a, b Means in the same column with different superscripts are significantly different (P<0.05) LF Low-forage diet, HF High-forage diet (OP111 1R toXiCit ill ildUlt dails'' Calttle iS bC1ing mici as''igls d1ta(ilos'ed in the L'K. 'I'lh \Vetetrmilars Laboratorie's icncv ccotrded 34 iniidenixts rom I980) to 1998, 1atid 33' separa.te 11be s \v c -alt-1tected ft o1il 1 999 to 20)0)2 (I is eCse C ld othitl-1)02. ).li It pritciple, coppet iiitoxicatioIn in cattlet is like the ctoIditiOti ill shlccp altiout (hli close Iratcs that CanSe alCCLnnn11a]1 tiOnl ate ninCh h, liglher ini caIttle Underssnod and SLIttlC 1 999). III s1le p, coppet Poisoning is a to )-stagc [pi (ceSs. In the tii st stage Cop)[)per aCCnInllltes ill tlhe li\ Cer tInSillng SLiti)CIill d'etllet ationl \\sitli thei e'e1a's (it Cnisvilmes ilnto the blood. 1,)nIin10 tile SeCCIond Stag.C, e\tenSi\ C lis er degeneir1titoll OCCnrPS llldC01[)t'' i 1't1t'IXt'sd t-lOIll the liI'V'l', LISLI, 1 L IS C ltlAlT 'I .itlt.1 clipper is reeae tto hels i,on vl Canng hlia'leilcosNtic crIisis Unldlets rood and StLittl 1'999). 1r)r'atl,tic tic Iases ill the colnctiltrl tiolt of coppClt ill the blood allt otily sceni in the secotid phalISe (SoLttleP 19)94). ''llLIS, ll helrds sw ith cliti cal co pper tOxicity, clitiical cases pt robablsy Iet'pcstcit otlly a silIl pot tiotl of actnill Cases of cpe poislloning. Lis ese 1ttd litlict's 2))_2 Itepot tei a lbtcid pi valci-icc o(t Iess thia pel' Ctllt, butt ill 18 hlic'ls wlhich thle itlnvestigat'cltcd closels, 1( hla1d1 aisignificant p 'aletIlCC (it OS cliniMcaI lih)ptic degeticcrtiotl(celvsitec isVer Ctl/ 1 ie con1cti1tratiotIs il petIiplcral blood). -k CSt( )[) [)C I to)NiCitv CSS It\N( tlmF1(ttX, IICt0 t(l))t1 t\l Ct1LICAsc(fpet tOI..It is a twso(Istagle pr-oces heaopts o to c0ppr iiltakc tilts OCliCl ill lhcrds W ithoLIt clinlcal sI (iils (it toxticits. Howeveet, a ss ide range of factot s IalId discases cai sign int le atte Ilood is \t eI s t1 ileCs, so thir ele vatio(t1 is lot ciagim"lostic of fit t-stalgc copprCl toicitv. 1(1 clCillonllStrIte the li1ik, it is itilpOt tant t(i shols that ccl TlteCl is et eIizs ilies dtearCIse ill Itespolus to the t etmiiovil ot clpper I-This slort C(lili it,tIlication desc riics aii irisesti.ationI ill a 25))-cos cdait itv ill s(i0ttli-wsset ScotlInd that hlad been fedi xecess COp pCI, bUit hIld repot-ted iio cliical cases (itfcopper poisoIlIssruwCts liactaltitig, lhoLIscd ccs Nscrc selccteciaid filooch Satiillplecl, LISitig licparitliXscd tUtiCS, t() IllaStLl eC plaisma copperC Illd (uILIll.late dclisydrogerase ( in aftet-els atecd copfpcicoticciltr Itiollt sswcre tfoLitid ii a calf at postiliot-tetlil Cexillai llatiol. ti c(s\ss ere silecl fr-otii a grou.tp b eiCig ted a h'ight-o gIeC (i 1) diet, aiid I \VsClC Salllpled ft-01l1 oia gi otIp beingL td a los-sforage diet in Nklrcll 2003 (titiic 1)I lic cowss setre sepat lItcd iiito tsso cliffertcit totrage rcgitileC IsbeIlaSe tIlC fatlIll W51, pat I lit af loago-tem i tIstus (if geCletic atich etnvis ilinenit initeractiolls; tIlh tsso gr-oups ...
come directly from patients whereas NICE in the UK, prefer values from the general population. This is essentially a normative judgement, but do these values differ? The aim of this study is to compare utility values elicited from the two samples of UK respondents: a general population sample and a sample of patients with Crohn's disease (CD). METHODS: Eight health state vignettes associated with complex perianal fistulae in CD were developed and refined from interviews with patients and these were validated by clinicians. An on-line time trade off (TTO) was used to elicit preferences. In addition to valuing the hypothetical vignettes, patients with CD were asked to value their own current health state. RESULTS: In total 835 respondents were included in the general population study of the and were reflective of the UK population in age and gender. In the patient study, 162 patients with CD were included. Non-remission states were valued much lower than the remission state by both samples: ranging from 0.20 for proctectomy with negative outcome to 0.66 for chronic symptomatic fistulae with mild symptoms. Patients reported slightly higher values than the general population for most health states. The relative difference in mean values was greatest for the most severe health states. This is consistent with our finding from the subgroup analysis of the general population sample in which respondents with experience (self, family or friend has CD) provided higher estimates than those without any experience of CD. CONCLUSIONS: Patients reported slightly higher values than the general population for most health states; the difference was greatest for the most severe health states.
flows and the required cost of capital, can be used to validate the price of the new drug from a narrow investor's perspective. The free cash flow represent the sales from the pharmaceuticals, and cash necessary for capital expenditures represent the costs for research & development (R&D) and marketing. The cost of capital refers to the opportunity cost of making a specific investment, which is the rate of return required to persuade the investor to make a given investment. Conclusion: We propose a policy approach for the evaluation of innovative drugs by bridging concepts from health economics and business economic valuation. This approach may justify a drug price from an investor's perspective when the ICER exceeds the threshold and may be used in negotiations between governments and companies.
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