and met inclusion criteria.
Not applicable.
Relative cost (in Canadian dollars) of providing units with recycled components compared with purchasing new units.
The average cost of a used wheelchair was Can $698.11. The average cost of a new chair was $2143.69, leading to an average savings per chair of $1445.58. Of the 49 chairs issued, this resulted in a total cost savings of $85,393.97. When labor costs were taken into account ($50,060.26), the savings amounted to $35,333.71. Overall cost reduction was 41.3%.
A retrospective analysis shows evidence of cost containment. Long-term sustainability of the program requires ongoing analysis of the cost and environmental advantages of a recycling program and review of benefits provided in relation to the ability to meet patient needs. This delivery model does incorporate accountability and a policy framework, which could serve as a model for other centers.
PubMed ID
22410182 View in PubMed
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Cost efficiency comparison of four video-based techniques for assessing upper arm postures.

https://arctichealth.org/en/permalink/ahliterature126241
Source
Ergonomics. 2012;55(3):350-60
Publication Type
Article
Date
2012
Author
Mahmoud Rezagholi
Svend Erik Mathiassen
Per Liv
Author Affiliation
Department of Occupational and Public Health Sciences, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden. madrei@hig.se
Source
Ergonomics. 2012;55(3):350-60
Date
2012
Language
English
Publication Type
Article
Keywords
Algorithms
Arm - physiology
Barbering
Biomechanical Phenomena
Cost-Benefit Analysis
Female
Hair
Humans
Occupational Exposure - analysis
Posture
Sweden
Task Performance and Analysis
Videotape Recording - economics
Abstract
Many video-based techniques for assessing postures at work have been developed. Choosing the most appropriate technique should be based on an evaluation of different alternatives in terms of their ability to produce posture information at low input costs, i.e. their cost efficiency. This study compared four video-based techniques for assessing upper arm postures, using cost and error data from an investigation on hairdressers. Labour costs associated with the posture assessments from the video recordings were the dominant factor in the cost efficiency comparison. Thus, a work sampling technique associated with relatively large errors appeared, in general, to be the most cost-efficient because it was labour-saving. Measurement bias and other costs than labour cost for posture assessment influenced the ranking and economic evaluation of techniques, as did the applied measurement strategy, i.e. the numbers of video recordings and repeated assessments of them.
The cost efficiency of four video-based techniques for assessing upper arm postures was compared. Work sampling techniques were in general more cost efficient than continuous observations since they were labour-saving. Whilst a labour cost dominated the comparison, 'hidden costs', bias and measurement strategy also influenced this dominance.
PubMed ID
22409172 View in PubMed
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Assessing the efficiency of priorities for traffic law enforcement in Norway.

https://arctichealth.org/en/permalink/ahliterature126271
Source
Accid Anal Prev. 2012 Jul;47:146-52
Publication Type
Article
Date
Jul-2012
Author
Rune Elvik
Céline Vallet Sogge
Lasse Lager
Finn Harald Amundsen
Live Tanum Pasnin
Runar Karlsen
Knut Fosli
Author Affiliation
Institute of Transport Economics, Gaustadalléen 21, NO-0349 Oslo, Norway. re@toi.no
Source
Accid Anal Prev. 2012 Jul;47:146-52
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Accident Prevention - economics - legislation & jurisprudence - statistics & numerical data
Accidents, Traffic - legislation & jurisprudence - prevention & control - statistics & numerical data
Automobile Driving - legislation & jurisprudence - statistics & numerical data
Cost-Benefit Analysis
Efficiency
Humans
Law Enforcement
Norway
Police
Abstract
This paper assesses the efficiency of priorities for traffic law enforcement in Norway. Priorities are regarded as efficient if: (1) enforcement ensures a sufficient level of deterrence to keep down the rate of violations; (2) selection of target violations for enforcement is based on the risk attributable to them; and (3) an optimal level of enforcement is selected, i.e. the marginal benefits of enforcement in terms of preventing accidents equal the marginal costs of enforcement. The efficiency of current traffic law enforcement in Norway is assessed in terms of these criteria. It is found that the risk of apprehension varies considerably between different traffic violations. These variations do not reflect the risk attributable to the violations, i.e. it is not the case that the risk of apprehension is higher for violations that make a large contribution to fatalities and injuries than for violations that make a smaller contribution. In principle, shifting priorities so as to increase the risk of apprehension for some violations and reduce it for other violations could make police enforcement slightly more efficient. The main finding, however, is that the current level of enforcement is too low. Cost-benefit analyses show that substantially increasing the amount of police enforcement is cost-effective.
PubMed ID
22405243 View in PubMed
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Vitamin K supplementation for the primary prevention of osteoporotic fractures: is it cost-effective and is future research warranted?

https://arctichealth.org/en/permalink/ahliterature126332
Source
Osteoporos Int. 2012 Nov;23(11):2681-92
Publication Type
Article
Date
Nov-2012
Author
O. Gajic-Veljanoski
A M Bayoumi
G. Tomlinson
K. Khan
A M Cheung
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Source
Osteoporos Int. 2012 Nov;23(11):2681-92
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Bone Density Conservation Agents - economics - therapeutic use
Calcium - economics - therapeutic use
Canada - epidemiology
Cholecalciferol - economics - therapeutic use
Cost-Benefit Analysis
Dietary Supplements
Drug Costs - statistics & numerical data
Drug Therapy, Combination
Female
Health Care Costs - statistics & numerical data
Humans
Middle Aged
Models, Econometric
Osteoporosis, Postmenopausal - complications - drug therapy - economics
Osteoporotic Fractures - economics - epidemiology - etiology - prevention & control
Quality of Life
Quality-Adjusted Life Years
Treatment Outcome
Vitamin K 1 - economics - therapeutic use
Vitamin K 2 - economics - therapeutic use
Abstract
Lifetime supplementation with vitamin K, vitamin D(3), and calcium is likely to reduce fractures and increase survival in postmenopausal women. It would be a cost-effective intervention at commonly used thresholds, but high uncertainty around the cost-effectiveness estimates persists. Further research on the effect of vitamin K on fractures is warranted.
Vitamin K might have a role in the primary prevention of fractures, but uncertainties about its effectiveness and cost-effectiveness persist.
We developed a state-transition probabilistic microsimulation model to quantify the cost-effectiveness of various interventions to prevent fractures in 50-year-old postmenopausal women without osteoporosis. We compared no supplementation, vitamin D(3) (800 IU/day) with calcium (1,200 mg/day), and vitamin K(2) (45 mg/day) with vitamin D(3) and calcium (at the same doses). An additional analysis explored replacing vitamin K(2) with vitamin K(1) (5 mg/day).
Adding vitamin K(2) to vitamin D(3) with calcium reduced the lifetime probability of at least one fracture by 25%, increased discounted survival by 0.7 quality-adjusted life-years (QALYs) (95% credible interval (CrI) 0.2; 1.3) and discounted costs by $8,956, yielding an incremental cost-effectiveness ratio (ICER) of $12,268/QALY. At a $50,000/QALY threshold, the probability of cost-effectiveness was 95% and the population expected value of perfect information (EVPI) was $28.9 billion. Adding vitamin K(1) to vitamin D and calcium reduced the lifetime probability of at least one fracture by 20%, increased discounted survival by 0.4 QALYs (95% CrI -1.9; 1.4) and discounted costs by $4,014, yielding an ICER of $9,557/QALY. At a $50,000/QALY threshold, the probability of cost-effectiveness was 80% while the EVPI was $414.9 billion. The efficacy of vitamin K was the most important parameter in sensitivity analyses.
Lifetime supplementation with vitamin K, vitamin D(3), and calcium is likely to reduce fractures and increase survival in postmenopausal women. Given high uncertainty around the cost-effectiveness estimates, further research on the efficacy of vitamin K on fractures is warranted.
PubMed ID
22398856 View in PubMed
Less detail

Cost-effectiveness of dabigatran etexilate for stroke prevention in non-valvular atrial fibrillation. Applying RE-LY to clinical practice in Denmark.

https://arctichealth.org/en/permalink/ahliterature126378
Source
J Med Econ. 2012;15(4):695-703
Publication Type
Article
Date
2012
Author
Lars K Langkilde
Mikael Bergholdt Asmussen
Mikkel Overgaard
Author Affiliation
Wickstrøm & Langkilde ApS, Vejle, Denmark. ll@wlpharma.com
Source
J Med Econ. 2012;15(4):695-703
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Antithrombins - economics - therapeutic use
Atrial Fibrillation - complications
Benzimidazoles - economics - therapeutic use
Cost-Benefit Analysis
Denmark
Female
Humans
Male
Models, Theoretical
Myocardial Infarction - economics
Pyridines - economics - therapeutic use
Risk assessment
Stroke - prevention & control
Warfarin - economics - therapeutic use
Abstract
To estimate the economic implications of introducing dabigatran etexilate ('dabigatran') for anti-coagulation therapy in Danish patients with non-valvular atrial fibrillation based on results of the RE-LY trial.
The lifetime cost and outcomes of dabigatran and warfarin were estimated using a previously published cost-effectiveness model. The model utilizes the data from the RE-LY study to estimate the costs and outcomes of stroke prevention in atrial fibrillation. Cost estimates were based on official Danish tariffs and prices, and published literature on the cost of stroke. In the base-case analysis a conservative approach was adopted applying tariffs from the lowest range for the cost of International Normalized Ratio (INR) monitoring associated with warfarin. The effectiveness measure of the analysis was quality-adjusted life-years (QALY).
The model estimated that the mean cost per patient for the remaining life-time is euro 16,886 treated with warfarin and euro 18,752 treated with dabigatran. This was associated with mean QALYs per patient of 8.32 with warfarin and 8.59 with dabigatran. The resulting incremental cost-effectiveness ratio (ICER) of ~ euro 7000 per QALY gained is regarded as cost-effective by Danish standards. This conclusion was seen to be robust to realistic variations in input parameters, including adjustment for the RE-LY centres achieving the best INR monitoring quality. Threshold analysis revealed that dabigatran would be cost-saving in settings where the cost of warfarin monitoring exceeds euro 744 per year.
The analysis does not include all aspects of Danish clinical practice anti-coagulation that will influence cost-effectiveness of dabigatran, e.g., this study did not attempt to model quality of anticoagulation monitoring and under-utilization in clinical practice.
Based on the outcomes observed in the RE-LY trial, dabigatran represents a cost-effective alternative to warfarin in Denmark for all patients with atrial fibrillation within the licensed indication of dabigatran.
PubMed ID
22397590 View in PubMed
Less detail

Single slice vs. volumetric MR assessment of visceral adipose tissue: reliability and validity among the overweight and obese.

https://arctichealth.org/en/permalink/ahliterature126394
Source
Obesity (Silver Spring). 2012 Oct;20(10):2124-32
Publication Type
Article
Date
Oct-2012
Author
Greg Maislin
Murtuza M Ahmed
Nalaka Gooneratne
Matt Thorne-Fitzgerald
Christopher Kim
Karen Teff
Erna S Arnardottir
Bryndis Benediktsdottir
Hildur Einarsdottir
Sigurdur Juliusson
Allan I Pack
Thorarinn Gislason
Richard J Schwab
Author Affiliation
Center for Sleep and Circadian Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. fgm@mail.med.upenn.edu
Source
Obesity (Silver Spring). 2012 Oct;20(10):2124-32
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Body mass index
Cost-Benefit Analysis
Female
Humans
Iceland - epidemiology
Intra-Abdominal Fat - pathology
Linear Models
Magnetic Resonance Imaging - methods
Male
Middle Aged
Neck
Obesity - epidemiology - pathology
Predictive value of tests
Reproducibility of Results
Risk factors
Sleep Apnea Syndromes - epidemiology - pathology
Waist Circumference
Abstract
Visceral adipose tissue (VAT) is associated with abnormal cardiovascular and metabolic profiles. Total VAT volume of the abdominal compartment by magnetic resonance imaging (MRI) is the gold-standard measurement for VAT but is costly and time consuming. Prior studies suggest VAT area on a single slice MR image may serve as a surrogate for total VAT volume but it is unknown if this relationship is maintained in overweight and obese men and women. Untreated sleep apnea subjects enrolled into the Icelandic Sleep Apnea Cohort (ISAC) underwent abdominal MRI. VAT area and subcutaneous adipose tissue (SAT) area at the L2-L3 and L4-L5 interspaces and total VAT and SAT volumes were determined by manual examination using image analysis software; 539 men and 129 women with mean ages of 54.1 and 58.8 years and mean BMI of 32.2 kg/m(2) and 33.7 kg/m(2), respectively, were studied. Mean total VAT volume was 40% smaller and mean total SAT was 25% larger among females compared with males. The correlation with VAT volume was significantly larger for L2-L3 VAT area (r = 0.96) compared to L4-L5 VAT area (r = 0.83). The difference in correlation coefficients was statistically significant (nonparametric bootstrap P
Notes
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PubMed ID
22395811 View in PubMed
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Cost-utility analysis of primary prophylaxis versus secondary prophylaxis with granulocyte colony-stimulating factor in elderly patients with diffuse aggressive lymphoma receiving curative-intent chemotherapy.

https://arctichealth.org/en/permalink/ahliterature126410
Source
J Clin Oncol. 2012 Apr 1;30(10):1064-71
Publication Type
Article
Date
Apr-1-2012
Author
Kelvin K W Chan
Eric Siu
Murray D Krahn
Kevin Imrie
Shabbir M H Alibhai
Author Affiliation
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Kelvin.chan@sunnybrook.ca
Source
J Clin Oncol. 2012 Apr 1;30(10):1064-71
Date
Apr-1-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - administration & dosage - adverse effects
Cost-Benefit Analysis
Drug Administration Schedule
Female
Granulocyte Colony-Stimulating Factor - administration & dosage - economics - therapeutic use
Humans
Lymphoma, Non-Hodgkin - drug therapy - economics
Male
Markov Chains
Middle Aged
Ontario
Primary Prevention - economics - methods
Quality-Adjusted Life Years
Secondary Prevention - economics - methods
Treatment Outcome
Abstract
The 2006 American Society of Clinical Oncology (ASCO) guideline recommended primary prophylaxis (PP) with granulocyte colony-stimulating factor (G-CSF) instead of secondary prophylaxis (SP) for elderly patients with diffuse aggressive lymphoma receiving chemotherapy. We examined the cost-effectiveness of PP when compared with SP.
We conducted a cost-utility analysis to compare PP to SP for diffuse aggressive lymphoma. We used a Markov model with an eight-cycle chemotherapy time horizon with a government-payer perspective and Ontario health, economic, and cost data. Data for efficacies of G-CSF, probabilities, and utilities were obtained from published literature. Probabilistic sensitivity analysis (PSA) was conducted.
The incremental cost-effectiveness ratio of PP to SP was $700,500 per quality-adjusted life-year (QALY). One-way sensitivity analyses (willingness-to-pay threshold = $100,000/QALY) showed that if PP were to be cost-effective, the cost of hospitalization for febrile neutropenia (FN) had to be more than $31,138 (2.5 × > base case), the cost of G-CSF per cycle less than $960 (base case = $1,960), the risk of first-cycle FN more than 47% (base case = 24%), or the relative risk reduction of FN with G-CSF more than 91% (base case = 41%). Our result was robust to all variables. PSA revealed a 10% probability of PP being cost-effective over SP at a willingness-to-pay threshold of $100,000/QALY.
PP is not cost-effective when compared with SP in this population. PP becomes attractive only if the cost of hospitalization for FN is significantly higher or the cost of G-CSF is significantly lower.
PubMed ID
22393098 View in PubMed
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