Background and objective: Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. Methods: Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine qualityadjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. Results: Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was <14 weeks, and was more costly when 2-h nursing time per week was assumed for catheter drainage. Conclusion: IPC is cost-effective when compared with talc, although substantial uncertainty exists around this estimate. IPC appears most cost-effective in patients with limited survival. If significant nursing time is required for catheter drainage, IPC becomes less likely to be cost-effective. Either therapy may be considered
RATIONALE: Panic disorder (PD) has been shown to be associated with worse asthma outcomes in individuals with asthma, but the psychophysiological mechanisms underlying this association remain unclear. Some theories suggest that asthmatics with PD have worse underlying asthma severity and some argue that they simply report more symptoms based on their tendency to catastrophize bodily sensations. METHODS: A total of 39 patients (19 with and 20 without PD) with physician-diagnosed asthma underwent standard metacholine challenge testing (MCT). Demographic and medical/asthma history information was collected at baseline. Pre and post MCT patients completed the Panic symptom scale (PSS), the Modified Borg Scale (MBS), and the Subjective distress visual analogue scale (SD-VAS). Heart rate (HR), systolic, and diastolic blood pressure (SBP/DBP) were recorded pre, during, and post MCT. RESULTS: There were no differences in PC20 values between asthmatics with and without PD (F=0.21, p=0.652). PD patients had a higher number of panic symptoms (from the PSS) at post-test compared to those without PD ([M (SD)] PD pre = 2.21 (2.42), PD post = 5.00 (3.32); non-PD pre = 0.75 (1.07), non-PD post = 2.25 (1.89): F=5.05, p=0.031). There were no differences in MBS (F=0.70, p=0.407), SD-VAS anxiety (F=0.36, p=0.554), SD-VAS worry (F=0.84, p=0.366), HR (F=0.06, p=0.805), SBP (F=0.49, p=0.487), or DBP (F=0.01, p=0.942) between PD and non-PD patients. CONCLUSIONS: Results suggest that having PD is associated with increased subjective responses during MCT, with no impact on objective measures of asthma. Future research should focus on the potential impact of these increased panic attack-like symptoms on long-term asthma care and if intervening on them influences outcomes such as emergency room visits. Financial Support: SLB and KLL were supported by CIHR and FRQS salary awards.
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