The (7,8). To approach these questions, a variety of cDNA and genomic collagen clones from a number of species have been isolated, including the human al(I) (9, 10) and a2(I) genes (11, 12). We previously reported the isolation of the genomic clone CosHcoll from a human placental cosmid library (13), using the chicken al(I) cDNA clone pCg54 as a probe (14). This cosmid clone contains a 36-kilobase (kb) insert and crosshybridizes with collagen al(I) mRNA. However, the amino acid sequence derived from 1 kb of the clone showed only 60-70% homology to chicken and bovine al(I) and a2(I) collagen, and it did not match the human al(III) amino acid sequence. Since interspecies protein sequence homologies between collagens of the same type are usually greater than 80%, we concluded that CosHcoll did not code for any of these chains. In the absence of positive identification, we labeled the clone an al(I) collagen-like gene.
We have characterised a highly polymorphic region 1.3kb downstream of the human Type II collagen gene. It consists of a highly AT-rich tandem repetitive region (minisatellite) approximately 650bp long. Two alleles had been observed previously, differing in size by approximately 300bp. When this region was cloned from four unrelated individuals carrying the larger allele, DNA sequence data identified three alleles, suggesting far higher polymorphism than was originally supposed. This minisatellite was shown to be present in a single copy in the human genome, and to have arisen after the divergence of Old and New World monkeys.
Tiotropium is associated with a reduced risk of exacerbations and COPD-related referrals and hospitalisation compared to combined ipratropium/salbutamol in patients with COPD.
Aims: This study presents a cost-effectiveness and budget impact analysis comparing cost and outcomes for UK patients with COPD treated with either tiotropium, ipratropium or salmeterol.Methods: A previously-published COPD cost-effectiveness model was adapted for the UK, then used to estimate the cost-effectiveness of tiotropium compared to salmeterol and ipratropium. Additional epidemiological data were used to estimate the budget impact of switching patients from ipratropium or salmeterol to tiotropium.Results: In England, the estimated annual cost per patient on tiotropium was £1350, on salmeterol was £1404, and on ipratropium was £1427; in Scotland/Wales/Northern Ireland (S/W/NI) these costs were £1439, £1565, and £1631, respectively. Tiotropium patients experienced better quality-adjusted life-years (QALYs) across all comparisons, and this option was therefore dominant compared to salmeterol and ipratropium. The probability of tiotropium being dominant ranged from 72% to 87% across comparisons. At a willingnessto-pay threshold of £20,000 per QALY, tiotropium had at least a 97% chance of being cost-effective. The estimated annual saving per primary care trust (PCT) of switching patients from salmeterol and ipratropium to tiotropium in England was £230,000 and in S/W/NI was £160,000.Conclusions: Tiotropium is a cost-effective alternative to ipratropium and salmeterol, and switching COPD patients from ipratropium and salmeterol to tiotropium could result in considerable cost savings for PCTs along with improvements in quality-of-life.
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.