Islet cell transplantation is in clinical development for type 1 diabetes. There are no data on the cost in relationship to its benefits. We performed a cost-effectiveness analysis and made a comparison with standard insulin therapy, using Markov modeling and Monte Carlo simulations. The patient population was adults aged 20 yr suffering from hypoglycemia unawareness. Data were estimates from literature and clinical trials: costs were based on the situation in the United States. For insulin therapy, cumulative cost per patient during a 20-yr follow-up was $663,000, and cumulative effectiveness was 9.3 quality-adjusted life years (QALY), the average cost-effectiveness ratio being $71,000 per QALY. Islet transplantation had a cumulative cost of $519,000, a cumulative effectiveness of 10.9 QALY, and an average cost-effectiveness ratio of $47,800. During the first 10 yr, costs for transplantation were higher, but cumulative effectiveness was higher from the start onwards. In sensitivity analyses, the need for one instead of two transplants during the first year did not affect the conclusions, and islet transplantation remained cost-saving up to an initial cost of the procedure of $240,000. This exploratory evaluation shows that islet cell transplantation is more effective than standard insulin treatment, and becomes cost-saving at about 9-10 yr after transplantation.
When the names of child victims and other identifying information appear in the media it can exacerbate trauma, complicate recovery, discourage future disclosures and inhibit cooperation with authorities for the children involved. In this study, we evaluated the amount of identifying information available in a systematic sample of 561 newspaper articles about non-fatal child victimizations published from 1 January 2003 to 31 December 2004. Identifying information about the victim (e.g. name of the child’s street, school or a family member’s full name) was published in 51 percent of articles covering child victimizations. For cases of sexual assault, victim identifiers were most likely to be included when the alleged offender was related to the victim or was a high-profile community member. Based on these findings, we examine the arguments for and against more restrictive policies regarding identifying information, and suggest some guidelines that would provide additional protections for child victims.
Despite limitations in the model and lack of trial data, and under the assumption that islet transplantation outcomes for young adult type 1 diabetes patients are not dependent on the source of islet cells, this health-economic evaluation suggests that porcine islet cell xenotransplantation may prove to be a cost-effective and possibly cost-saving procedure for type 1 diabetes compared to standard management.
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