A modelling approach is used to analyse the cost effectiveness of prescribing angiotensin converting enzyme (ACE) inhibitors, compared with standard practice, as first-line therapeutic agents in the treatment of heart failure in The Netherlands. Data concerning costs, incidence, prevalence and survival are used to construct an age-dependent semi-Markov-chain model. Two scenarios are compared. The first reflects the continuation of common practice. The second, containing assumptions made on the basis of results from randomised clinical trials, reflects the situation in which ACE inhibitors are given as first-line pharmacotherapy. Conditional on the estimates and assumptions made, it is shown that prescribing ACE inhibitors as first-line pharmacotherapy will improve survival by about 4% over the first 10 years, and will save about 17% in costs over the first 10 years. Sensitivity analysis shows the robustness of the conclusions to all major parameters.
RÉSUMÉA l'aide de huit critères mesurant la «réceptivité au soutien informel,» cette étude examine les attitudes de personnes âgées de 65 ans et plus, vivant de façon autonome, par rapport aux soins formels et informels. Ces travaux examinent de plus la relation entre ces attitudes et les préférences quant à la panoplie de soins dans diverses situations (hypothétiques) où les soins nécessaires différent quant à leur nature et leur durée prévue. Au-delà de l'expérience de la personne âgée quant aux soins antérieurement reçus, de ses caractéristiques individuelles et sociales, les attitudes envers les soins s'avèrent être en eux-mêmes un puissant indicateur des préférences des personnes âgées en matière de soins. Les décideurs peuvent utiliser cette attitude envers les soins comme instrument permettant de guider à long terme les préférences et le recours des personnes âgées à ces services de soins.
This article focuses on the evaluative criteria of elderly community residents regarding their preferences in cases of long-term care decision-making. An overall picture of the evaluative criteria which the elderly use to evaluate various alternatives for long-term care are assessed. Furthermore, we determined which of these evaluative criteria may be considered as the most important by the elderly. A good relationship with informal carers appears almost pre-conditional to a preference for informal support. The desire not to burden acquaintances, as well as a positive previous experience with this type of care, are the most important reasons stated for choosing formal or private services. Insights into criteria that are used to evaluate different care arrangements clarify and refine our perspective on future developments.
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