The succinic oxidase systemwasreconstructed, in presence of exogenous cytochrome c, from two inactive preparations, one, from the Neuro8pora strain C117, providing succinic dehydrogenase, the other from alkali-treated wild-type Neuro8pora or heart muscle preparations, providing cytochrome oxidase. 2. It was found in spectroscopic experiments that particles from the Neuro8pora strain poky reacted directly with wild-type or heart muscle particles to reconstruct the succinic oxidase system in the absence of a soluble component. I wish to thank Professor D. Keilin, F.R.S., for his interest and advice, and Mr P. B. Scutt for the samples of heart muscle preparation.
Background
Paediatric patients being treated for long-term physical health conditions (LTCs) have elevated mental health needs. However, mental health services in the community are difficult to access in the usual course of care for these patients. The Lucy Project – a self-referral drop-in access point—was a program to address this gap by enrolling patients for low-intensity psychological interventions during their treatment for LTCs. In this paper, we evaluate the cost-effectiveness of the Lucy Project.
Methods
Using a pre-post design, we evaluate the cost-effectiveness of the intervention by calculating the base-case incremental cost-effectiveness ratio (ICER) using outcomes data and expenses recorded by project staff. The target population was paediatric patients enrolled in the program with an average age of 9 years, treated over a time horizon of 6 months. Outcome data were collected via the Paediatric Quality of Life Inventory, which was converted to health utility scores using an instrument found in the literature. The QALYs were estimated using these health utility scores and the length of the intervention. We calculate a second, practical-case incremental cost-effectiveness ratio using streamlined costing figures with maximum capacity patient enrolment within a one-year time horizon, and capturing lessons learned post-trial.
Results
The base-case model showed an ICER of £21,220/Quality Adjusted Life Years (QALY) gained, while the practical model showed an ICER of £4,359/QALY gained. The practical model suggests the intervention garners significant gains in quality of life at an average cost of £309 per patient. Sensitivity analyses reveal use of staff time was the greatest determinant of the ICER, and the intervention is cost-effective 75% of the time in the base-case model, and 94% of the time in the practical-case model at a cost-effectiveness threshold of £20,000/QALY gained.
Conclusions
We find the base-case intervention improves patient outcomes and can be considered cost-effective according to the National Institute for Health and Care Excellence (NICE) threshold of £20,000—£30,000/QALY gained, and the practical-case intervention is roughly four times as cost-effective as the base-case. We recommend future studies incorporate a control group to corroborate the effect size of the intervention.
There is considerable evidence that the calcium salts of many multivalent acids are incompletely dissociated in solution (Martell & Calvin, 1952); among others the dissociation constant of calcium hydrogen phosphate has been measured (Greenwald, Redish & Kibrick, 1940; Davies & Hoyle, 1953). Since glucose 1-phosphate (G1-P) is known to occur in calcifying cartilage (see, for example, McLean & Urist, 1955) it is of interest to obtain detailed information about any interactions between its anions and Ca2+ ions. The titration curves of K2G1-P with hydrochloric acid in the presence of sodium chloride or calcium chloride of equal ionic strength (Fig. 1) show that Ca2+ ions interact with the species G1_P2but not with HG1-PW. These findings are similar to those with Mg2+ ions and G1-P (Clarke, Cusworth & Datta, 1954). It has therefore been assumed that the only complex formed in significant amounts is CaGl-P and the possibility that complexes such as CaHG1-P+ or Ca(HG1-P)2 were formed has been ignored. Accordingly, 11 G1-P buffers containing calcium chloride were examined potentiometrically in cells without liquid junction of the type Pt.H2 (1 atm.) KHG1-P (mna).K2GL-P (fn). CaCl2 (mn8) AgCl. Ag at 100, 200, 300, 40°and 50°. From the e.m.f. of these cells, together with the values of ina, nib and mns, the dissociation constant of CaGl-P Ks K acs+aGl-p2 (1) was calculated by the method used for the magnesium salt (Clarke et al. 1954). The values oflog K8 at different temperatures were found to vary according to the Harned & Robinson (1940) equation-log K,=A/T-D+CT,
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