data about the manner in which PAM visualizes different tumor types. CONCLUSIONS: Using expert elicitation prior distributions for sensitivity and specificity of PAM were obtained. This evidence could be used in early health economic models to establish cost-effectiveness. However, experts expressed difficulties estimating the performance based on limited data. The expression of uncertainty surrounding their beliefs reflects the infancy of the diagnostic method, however further clinical trials should be commissioned to indicate whether these results are valid. Before that, the use of the elicited priors in health economic models requires careful consideration.OBJECTIVES: A small number of patients with minor head injury deteriorate, resulting in serious injury or death. Clinical features are often used to identify which patients with minor head injury are likely to deteriorate and therefore need CT scanning. To estimate the value of these characteristics for diagnosing intracranial injury (including the need for neurosurgery) in adults, children and infants, a systematic review and meta-analysis of diagnostic accuracy was undertaken. METHODS: Citations were identified through electronic searches of several key databases, including MEDLINE, from inception to March 2010. Cohort studies of patients with minor head injury (Glasgow Coma Score [GCS], 13-15) were selected if they reported data on the diagnostic accuracy of individual clinical characteristics for intracranial or neurosurgical injury. Study selection, quality assessment and data extraction were performed by one reviewer and checked by at least another. Where results allowed, pooled sensitivity, specificity and likelihood ratios were estimated through meta-analysis. RESULTS: Data were extracted from 71 studies (with cohort sizes ranging from 39 to 31694 patients). The most useful clinical characteristics for identifying those with intracranial injury were depressed or basal skull fracture in both adults and children (positive likelihood ratio [PLR], Ͼ10). Other useful characteristics in adults or children included focal neurological deficit, post traumatic seizure (PLR Ͼ5), persistent vomiting, and coagulopathy (PLR 2 to 5). Characteristics that had limited diagnostic value included loss of consciousness and headache in adults and scalp haematoma and scalp laceration in children. Few studies were undertaken in children and even fewer reported data for neurosurgical injuries. CONCLUSIONS: Amongst other characteristics, depressed or basal skull fracture indicated increased risk of intracranial injury and the need for CT scanning in adults and children. Other characteristics, such as headache in adults and scalp laceration of haematoma in children, do not reliably indicate increased risk.
OBJECTIVES: Estimate potential direct savings for the Mexican Healthcare System generated by the operation of the ЉTechnical Guidelines for distribution of food and beverages in establishments of basic educationЉ targeting population of 6 to 14 years of age. METHODS: The authors use the micro-simulation model ЉChronic Disease Prevention (CDP)Љ developed by the OECD-WHO for projecting health gains and costs of treatment in a period of 100 years. The model was adjusted to accommodate the range of ages stated in the Guidelines and uses information of incidence, prevalence, mortality, population at risk, annual unit costs and relative risk of selected chronic diseases (diabetes mellitus type 2, hypertension, cardio-and cerebro-vascular, hypercholesterolemia) attributable to obesity as well as the treatment of obesity as disease itself for the Mexican context. Sensitivity analyses were developed for most variables used in the model. RESULTS: Under the base case scenario present value of potential savings in total spending on medical care associated with the implementation of the Guidelines amount to USD$1,052.2 million in 2008. Most savings are derived from averted cases of hypertension (32.7%), obesityoverweight (28.6%) and diabetes mellitus type II (17.8%). Results are robust to changes in all parameters analyzed. Amounts obtained are an underestimation of potential savings as neither expensive complications as renal failure nor other chronic diseases attributable to obesity as arthritis, colorectal or breast cancer were included. CONCLUSIONS: The Guidelines, developed by both Ministry of Public Education and Ministry of Health, represent a good example of cooperation among different sectors to solve a complex public health problem. Results shows the importance of implementing preventive interventions aimed at reducing the prevalence of chronic diseases related to poor eating habits, inadequate physical activity and obesity in Mexico. The implementation of the Guidelines involves significant direct savings that can be assigned to other health needs of the Mexican population.
guanfacine extended release (GXR), to long-acting psychostimulants vs. maintaining existing long-acting psychostimulant monotherapy in children and adolescents with ADHD and suboptimal response to psychostimulant monotherapy. METHODS: A one-year Markov model was developed from a US third-party payer perspective. Effectiveness was measured by quality-adjusted life year (QALY). The model assumed patients transitioned among four health states (normal, mild, moderate, and severe), defined based on the Clinical Global Impressions-Severity (CGI-S) scale. Transition probabilities were estimated in an ordered logit model using patient-level data from a Phase III clinical trial comparing psychostimulants plus GXR with psychostimulants plus placebo (nϭ461). The model assumed that patients in moderate or severe states after week eight would discontinue ADHD treatment and remain in that state. Direct costs included drug wholesale acquisition costs (WAC) and medical costs, in 2010 US dollars. Health state utilities were obtained from the literature. Disutilities associated with adverse events were applied for the first four weeks. One-way sensitivity analyses (SA) were conducted by varying key model inputs. RESULTS: Adding GXR to existing psychostimulant monotherapy was associated with an incremental drug cost of $1016 but lower medical cost of $124, resulting in a total one-year incremental cost of $892. The addition of GXR led to an incremental QALY of 0.03 and an incremental costeffectiveness ratio (ICER) of $31,660/QALY. In one-way SA, ICERs ranged from $19,723/QALY to $46,631/QALY. CONCLUSIONS: This is the first cost-effectiveness analysis of psychostimulants with adjunctive medication. Adjunctive therapy of GXR with psychostimulants is cost-effective based on a willingness-to-pay threshold of $50,000/QALY.
vención Coronaria Percutánea). La medida de efectividad fue la tasa de éxitos clínicos sin eventos adversos cardiovasculares mayores a 3 años. El costo y la efectividad los tratamientos se obtuvo del seguimiento clínico de la cohorte de nϭ230 pacientes en el Hospital de Cardiología del IMSS seguidos por 3 años. Se utilizó la técnica de micro-costeo, los costos provienen de bases de costos institucionales (2010). Los resultados están expresados en dólares americanos (USD) del 2010 (tipo de cambio MX$12.63: $1 USD). Se empleó una tasa de descuento del 5%. Además del modelo determinístico, se realizó un análisis de sensibilidad probabilístico y se estimó la curva de aceptabilidad. RESULTADOS: El 59.3% de los pacientes de la cohorte utilizó BMS y el 40.87% DES. El grupo con DES mostró los mayores costos promedio por paciente USD$16,635 comparado con BMS USD$13,432. Las efectividades DES encontradas fueron de 88% y las de BMS 74%. La RCE fue de USD$15,263 en el caso de DES y de USD$22,480 con BMS. El DES se ubicó como la alternativa costo-efectiva y dominante frente al empleo del BMS. La curva de aceptabilidad muestra que el tratamiento de DES se ubicó como la alternativa costoefectiva independientemente de la Disponibilidad a Pagar por parte de la institución. CONCLUSIONES: Los resultados del análisis realizado sugieren que DES es una alternativa de tratamiento intervencionista de revascularización con mejores resultados en salud, y que también representa una alternativa costo ahorradora respecto a BMS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.