The publications reviewed revealed DVSS to offer certain advantages with respect to Heller myotomy, gastrectomy, and cholecystectomy. However, these results should be interpreted with caution until randomized clinical trials are performed and, with respect to oncologic indications, studies include variables such as survival.
LS takes longer than OS but offers several short-term benefits. However, complication rates are similar for both procedures and no differences were found in long-term outcomes.
The available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.
The women who underwent no breast reconstruction suffered more emotional problems than those who underwent a reconstruction procedure. In general, all groups reported a postprocedure preference for IBR in their questionnaire answers. The aesthetic results achieved by IBR seem to be those best accepted.
FDG-PET is insufficiently sensitive to rule out small primary tumours. Due to the high number of false positives returned, it cannot replace axillary dissection in axillary lymph gland staging. A complete biochemical response identified by FDG-PET should not be relied upon to mean an absence of disease since the technique cannot detect residual microscopic elements.
This study showed that while HTA programs in LA have attempted to address the main goals of HTA, they have done so through the production of short documents that focus on practical high-technology areas of importance to two specific target groups. Clinical and economic considerations still take precedence over ethical, social, and/or legal issues. Thus, an integrated conceptual framework in LA is wanting.
For each country, published local costs have been applied to the resource use. Results have been stratified by glomerular filtration rate (GFR) at one-year post-transplant. RESULTS: Across these countries, the total three-year cost of post-transplant care varies depending on local treatment practices, from a minimum of €36,000 per patient in Poland to a maximum of €77,000 in the The Netherlands. Consistently across all countries, the average three-year costs decrease as a result of improved graft functioning status (increased GFR) at one year. The average three-year costs for a patient with a GFRՆ45 at one year are 29% lower than those with Ͻ30GFR in the The Netherlands, 40% lower in Italy, 43% lower in Belgium, 50% lower in the UK, and 51% lower in Poland. CONCLUSIONS: This study demonstrates that in five European countries, worsening post-transplant renal function contributes to substantive increases in resource use, with some variation across regions. Therefore management strategies that promote renal function after transplantation are likely to provide important resource savings. Additional analyses are ongoing in Spain, Czech Republic, Hungary, Germany and Sweden to further confirm these observations.
OBJECTIVES:The main objective of this study is to evaluate the cost-effectiveness of total hip arthroplasty through anterolateral minimally invasive surgery (MIS) and compare it with the traditional approach. METHODS: A study was conducted to compare traditional and minimally invasive surgical techniques for total hip arthroplasty in a population of 340 patients at two Spanish hospitals (the Virgen de las Nieves University Hospital of Granada and the Serranía de Ronda Hospital) during the year 2007. The design of the study was a prospective stochastic costeffectiveness analysis, where effectiveness data were collected over a one-year period at individual patient levels and costs were gathered from the analytical accounting system of Virgen de las Nieves University Hospital. Effectiveness was measured in functional terms (clinical) and self-perceived quality of life (SF-12 survey) during the first 6 postoperative weeks. RESULTS: After 6 postoperative weeks, in comparison with the conventional technique, a pattern in improvements for MIS was observed for length of hospital stay (hospitalization time was 4.97 days shorter); for operative time (an average of 83.3 minutes for MIS patients and 97.8 minutes for the control group); and for average length of skin incision (9.83 cm. for the MIS group and 16.2 cm. for the control group). The total cost of THA with MIS was lower (4519.19 €) than the cost of traditional hip replacement (6722.46 €). Incremental effectiveness value in terms of quality of life was 0.11 points in the SF-12 survey for MIS. The cost-effectiveness analysis reveals a strong dominance of MIS versus traditional THA. CONCLUSIONS: The study showed that the minimally invasive technique reduces inpatient resource utilization and improves self perceived quality of life of patients compared with the tradit...
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