OBJECTIVES: Mastitis is one of the most frequent and costly diseases in the dairy industry with gram-negative bacteria being the main causal agent. Since most antibiotics have minimal effect on shortening the duration of clinical mastitis caused by gram-negative pathogens (gram-CM) and because of a high spontaneous cure rate, antibiotics are often not recommended for treating Gram-CM. The purpose of this study was to develop a model comparing 5-day treatment with ceftiofur hydrochloride to no treatment of gram-CM, also allowing easy adaptations to reflect the high variability of prices and cost data in livestock. METHODS: A decision tree was developed in MS Excel considering first and recurrent CM episodes, culling and death of cows with gram-CM. Cure rates and other clinical data were derived from published studies. Costs and losses associated with CM and its treatment, culled or dead cows as well as income generated from saleable milk production or sold cows were considered. Cost and income values were derived from public sources (US-2010, perspective of the producer). All input parameters were varied extensively in one-way sensitivity analyses. RESULTS: With US-2010 cost/ prices, income from saleable milk was $3,039.35 (ceftiofur) and $3069.67 (no treatment), and costs associated with the disease and treatment totaled to $215.12 (ceftiofur) and $246.60 (no treatment) over the entire lactation period, resulting in a $1.16 higher margin per treated cow with a 5-day treatment with ceftiofur compared to no treatment of gram-CM. More cows were cured and fewer cows culled or died with ceftiofur. The model was most sensitive to ceftiofur cure rate and selfcure rate. CONCLUSIONS: Compared to no treatment, ceftiofur's higher treatment costs and less income due to milk discard were offset by a better efficacy, resulting in less disease associated costs of gram-CM.
extrapolated for the years 2012-2016 by applying population forecasts from the official Finnish statistics. Health care resource use and Finnish unit costs (€2011, societal perspective) were obtained from published national sources. RESULTS: Approximately 35% of the 2.2 million Finns of over 50 years of age can be considered to be at moderate or high risk for PDs due to the underlying chronic medical conditions. The vaccination of these people with PCV13 could provide an estimated net budget savings of about €218 million compared to the current no-vaccination situation during the five years. Among the risk groups considered, the largest net savings (€66.2 million) could be expected to be obtained by vaccinating people with heart disease due to its high prevalence in the target population. CONCLUSIONS: The immunization of adults (Ͼ50 years) at higher PD-risk with PCV13 vaccine will potentially lead to substantial cost savings during the forthcoming years in Finland. OBJECTIVES:To estimate the budget impact associated with use of Atazanavir as 1st line treatment in Spanish market of antiretroviral drugs for VIH patients, on stable and sever health state. METHODS: An economic Model was developed to evaluate the Budget Impact of using Atazanavir (ATV), as 1st line treatment, for VIH patients in the Spanish National Health System perspective, over a 10-year period. Therapies included in the analysis were Darunavir (DRV), Lopinavir (LPV) and Efavirenz (EFV). Patient data were obtained through microsimulation model, with a patient cohort simulated, statistically significant and representative (Nϭ 40,000). The costs were obtained from local databases and were considered pharmaceutical and direct health care costs. An annual discount rate assumed was of 3%.The discontinuation rates after AEs assumed for all treatments were: 71.3% from diarrhea, 61.3% from nausea, 28.8% from jaundice, 82.5% from rash and 55% from CNS events. The results of BIM per patient were presented at annual and cumulative level. RESULTS: Atazanavir use led to differential annual costs per patient after 10 years of treatment of 595€, 209€ and 76€, with respect to DRV, LPV and EFV. The highest savings generated by ATV derived from durable health of 1 st line treatment (807€ DRV, 909€ LPV and 1045€ EFV), followed by return to health and durable viral suppression. This savings offset ATV drug cost versus other antiretroviral drugs. CONCLUSIONS: This analysis showed that treatment with Atazanavir for VIH patients, on stable and sever health state, generates net savings for Spanish National Health System: 595€, 209€ and 76€, with respect to DRV, LPV and EFV, in terms of differential annual costs per patient after 10 years treatment.
the highest incidence was seen in 45 to 54 year olds. In 2007 and 2008 the highest incidence was in 55 to 64 year olds. Hepatitis A incidence was highest in the West census regions for each year from 2005-2008. CONCLUSIONS: In a large commercially insured population, we observed similar hepatitis A incidence rates for males and females across all years examined. Incidence was highest in 45 -54 and 55 -64 year olds. The West region had the highest incidence. No evidence of a decline in incidence presented across the years examined. These results are in line with the fact that hepatitis A vaccination rates remain low, despite the availability of effective hepatitis A vaccines, and the increased number of patient populations in whom hepatitis A vaccination is recommended.
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